TY  - JOUR
A1  - Leutritz, Anna Linda
A1  - van Braam, Lara
A1  - Preis, Katharina
A1  - Gehrmann, Andrea
A1  - Scherf-Clavel, Maike
A1  - Fiedler, Katrin
A1  - Unterecker, Stefan
A1  - Kittel-Schneider, Sarah
T1  - Psychotropic medication in pregnancy and lactation and early development of exposed children
JF  - British Journal of Clinical Pharmacology
N2  - There is still limited knowledge about alterations of blood concentrations of psychotropic drugs during pregnancy, the transfer of psychotropic drugs into breastmilk and the effects on exposed children. We investigated changes in concentrations of psychopharmacological medication during pregnancy and lactation in serum and breastmilk at different time points in a naturalistic sample of 60 mothers and observed the development of the exposed children in the first 12 months. We found a decrease in serum concentrations from the first to the second trimester of amitriptyline, duloxetine, escitalopram, quetiapine and sertraline. Citalopram stayed rather stable during pregnancy, sertraline levels interestingly increased again from the second to the third trimester. High concentration-by-dose ratios in breastmilk were found for venlafaxine as well as lamotrigine, low for quetiapine and clomipramine. Similarly, clomipramine and quetiapine showed low milk/serum–penetration ratios. Regarding the birth outcome measures in children, we found no significant differences between in utero exposed compared to nonexposed newborns. There were no significant differences in the development in the first 12 months. Psychotropic medication in the peripartum needs a balancing of risks and benefits and a continuous therapeutic drug monitoring can be a guidance for clinicians to monitor drug alteration patterns, which are likely to occur due to physiological pregnancy-associated changes in pharmacokinetics. Accordingly, therapeutic drug monitoring can optimize a medication in pregnancy and lactation with the lowest effective dose.
KW  - antidepressants
KW  - psychotropic medication
KW  - pregnancy
KW  - peripartum
KW  - mental disorders
KW  - lactation
KW  - child development
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318954
VL  - 89
IS  - 2
SP  - 737
EP  - 750
ER  - 
TY  - JOUR
A1  - Gehrmann, Andrea
A1  - Fiedler, Katrin
A1  - Leutritz, Anna Linda
A1  - Koreny, Carolin
A1  - Kittel-Schneider, Sarah
T1  - Lithium medication in pregnancy and breastfeeding — a case series
JF  - Medicina
N2  - Lithium salts are the first-line prophylaxis treatment for bipolar disorder in most guidelines. The majority of bipolar women are treated with mood stabilizers at the time they wish to get pregnant. One reason for this is the rising average age at first childbirth, at least in the high-income countries, which increases in general the likelihood of a medication with psychotropic drugs. Previously, lithium exposition during pregnancy was thought to strongly increase the risk of severe cardiac malformation. However, recent studies only point to a low teratogenic risk, so nowadays an increasing number of women are getting pregnant with ongoing lithium treatment. Regarding lithium medication during breastfeeding, there is evidence that lithium transfers to the breastmilk and can also be detected in the infants' serum. The influence on the infant is still a largely understudied topic. Regular monitoring of the infants' renal clearance, thyroid function, and lithium levels is warranted when breastfeeding under lithium exposure. In this case series, we present three case reports of bipolar mothers who were treated with lithium during pregnancy and breastfeeding to add to the scarce literature on this important topic. In short, we strengthen the importance of therapeutic drug monitoring due to fluctuating plasma levels during pregnancy and after birth, and we can report the birth and development of three healthy infants despite lithium medication during pregnancy and breastfeeding.
KW  - lithium
KW  - pregnancy
KW  - lactation
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-285640
SN  - 1648-9144
VL  - 57
IS  - 6
ER  -