There is still limited knowledge about alterations of blood concentrations of psychotropic drugs during pregnancy, the transfer of psychotropic drugs into breastmilk and the effects on exposed children. We investigated changes in concentrations of psychopharmacological medication during pregnancy and lactation in serum and breastmilk at different time points in a naturalistic sample of 60 mothers and observed the development of the exposed children in the first 12 months. We found a decrease in serum concentrations from the first to the second trimester of amitriptyline, duloxetine, escitalopram, quetiapine and sertraline. Citalopram stayed rather stable during pregnancy, sertraline levels interestingly increased again from the second to the third trimester. High concentration‐by‐dose ratios in breastmilk were found for venlafaxine as well as lamotrigine, low for quetiapine and clomipramine. Similarly, clomipramine and quetiapine showed low milk/serum–penetration ratios. Regarding the birth outcome measures in children, we found no significant differences between in utero exposed compared to nonexposed newborns. There were no significant differences in the development in the first 12 months. Psychotropic medication in the peripartum needs a balancing of risks and benefits and a continuous therapeutic drug monitoring can be a guidance for clinicians to monitor drug alteration patterns, which are likely to occur due to physiological pregnancy‐associated changes in pharmacokinetics. Accordingly, therapeutic drug monitoring can optimize a medication in pregnancy and lactation with the lowest effective dose.
Aim There is still only little knowledge about alterations of blood
concentrations of psychotropic drugs during pregnancy, the transfer of
psychotropic drugs into breast-milk and the effects on exposed children.
Methods We investigated changes in concentrations of
psychopharmacological medication during pregnancy and lactation in serum
and breast milk at different time points in a naturalistic sample of 60
mothers and observed the development of the exposed children in the
first 12 months. Results We found a decrease in serum concentrations
from the first to the second trimester of amitriptyline, duloxetine,
escitalopram, quetiapine and sertraline. Citalopram stayed rather stable
during pregnancy, sertraline levels interestingly increased again from
the second to the third trimester. Highest concentration-by-dose-ratios
in breast milk were found for venlafaxine as well as lamotrigine, lowest
for quetiapine and clomipramine. Similarly, clomipramine and quetiapine
showed lowest milk/serum-penetration-ratios. Regarding the birth outcome
measures in children we found no significant differences between in
utero exposed compared to non-exposed new-borns. There were no
significant differences in the development in the first 12 months.
Conclusion Psychotropic medication in the peripartum needs a balancing
of risks and benefits and a continuous therapeutic drug monitoring (TDM)
can be a guidance for clinicians to monitor drug alteration patterns,
which are likely to occur due to physiological pregnancy-associated
changes in pharmacokinetics. Accordingly, TDM can optimize a medication
in pregnancy and lactation with the lowest but effective dose.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.