title: Abnormal pregnancy outcome associated with high-dose maternal tranylcypromine therapy: Case report and literature review.
abstract: Tranylcypromine is a non-selective inhibitor of monamine oxidase which also inhibits the reuptake of norepinephrine. Spontaneous hypertensive reactions to the drug have been reported. In sheep tranylcypromine has been shown to cause a dose-dependent reduction in uterine blood flow. A similar effect in a pregnant woman might induce constriction of the uterine arteries and temporary fetal hypoxia.
  
  
  
  MotherSafe is a state-based Teratogen Information service and currently provides counselling to around 22,000 consumers and healthcare professionals annually regarding exposures during pregnancy and breastfeeding We report on the outcome of 2 pregnancies in a patient treated with high dose tranylcypromine as well as pimozide, diazepam and alprazolam. The first pregnancy resulted in fetal death and autopsy revealed facial dysmorphism with ocular hypertelorism, cardiac defect and placental infarcts. The second pregnancy continued to term but the baby had similar dysmorphic features as well as an atrio-ventricular septal defect and craniosynostosis.
  
  
  
  Due to their unpredictable interactions with many drugs and foods, MAO inhibitors such as tranylcypromine are not commonly used to treat depression and reports of use in pregnancy are rare. We report the outcome of 2 pregnancies with exposure to high doses of tranylcypromine resulting in children with a similar pattern of malformations. The aetiology is unknown but may relate to the vasoactive properties of the drug in above-therapeutic doses.
authors.affiliation: Mothersafe, Royal Hospital for Women, Randwick, NSW, 2031, Australia; University of New South Wales, Randwick, NSW, 2031, Australia. Electronic address: Debra.kennedy@health.nsw.gov.au.
authors.forename: Debra
authors.initials: D
authors.lastname: Kennedy
authors.affiliation: Discipline of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: William S
authors.initials: WS
authors.lastname: Webster
authors.affiliation: Mothersafe, Royal Hospital for Women, Randwick, NSW, 2031, Australia.
authors.forename: Majella
authors.initials: M
authors.lastname: Hill
authors.affiliation: Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW, 2114, Australia.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Ritchie
mesh_terms: D000015:Abnormalities, Multiple / Q000139:chemically induced*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019465:Craniofacial Abnormalities / Q000139:chemically induced*; D003863:Depression / Q000188:drug therapy; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006330:Heart Defects, Congenital / Q000139:chemically induced*; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D013723:Teratogens; D014191:Tranylcypromine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors; D013723:Teratogens; D014191:Tranylcypromine
keywords: Fetal abnormalities; High-dose; Maternal depression; Pregnancy outcome; Tranylcypromine