Methotrexate is a rather dangerous drug and must be used really cautiously, particularly in pregnant and breastfeeding mothers. We get this call all the time in breastfeeding mothers using this drug. Fortunately we found this mother who was willing to give milk samples following high dose therapy for Placenta Accreta. This mom received 92 mg methotrexate following delivery. Interestingly, milk levels were really low. This is an antifolate drug used in many diseases, and is quite risky around pregnant women and previously I thought in breastfeeding mothers. This data suggests that milk levels of methotrexate, even following this high dose, are quite low (RID= 0.11%). This was one of those questions I always hated to answer, because we had NO data on its transmission into human milk, and its relatively dangerous. Seems its levels in milk are very low. We still need to be cautious, but I can rest a bit easier now. TWH