Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany.
Department of Gynecology and Obstetrics, RWTH Aachen University, Germany.
Prog Neuropsychopharmacol Biol Psychiatry. 2017 Oct 3;79(Pt B):213-219. doi: 10.1016/j.pnpbp.2017.06.030. Epub 2017 Jun 27.
Aim of the study was to measure and correlate citalopram concentrations in maternal blood, amniotic fluid and umbilical cord blood to account for the distribution of the drug between these three compartments.
Concentrations of citalopram were measured in twelve mother infant pairs at the time of delivery. Data are provided as median values, first (Q1) and third (Q3) quartiles as well as ranges. To account for the penetration ratio into amniotic fluid and cord blood, the concentration of citalopram in was divided by the concentration in maternal serum. Correlations between daily dosage, maternal serum concentrations and umbilical cord blood concentrations were computed for twelve patients. As amniotic fluid was only available for nine mother infant pairs, appropriate calculations are provided for these mother-infant pairs.
The median daily dosage of citalopram was 20mg (Q1: 10mg, Q3: 20mg; range 10-40mg). The relation between the daily dosage of citalopram and its concentrations in maternal serum was highly significant (r=0.667, p=0.018). Maternal serum concentrations and cord blood concentrations were positively correlated (r=0.790, p=0.002) with a median penetration ratio into the fetal circulation of 0.78 (Q1: 0.52, Q3: 1.16, range 0.46-1.66). The median penetration ratio into amniotic fluid was 1.8 (Q1: 1.07, Q3: 2.64; range 0.52-6.97).
Citalopram concentrations in amniotic fluid and cord blood give evidence that maternally administered citalopram is constantly accessible to the fetus via amniotic fluid. A high correlation between maternal serum concentrations of citalopram and umbilical cord blood concentrations highlights a predictive role of quantifying drug concentrations in maternal serum for assessing drug concentrations in the fetal circulation. Findings support the important role of therapeutic drug monitoring in maintaining the safety of pregnant women and exposed infants.
本研究旨在测量并比较西酞普兰在产妇血液、羊水和脐血中的浓度，以了解药物在这三个部位的分布情况。
在分娩时，对 12 对母婴进行了西酞普兰浓度测量。数据以中位数、第一（Q1）和第三（Q3）四分位数以及范围的形式呈现。为了说明药物在羊水和脐血中的渗透比率，将西酞普兰在羊水和脐血中的浓度除以产妇血清中的浓度。对 12 名患者的每日剂量、产妇血清浓度和脐血浓度进行了相关性计算。由于只有 9 对母婴提供了羊水样本，因此对这些母婴进行了适当的计算。
西酞普兰的中位日剂量为 20mg（Q1：10mg，Q3：20mg；范围 10-40mg）。西酞普兰的日剂量与其在产妇血清中的浓度之间存在高度显著的关系（r=0.667，p=0.018）。产妇血清浓度与脐血浓度呈正相关（r=0.790，p=0.002），胎儿循环中的药物渗透比率中位数为 0.78（Q1：0.52，Q3：1.16，范围 0.46-1.66）。药物渗透入羊水的中位数为 1.8（Q1：1.07，Q3：2.64；范围 0.52-6.97）。
羊水和脐血中的西酞普兰浓度表明，母体给予的西酞普兰可通过羊水不断进入胎儿体内。产妇血清中西酞普兰浓度与脐血浓度之间的高度相关性突显了定量测定产妇血清中药物浓度对评估胎儿循环中药物浓度的预测作用。这些发现支持了治疗药物监测在保障孕妇和暴露于药物的婴儿安全方面的重要作用。
