Placental passage of tricyclic antidepressants.
BACKGROUND
The use of antidepressants during pregnancy continues to garner considerable attention, though there are limited investigations that have sought to quantify fetal exposure.


METHODS
Maternal and umbilical cord sera were collected at delivery from ten women taking nortriptyline and seven taking clomipramine. Placental passage was calculated as the ratio of umbilical cord to maternal serum concentration. Obstetrical outcome data were gathered from subjects at delivery.


RESULTS
The placental passage ratio of nortriptyline and its active metabolite, cis-10-hydroxynortriptyline, were .68 +/- .40, 1.40 +/- 2.40, respectively. Clomipramine and desmethylclomipramine ratios were .60 +/- .50, .80 +/- .60. Obstetrical complications, such as pre-term delivery and pregnancy induced hypertension, were increased compared to the national average.


CONCLUSIONS
The in vivo ratios of umbilical cord to maternal serum drug concentrations demonstrate considerable fetal exposure and differ greatly from previous results utilizing ex vivo perfusion.
Loughhead
Ada M
AM
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Stowe
Zachary N
ZN
Newport
D Jeffrey
DJ
Ritchie
James C
JC
DeVane
C Lindsay
CL
Owens
Michael J
MJ
D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001724:Birth Weight / Q000187:drug effects; D002997:Clomipramine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000097:blood* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008431:Maternal-Fetal Exchange / Q000502:physiology*; D009661:Nortriptyline / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics* / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000188:drug therapy
D000929:Antidepressive Agents, Tricyclic; C012273:desmethylclomipramine; C013567:10-hydroxynortriptyline; D009661:Nortriptyline; D002997:Clomipramine