Antidepressant transfer into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis.
Antidepressant transfer into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis.
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DOI：
10.1016/j.pnpbp.2020.110228
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发表时间：
2021-04-20
影响因子：
5.6
通讯作者：
Spigset O
中科院分区：
文献类型：
--
作者：
Schoretsanitis G;Westin AA;Stingl JC;Deligiannidis KM;Paulzen M;Spigset O
关于抗抑郁药进入胎儿、新生儿和婴儿体液的能力的数据已经逐渐可用，但抗抑郁药转移的机制仍然知之甚少。在这里，我们计算了渗透率在一系列矩阵的合并样本的孕妇/哺乳期妇女服用抗抑郁药。我们对PubMed和EMBASE进行了系统的文献检索，以确定从母体血液、羊水、脐带血和/或母乳中提取抗抑郁药浓度的研究。通过将羊水、脐带血浆或母乳中的浓度除以母体血浆浓度来计算穿透率。当多项研究的数据可用时，我们计算了综合渗透率，通过研究规模加权研究平均值。确定了85项合格研究。对于羊水，文拉法辛（平均值2.77，活性部分范围0.43-4.70）和西酞普兰（平均值2.03，范围0.35-6.97）的渗透率估计最高，而氟伏沙明（平均值0.1）和氟西汀（平均值0.11，活性部分范围0.02-0.2）的渗透率最低。对于脐带血浆，去甲替林的比值最高（平均值2.97，范围0.25-26.43），其次是安非他酮（平均值1.14，范围0.3-5.08）。对于母乳，观察到文拉法辛（平均值2.59，范围0.85-4.85）、米安色林（平均值2.22，范围0.80-3.64）和艾司西酞普兰（平均值2.19，范围1.68-3.00）的比值最高。我们观察到抗抑郁药在进入胎儿、新生儿和婴儿体液的能力方面存在相当大的差异。测量母体血液样本中的抗抑郁药浓度可以提供胎儿/婴儿暴露的可靠估计，尽管需要进一步的证据证明浓度依赖性效应。
Data regarding the ability of antidepressants to enter fetal, newborn and infant fluids have become gradually available, but mechanisms of antidepressant transfer remain poorly understood. Here we calculated penetration ratios in an array of matrices from combined samples of pregnant/breastfeeding women taking antidepressants. We performed a systematic literature search of PubMed and EMBASE to identify studies with concentrations of antidepressants from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal plasma concentration. When data from multiple studies were available, we calculated combined penetration ratios, weighting the study mean by study size. Eighty-five eligible studies were identified. For amniotic fluid, the highest penetration ratios were estimated for venlafaxine (mean 2.77, range 0.43–4.70 for the active moiety) and citalopram (mean 2.03, range 0.35–6.97), while the lowest ratios were for fluvoxamine (mean 0.1) and fluoxetine (mean 0.11, range 0.02–0.2 for the active moiety). For umbilical cord plasma, nortriptyline had the highest ratio (mean 2.97, range 0.25–26.43) followed by bupropion (mean 1.14, range 0.3–5.08). For breast milk, the highest ratios were observed for venlafaxine (mean 2.59, range 0.85–4.85), mianserin (mean 2.22, range 0.80–3.64) and escitalopram (mean 2.19, range 1.68–3.00). We observed considerable variability across antidepressants regarding their ability to enter fetal, newborn and infant fluids. Measuring antidepressant concentrations in a maternal blood sample can provide a reliable estimate of fetal/infant exposure, although further evidence for concentration-dependent effects is required.
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