At what point in pregnancy should methotrexate be discontinued for a lupus patient considering conception?

Discontinuing methotrexate 30 days prior to conception is recommended for lupus patients planning to become pregnant. Methotrexate is a teratogenic medication that can adversely affect fetal development, particularly during the early stages of pregnancy when critical organ development is taking place. By stopping the medication at least a month before trying to conceive, the patient's body has time to eliminate the drug, reducing the risk of any effects on the embryo.

This time frame allows for the potential recovery of the patient's body's own immunological balance while minimizing the risk to the fetus. Many guidelines suggest a minimum of one full menstrual cycle without the drug before conception, which is typically around 30 days. This practice ensures that the medication is out of the system, providing a safer environment for pregnancy.

Options that suggest discontinuation at longer intervals or not discontinuing the medication altogether do not align with current recommendations regarding the safety of drugs like methotrexate during conception and pregnancy, underscoring the importance of careful planning for lupus patients considering pregnancy.