title: Transplacental Distribution of Lidocaine and Its Metabolite in Peridural Anesthesia Administered to Patients With Gestational Diabetes Mellitus.
abstract: BACKGROUND
  Neonatal effects of drugs administered to mothers before delivery depend on the quantity that crosses the placental barrier, which is determined by the pharmacokinetics of the drug in the mother, fetus, and placenta. Diabetes mellitus can alter the kinetic disposition and the metabolism of drugs. This study investigated the placental transfer of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in pregnant women with gestational diabetes mellitus (GDM) submitted to peridural anesthesia.
  
  
  METHODS
  A total of 10 normal pregnant women (group 1) and 6 pregnant women with GDM (group 2) were studied, all at term. The patients received 200 mg 2% lidocaine hydrochloride by the peridural locoregional route. Maternal blood samples were collected at the time of delivery and, after placental expulsion, blood samples were collected from the intervillous space, umbilical artery, and vein for determination of lidocaine and MEGX concentrations and analysis of the placental transfer of the drug.
  
  
  RESULTS
  The following respective lidocaine ratios between the maternal and the fetal compartments were obtained for groups 1 and 2: umbilical vein/maternal peripheral blood, 0.60 and 0.46; intervillous space/maternal blood, 1.01 and 0.88; umbilical artery/umbilical vein, 0.77 and 0.91; and umbilical vein/intervillous space, 0.53 and 0.51. The following MEGX ratios for groups 1 and 2 were, respectively, fetal/maternal, 0.43 and 0.97; intervillous space/maternal blood, 0.64 and 0.90; umbilical artery/umbilical vein, 1.09 and 0.99; and umbilical vein/intervillous space, 0.55 and 0.78.
  
  
  CONCLUSIONS
  Gestational diabetes mellitus did not affect the transplacental transfer of lidocaine but interfered with the transfer of MEGX, acting as a mechanism facilitating the transport of the metabolite.
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil elainemoises@hcrp.fmrp.usp.br.
authors.forename: Elaine Christine Dantas
authors.initials: EC
authors.lastname: Moises
authors.affiliation: Women and Children Department, Fluminense Federal University, Rio de Janeiro, Brazil.
authors.forename: Luciana de Barros
authors.initials: Lde B
authors.lastname: Duarte
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil.
authors.forename: Ricardo de Carvalho
authors.initials: Rde C
authors.lastname: Cavalli
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil.
authors.forename: Daniela Miarelli
authors.initials: DM
authors.lastname: Carvalho
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil.
authors.forename: Gabriela Campos de Oliveira
authors.initials: GC
authors.lastname: Filgueira
authors.affiliation: Department of Clinical Analysis, Toxicology and Food Sciences, Faculty of Pharmaceutical Sciences of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil.
authors.forename: Maria Paula
authors.initials: MP
authors.lastname: Marques
authors.affiliation: Department of Clinical Analysis, Toxicology and Food Sciences, Faculty of Pharmaceutical Sciences of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil.
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Lanchote
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil.
authors.forename: Geraldo
authors.initials: G
authors.lastname: Duarte
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood*; D016640:Diabetes, Gestational / Q000097:blood* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000097:blood*; D008431:Maternal-Fetal Exchange / Q000187:drug effects / Q000502:physiology*; D010920:Placenta / Q000187:drug effects / Q000378:metabolism*; D011247:Pregnancy; D014018:Tissue Distribution / Q000187:drug effects / Q000502:physiology; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: gestational diabetes mellitus; lidocaine; monoethylglycinexylidide; placental transfer; pregnancy