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A pilot study of newer
antidepressant concentrations in cord and maternal serum and possible
effects in the neonate.
Rampono J, Proud S, Hackett
LP, Kristensen JH, Ilett KF.
Department of Psychological
Medicine, Womens and Childrens Health Service Subiaco, WA,
Australia.
Antidepressants are often used antenatally, and
placental transfer may lead to adverse effects (toxicity) in the
neonate. Pregnant women taking fluoxetine (n=4), sertraline (n=4),
paroxetine (n=2) or venlafaxine (n=1) in the last trimester were
studied. Maternal and cord sera were collected at delivery and infant
serum on day 5 after birth for measurement of antidepressant
concentrations. Neonatal Abstinence Scores (NAS) were measured in the
infants on days 13 after birth. In maternal serum, median drug
concentrations were: fluoxetine (96 gl), norfluoxetine (110 gl),
sertraline (11 gl), desmethylsertraline (38 gl), paroxetine (mean 12
gl), venlafaxine (220 gl), and O-desmethylvenlafaxine (392 gl).
Corresponding median values in cord serum were: fluoxetine (65 gl),
norfluoxetine (81 gl), sertraline (10 gl), desmethylsertraline (27 gl),
paroxetine (mean 6 gl), venlafaxine (232 gl), and O-desmethylvenlafaxine
(406 gl). Corresponding median cordmaternal concentration ratios were
0.67 for fluoxetine and 0.72 for norfluoxetine, 0.67 for sertraline and
0.63 for demethylsertraline, 0.52 (mean) for paroxetine, and 1.1 and 1.0
for venlafaxine and O-desmethylvenlafaxine respectively. The neonates of
two patients taking fluoxetine had high NAS. Only fluoxetine and
norfluoxetine were detected in infant serum. Our data show substantial
placental transfer of antidepressants, but only fluoxetine persisted in
the infants serum. Neonatal toxicity may be associated with serotonin
uptake blockade, and also be influenced by neonatal
clearance.
PMID: 15035694 [PubMed - as supplied by publisher]
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