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Endogenous digoxin-immunoreactive substance in human pregnancies.

S W Graves, R Valdes, B A Brown

    The Journal of Clinical Endocrinology and Metabolism
    |April 1, 1984
    PubMed
    Summary

    Pregnant women in their third trimester have a digoxin-like substance in their blood. This substance interferes with digoxin testing, complicating treatment for pregnant individuals needing cardiac medication.

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    Area of Science:

    • Obstetrics and Gynecology
    • Cardiology
    • Clinical Chemistry

    Background:

    • Cardiac glycosides, like digoxin, are crucial for managing heart conditions.
    • Accurate monitoring of digoxin levels is essential for patient safety and effective treatment.
    • Pregnancy can alter physiological parameters, potentially affecting drug pharmacokinetics and assay results.

    Purpose of the Study:

    • To investigate the presence of digoxin-like immunoreactive substances in the blood of third-trimester pregnant women.
    • To assess the impact of this endogenous substance on the accuracy of commercially available digoxin immunoassays.
    • To evaluate the clinical implications for managing pregnant patients requiring digoxin therapy.

    Main Methods:

    • Analysis of serum samples from 51 third-trimester pregnant women using four different commercial digoxin radioimmunoassays (RIAs).

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  • Testing for digoxin immunoreactivity in samples from non-digoxin-treated patients.
  • Assessment of the substance's half-life postpartum and its interaction with exogenous digoxin.

    • Main Results:

    • Digoxin immunoreactivity was detected in all pregnant women by three out of four assays.
    • The endogenous substance was not detectable 24 hours postpartum, indicating a short half-life (≤6 hours).
    • Three of the four assays could not differentiate between endogenous digoxin-like substance and exogenous digoxin.

    Conclusions:

    • Third-trimester pregnant women possess an endogenous substance that cross-reacts with digoxin immunoassays.
    • This cross-reactivity complicates the accurate therapeutic drug monitoring of digoxin in pregnant patients.
    • Clinical management requires careful consideration of these altered assay results during pregnancy.