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Abreu GR, Zaccarelli-Magalhães J, Féba LS, Penna EY, Silva JP, Teixeira MV, Manes M, Vergara GA, Rodrigues LMA, Fukushima AR, Ricci EL, Spinosa HS. Fluoxetine alters rat's milk properties causing impact on offspring's development. Toxicol Appl Pharmacol 2024; 483:116805. [PMID: 38191078 DOI: 10.1016/j.taap.2024.116805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
Fluoxetine is an antidepressant used to treat several conditions including postpartum depression. This disease causes cognitive, emotional, behavioral and physical changes, negatively affecting the mother, child and family life. However, fluoxetine is excreted in breast milk, causing short and long-term effects on children who were exposed to the drug during lactation, so studies that seek to uncover the consequences of these effects are needed. Thus, the aim of this study was to evaluate the effects of fluoxetine on the nutritional characteristics of milk and on growth and neurobehavioral development of the offspring on a rat model. Lactating rats were divided into 4 groups: control group and three experimental groups, which were treated with different doses of fluoxetine (1, 10 and 20 mg/kg) during the lactation. Dams body weight and milk properties were measured, as well as offspring's growth and physical and neurobehavioral development. Results showed that the use of fluoxetine during lactation decreased dam's body weight and alters milk's properties, leading to a decrease in offspring's growth until adulthood. Therefore, the use of fluoxetine during lactation needs to be cautiously evaluated, with the benefits to the mothers and the associated risk to the offspring carefully balance.
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Affiliation(s)
- Gabriel R Abreu
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - Julia Zaccarelli-Magalhães
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - Laís S Féba
- Health Science Institute, Mackenzie Presbyterian University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - Emily Y Penna
- Health Science Institute, Mackenzie Presbyterian University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - Julia P Silva
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - Mariana V Teixeira
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - Marianna Manes
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - Guilherme A Vergara
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, 05652-000 São Paulo, Brazil
| | | | - André R Fukushima
- Centro Universitário das Américas FAM, Rua Augusta, 1508, 01304-001 São Paulo, Brazil; School of Health Sciences IGESP, Rua da Consolação, 1025, 01301-000 São Paulo, Brazil
| | - Esther L Ricci
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil; Health Science Institute, Mackenzie Presbyterian University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil; School of Health Sciences IGESP, Rua da Consolação, 1025, 01301-000 São Paulo, Brazil
| | - Helenice S Spinosa
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
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Grzeskowiak LE, Saha MR, Nordeng H, Ystrom E, Amir LH. Perinatal antidepressant use and breastfeeding outcomes: Findings from the Norwegian Mother, Father and Child Cohort Study. Acta Obstet Gynecol Scand 2022; 101:344-354. [PMID: 35170756 DOI: 10.1111/aogs.14324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 01/03/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Antidepressant use is common in the perinatal period, but there are concerns that it can negatively impact on breastfeeding outcomes. The aim of this study was to examine the effects of perinatal antidepressant use on breastfeeding initiation and duration. MATERIAL AND METHODS This was a retrospective analysis of 80 882 mother-infant dyads in the Norwegian Mother, Father and Child Cohort Study (MoBa). Women were first classified according to self-reported mental disorders and timing of antidepressant use before and/or after gestational week 28 (i.e., early-mid-gestation and/or late-gestation use). We subsequently classified women according to self-reported mental disorders and antidepressant use postpartum and whether antidepressants were continued from late gestation or were new/restarted. Breastfeeding outcomes included breastfeeding initiation as well as predominant or any breastfeeding and abrupt breastfeeding discontinuation until 6 months. RESULTS Late-gestation antidepressant use was associated with a reduced likelihood of breastfeeding initiation (adjusted relative risk [aRR] 0.93; 95% confidence interval [CI] 0.90-0.97) but not predominant (aRR 0.96; 95% CI 0.67-1.39) or any (aRR 1.00; 95% CI 0.93-1.07) breastfeeding at 6 months compared with unexposed women with mental disorders. When examined according to postnatal antidepressant use, no differences in predominant (aRR 0.94; 95% CI 0.60-1.48) or any breastfeeding (aRR 0.99; 95% CI 0.91-1.07) at 6 months were evident among women who continued antidepressant use from late gestation into the postpartum period compared with unexposed women with mental disorders. In contrast, new/restarted antidepressant use postpartum was associated with a reduced likelihood of predominant (aRR 0.37; 95% CI 0.22-0.61) and any (aRR 0.49; 95% CI 0.42-0.56) breastfeeding at 6 months, as well as increased risk of abrupt breastfeeding discontinuation (aRR 2.64; 95% CI 2.07-3.37) compared with the unexposed women with mental disorders. CONCLUSIONS A complex relation exists between depression, antidepressant use, and breastfeeding outcomes. Antidepressant use in late pregnancy was associated with a reduced likelihood of breastfeeding initiation but not breastfeeding duration or exclusivity. In contrast, initiating or restarting antidepressants postpartum was associated with poorer breastfeeding outcomes. Overall, women taking antidepressants and women with a mental disorder may benefit from additional education and support to improve breastfeeding rates and promote maternal and infant health and wellbeing.
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Affiliation(s)
- Luke E Grzeskowiak
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Moni R Saha
- Judith Lumley Center, La Trobe University, Bundoora, Melbourne, Australia
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Eivind Ystrom
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Mental Disorders, The Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway
| | - Lisa H Amir
- Judith Lumley Center, La Trobe University, Bundoora, Melbourne, Australia.,Breastfeeding Service, Royal Women's Hospital, Parkville, Melbourne, Australia
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Affiliation(s)
- Philip O Anderson
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
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Nyárády K, Turai R, Funke S, Györgyi E, Makai A, Prémusz V, Bódis J, Sulyok E. Effects of perinatal factors on sirtuin 3, 8-hydroxy-2'- deoxyguanosine, brain-derived neurotrophic factor and serotonin in cord blood and early breast milk: an observational study. Int Breastfeed J 2020; 15:57. [PMID: 32552911 PMCID: PMC7302386 DOI: 10.1186/s13006-020-00301-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The profile of sirtuin 3 (SIRT3), 8-hydroxy-2'-deoxyguanosine (8-OHdG), brain-derived neurotrophic factor (BDNF) and serotonin (5-HT) in cord blood and in early breast milk was studied and it was related to perinatal factors. 5-HT and BDNF signalling systems have been claimed to play a critical role in intrauterine development, postnatal adaptation and lactation. Since prematurity and Caesarean birth are frequently associated with inflammation and related oxidative stress, an attempt was made to reveal the adaptive changes of the protective SIRT3 and the complex interplay among these bioactive components in cord blood and early breast milk. METHODS Three groups each consisting of 30 mothers were included in the study: mothers who underwent spontaneous vaginal birth at term (group I), Caesarean section at term (group II) and preterm birth (group III). Venous cord blood and early breast milk samples were collected for measuring the biomarkers. SIRT3, 8-OHdG, BDNF and 5-HT levels were determined by using commercially available ELISA kits. RESULTS It was demonstrated that cord blood levels of SIRT3, BDNF and 5-HT were markedly reduced whereas those of 8-OHdG were significantly elevated after preterm birth when compared with birth at term. The Caesarean section was associated with a moderate decrease in BDNF and 5-HT, however, both SIRT3 and 8-OHdG remained unaffected. Breast milk levels of all biomarkers studied proved to be independent of their corresponding cord blood concentrations. In response to preterm birth breast milk SIRT3, 8-OHdG and 5-HT increased significantly, while a drastic fall occurred in BDNF. A significant positive relationship was found of 5-HT with SIRT3 and 8-OHdG irrespective of the gestational age and the mode of delivery. CONCLUSIONS It is suggested that the selected biomarkers in the breast milk mostly derive from local production by the mammary glands and 5-HT may have an essential role in the control of this process.
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Affiliation(s)
- Kata Nyárády
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Réka Turai
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, Pécs, Hungary
| | - Simone Funke
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, Pécs, Hungary
| | - Erzsébet Györgyi
- Department of Laboratory Medicine, Medical School, University of Pécs, Ifjúság u. 13, Pécs, H-7624 Hungary
| | - Alexandra Makai
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Viktória Prémusz
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, Vörösmarty u. 4, Pécs, H-7621 Hungary
| | - József Bódis
- Department of Obstetrics and Gynaecology, Medical School, University of Pécs, Pécs, Hungary
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, Vörösmarty u. 4, Pécs, H-7621 Hungary
| | - Endre Sulyok
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, Vörösmarty u. 4, Pécs, H-7621 Hungary
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Fragoso YD, Adoni T, Brooks JBB, Finkelsztejn A, da Gama PD, Grzesiuk AK, Marques VD, Parolin MFK, Sato HK, Varela DL, Vasconcelos CCF. Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children. Neurol Ther 2018; 7:207-232. [PMID: 30167914 PMCID: PMC6283793 DOI: 10.1007/s40120-018-0110-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) management presently aims to reach a state of no (or minimal) evidence of disease activity. The development and commercialization of new drugs has led to a renewed interest in family planning, since patients with MS may face a future with reduced (or no) disease-related neurological disability. The advice of neurologists is often sought by patients who want to have children and need to know more about disease control at conception and during pregnancy and the puerperium. When MS is well controlled, the simple withdrawal of drugs for patients who intend to conceive is not an option. On the other hand, not all treatments presently recommended for MS are considered safe during conception, pregnancy and/or breastfeeding. The objective of the present study was to summarize the practical and evidence-based recommendations for family planning when our patients (women and men) have MS.Funding TEVA Pharmaceutical Brazil.
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Affiliation(s)
| | - Tarso Adoni
- Hospital Sirio-Libanes de Sao Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Henry K Sato
- Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
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Grzeskowiak LE, Leggett C, Costi L, Roberts CT, Amir LH. Impact of serotonin reuptake inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study. Br J Clin Pharmacol 2018. [PMID: 29522259 DOI: 10.1111/bcp.13575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS The aims of the present study were to examine the association between late pregnancy exposure to serotonin reuptake inhibitor (SRI) antidepressants and difficulties in achieving an adequate breast milk supply in women who have given birth to preterm infants, while accounting for the potential impacts of underlying maternal psychiatric illness. METHODS A retrospective cohort study was carried out of 3024 women delivering liveborn preterm infants (<37 weeks' gestation) between January 2004 and December 2008. The primary outcome was postnatal domperidone use, considered to be a valid proxy for the presence and pharmacological management of low milk supply. Relative risks adjusted for maternal sociodemographic characteristics and comorbidities (aRRs) were calculated for low milk supply, comparing women with late pregnancy exposure to SRI antidepressants (n = 86), women with a psychiatric illness but no antidepressant use (n = 126) and women with neither antenatal exposures (n = 2812). RESULTS Compared with non-exposed women, nonmedicated psychiatric illness [aRR 1.64; 95% confidence interval (CI) 1.16, 2.30] but not late pregnancy SRI use (aRR 1.00; 95% CI 0.59, 1.70) was associated with an increased risk of domperidone use, indicative of low milk supply. CONCLUSIONS These findings do not support the previously observed negative impacts of antidepressant use on breastfeeding, instead suggesting that women with an underlying psychiatric illness appear at greatest risk of experiencing low milk supply and could benefit from additional breastfeeding education and support.
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Affiliation(s)
- Luke E Grzeskowiak
- SA Pharmacy, Flinders Medical Centre, SA Health, Australia & Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Catherine Leggett
- SA Pharmacy, Women's and Children's Hospital, SA Health, Adelaide, SA, Australia
| | - Lynn Costi
- SA Pharmacy, Women's and Children's Hospital, SA Health, Adelaide, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
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