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Leutritz AL, van Braam L, Preis K, Gehrmann A, Scherf-Clavel M, Fiedler K, Unterecker S, Kittel-Schneider S. Psychotropic medication in pregnancy and lactation and early development of exposed children. Br J Clin Pharmacol 2023; 89:737-750. [PMID: 36103361 DOI: 10.1111/bcp.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/21/2022] [Accepted: 09/06/2022] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Anna Linda Leutritz
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Lara van Braam
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Katharina Preis
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Andrea Gehrmann
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Maike Scherf-Clavel
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Katrin Fiedler
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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Sahoo MK, Biswas H, Grover S. Safety Profile of Aripiprazole During Pregnancy and Lactation: Report of 2 Cases. TURK PSIKIYATRI DERGISI = TURKISH JOURNAL OF PSYCHIATRY 2023; 34:133-135. [PMID: 37357900 PMCID: PMC10552177 DOI: 10.5080/u26681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Aripiprazole, a second-generation antipsychotic (SGA) medication, is an efficacious treatment for schizophrenia and bipolar disorder. However, its effects on pregnancy and lactation are not yet fully documented. Despite aripiprazole being available since 2002, there is only limited information on the risks and benefits of this treatment during pregnancy. Most of the information is limited to populationbased studies examining malformation risk or case studies or small case series. The knowledge in this topic is still insufficient and there is a need to expand the literature. In this report, we present 2 cases exposed to aripiprazole during pregnancy and lactational period. In both our cases of aripiprazole exposure, no teratogenic effects were reported, and it was reassuring that the mothers did not develop gestational diabetes. However, both patients reported lactation failure. Keyword: Mental illness, antipsychotics, aripiprazole, pregnancy.
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Finnell RH, Caiaffa CD, Kim SE, Lei Y, Steele J, Cao X, Tukeman G, Lin YL, Cabrera RM, Wlodarczyk BJ. Gene Environment Interactions in the Etiology of Neural Tube Defects. Front Genet 2021; 12:659612. [PMID: 34040637 PMCID: PMC8143787 DOI: 10.3389/fgene.2021.659612] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
Human structural congenital malformations are the leading cause of infant mortality in the United States. Estimates from the United States Center for Disease Control and Prevention (CDC) determine that close to 3% of all United States newborns present with birth defects; the worldwide estimate approaches 6% of infants presenting with congenital anomalies. The scientific community has recognized for decades that the majority of birth defects have undetermined etiologies, although we propose that environmental agents interacting with inherited susceptibility genes are the major contributing factors. Neural tube defects (NTDs) are among the most prevalent human birth defects and as such, these malformations will be the primary focus of this review. NTDs result from failures in embryonic central nervous system development and are classified by their anatomical locations. Defects in the posterior portion of the neural tube are referred to as meningomyeloceles (spina bifida), while the more anterior defects are differentiated as anencephaly, encephalocele, or iniencephaly. Craniorachischisis involves a failure of the neural folds to elevate and thus disrupt the entire length of the neural tube. Worldwide NTDs have a prevalence of approximately 18.6 per 10,000 live births. It is widely believed that genetic factors are responsible for some 70% of NTDs, while the intrauterine environment tips the balance toward neurulation failure in at risk individuals. Despite aggressive educational campaigns to inform the public about folic acid supplementation and the benefits of providing mandatory folic acid food fortification in the United States, NTDs still affect up to 2,300 United States births annually and some 166,000 spina bifida patients currently live in the United States, more than half of whom are now adults. Within the context of this review, we will consider the role of maternal nutritional status (deficiency states involving B vitamins and one carbon analytes) and the potential modifiers of NTD risk beyond folic acid. There are several well-established human teratogens that contribute to the population burden of NTDs, including: industrial waste and pollutants [e.g., arsenic, pesticides, and polycyclic aromatic hydrocarbons (PAHs)], pharmaceuticals (e.g., anti-epileptic medications), and maternal hyperthermia during the first trimester. Animal models for these teratogens are described with attention focused on valproic acid (VPA; Depakote). Genetic interrogation of model systems involving VPA will be used as a model approach to discerning susceptibility factors that define the gene-environment interactions contributing to the etiology of NTDs.
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Affiliation(s)
- Richard H. Finnell
- Department of Molecular and Human Genetics and Medicine, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Carlo Donato Caiaffa
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Sung-Eun Kim
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, TX, United States
| | - Yunping Lei
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - John Steele
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Xuanye Cao
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Tukeman
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Ying Linda Lin
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Robert M. Cabrera
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Bogdan J. Wlodarczyk
- Department of Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
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