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Pharmacokinetics and Pharmacogenetics of Selective Serotonin Reuptake Inhibitors During Pregnancy: An Observational

Laura Pogliani1, Felicia S Falvella, Dario Cattaneo

  • 1*Department of Pediatrics, ASST Fatebenefratelli-Sacco, L. Sacco University Hospital, Milan; †Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco, L. Sacco University Hospital, Milan; ‡Department of Gynecology and Obstetrics, ASST Fatebenefratelli-Sacco, L. Sacco Hospital, University Hospital, Milan; §Department of Pediatrics, ASST Fatebenefratelli-Sacco, Ospedale dei Bambini V. Buzzi, Milan; ¶Clinical Pharmacology Unit, Consiglio Nazionale delle Ricerche Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università degli Studi di Milano, Milan; and ‖E. Medea Scientific Institute, Bosisio Parini, Italy.

Therapeutic Drug Monitoring
|January 4, 2017
PubMed

Insights

Selective serotonin reuptake inhibitors (SSRIs) may increase infant risks. This study examined SSRI pharmacogenetics and umbilical/maternal ratios, finding a link between higher SSRI concentrations and adverse infant outcomes.

Area of Science:

  • Pharmacology
  • Neonatal Medicine
  • Genetics

Background:

  • Selective serotonin reuptake inhibitors (SSRIs) are increasingly linked to potential risks in newborns, including malformations and withdrawal symptoms.
  • Individual genetic variations in drug metabolism (pharmacogenetics) may influence these risks.
  • Understanding the relationship between maternal SSRI levels and infant outcomes is crucial for prenatal care.

Purpose of the Study:

  • To investigate the impact of individual SSRI pharmacogenetics on infant outcomes.
  • To determine the umbilical/maternal plasma SSRI concentration ratio in pregnant women receiving SSRI therapy at delivery.

Main Methods:

  • Study included 34 pregnant women and their infants, with SSRI exposure in the third trimester.
  • Umbilical/maternal plasma SSRI concentration ratios were measured in 15 mothers at delivery.
  • Pharmacogenetic analyses were performed on blood samples to assess drug metabolism pathways.

Main Results:

  • Nineteen newborns exhibited clinical signs suggestive of SSRI toxicity.
  • A high umbilical/maternal plasma SSRI ratio was observed in 10 out of 15 evaluated newborns.
  • Metabolic analysis revealed 5 mothers as intermediate and 1 as a poor metabolizer for key CYP enzymes.

Conclusions:

  • Individualized psychopharmacological treatment considering maternal SSRI exposure and genetic background is recommended.
  • Tailoring SSRI therapy can optimize benefits and minimize risks for newborns.
  • This approach may establish a new standard of care in prenatal psychopharmacology.
Abstract

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