title: Placental passage of tricyclic antidepressants.
abstract: 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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: Ada M
authors.initials: AM
authors.lastname: Loughhead
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Stowe
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Newport
authors.forename: James C
authors.initials: JC
authors.lastname: Ritchie
authors.forename: C Lindsay
authors.initials: CL
authors.lastname: DeVane
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Owens
mesh_terms: 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
chemical_list: D000929:Antidepressive Agents, Tricyclic; C012273:desmethylclomipramine; C013567:10-hydroxynortriptyline; D009661:Nortriptyline; D002997:Clomipramine