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Poster Session 4

Category: Epidemiology

Poster Session 4

(1039) Association Between the Time-Interval of Conception After Methotrexate and the Following Pregnancy Outcomes

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Bar Rosh, MD

Resident
Rambam Health Care Campus
Haifa, HaZafon, Israel

Coauthor(s)

JH

Joul Hadad, MA

Carmel Medical Center
Haifa, Hefa, Israel
NG

Naomi Gronich, MD

Carmel Medical Center
Haifa, Hefa, Israel

Objective:
Methotrexate is commonly used to treat ectopic pregnancy, but its teratogenicity raises concerns about the optimal time interval needed until a following conception. Guidelines recommend a 3-months washout period, while the manufacturer advises 6 months. Evidence on the safety of early conception is limited. In this study we aimed to assess if a 1-month washout period following methotrexate treatment for ectopic pregnancy, is as safe as a longer interval.

Study Design:
We conducted a retrospective cohort study of women treated with 30-150 mg methotrexate for ectopic pregnancy in Clalit Health Services hospitals (2010–2021). The following pregnancies were categorized based on the time interval between methotrexate treatment and conception. Outcomes of the following pregnancies included major congenital malformations, spontaneous abortions, preterm birth, and low birth weight. Adjusted odds ratios (ORs) were estimated using generalized estimating equations.

Results:
The study included 711 cases. Conception occurred within 1-3 months in 38 cases, 3-6 months in 111, and > 6 months in 562. Major congenital malformations were diagnosed in 71 infants, with no significant differences between groups. Although numerically higher rates of congenital malformations associated with methotrexate embryopathy, preterm birth, and low birth weight were observed in the 1-3 months group, these differences were not statistically significant (Figure 1). Adjusted ORs for congenital malformations were 0.97 (95% CI, 0.28-3.42) for 1-3 months and 1.04 (95% CI, 0.48-2.24) for 3-6 months, compared to > 6 months (Table 1).

Conclusion:
Conception 1-3 and 3–6 months after methotrexate treatment for ectopic pregnancy does not appear to increase the risk of major fetal malformations. Conception within 1–3 months may warrant further study in larger cohorts.