Citalopram in pregnancy and lactation

Area of Science:

• Pharmacology
• Maternal-Fetal Medicine
• Neonatal Health

Background:

• Citalopram is widely used for depression and anxiety but its safety during pregnancy and lactation is not well-established.
• Limited data exists on citalopram and its metabolite concentrations in mothers and infants during pregnancy and postpartum.

Purpose of the Study:

• To evaluate the safety and efficacy of citalopram in pregnant and lactating women.
• To measure citalopram and its metabolite levels in maternal plasma and breast milk.
• To assess pregnancy outcomes and infant neurodevelopment up to one year of age.

Main Methods:

• Prospective study of 11 mothers taking citalopram and their infants, with a control group of 10 non-medicated women.
• Collection of plasma and breast milk samples during pregnancy, at delivery, and up to 2 months postpartum.
• Measurement of citalopram, desmethylcitalopram, and didesmethylcitalopram concentrations using HPLC; monitoring of pregnancy outcomes and infant neurodevelopment.

Main Results:

• Maternal citalopram doses (20-40 mg/day) resulted in low plasma concentrations.
• Infant plasma concentrations of citalopram and metabolites at delivery were 64-68% of maternal levels.
• Breast milk concentrations were 2-3 times higher than maternal plasma, but infant plasma levels remained very low or undetectable.
• Pregnancy outcomes and infant neurodevelopment up to 1 year were normal.
• Increased cytochrome P450 (CYP) 2D6 activity was observed during pregnancy.

Conclusions:

• Citalopram use during pregnancy appears to result in uncomplicated outcomes.
• Infant exposure to citalopram during lactation is minimal.
• Maternal therapeutic drug monitoring of citalopram is advised to reduce fetal exposure.