Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Alexianer Hospital Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany.
Department of Gynecology and Obstetrics, RWTH Aachen University, Germany.
Schizophr Res. 2018 May;195:252-257. doi: 10.1016/j.schres.2017.09.043. Epub 2017 Sep 29.
This prospective study is the first to measure and correlate quetiapine concentrations in maternal blood, amniotic fluid and umbilical cord blood to account for the distribution of quetiapine.
Concentrations of quetiapine are quantified in seven mother infant pairs at the time of delivery. Data are provided as median values, first (Q1) and third (Q3) quartiles and ranges. To account for the penetration ratio, the concentration of quetiapine in amniotic fluid and cord blood was divided by maternal concentrations. Correlations between daily dosage, maternal serum and umbilical cord blood concentrations were computed for seven patients while calculations for amniotic fluid were only available for six mother-infant pairs.
The median daily dosage of quetiapine was 300mg (Q1: 300mg, Q3: 600mg, range 200-800mg). There was a strong and significant correlation between maternal serum and cord blood concentrations (r=0.893, p=0.007). The median penetration ratio into fetal circulation was 0.18 (Q1: 0.16, Q3: 0.32; range 0.13-0.42), suggesting a low penetration. The median penetration ratio into amniotic fluid was 0.44 (Q1: 0.15, Q3: 0.96; range 0.09-1.70).
Quetiapine concentrations in amniotic fluid and cord blood give evidence that quetiapine is constantly accessible to the fetus with a relatively low penetration ratio. A high correlation between maternal serum and umbilical cord blood concentrations highlights a predictive role of quantifying drug concentrations in maternal serum for assessing drug concentrations in fetal circulation. Findings support the important role of therapeutic drug monitoring in supporting the efficacy and safety of psychopharmacological treatment strategies in highly vulnerable populations.
这是第一项前瞻性研究，旨在测量和关联奎硫平在产妇血液、羊水和脐血中的浓度，以解释奎硫平的分布情况。
在分娩时对 7 对母婴进行奎硫平浓度检测。数据以中位数、第一（Q1）和第三（Q3）四分位数以及范围表示。为了计算穿透率，将羊水中和脐血中的奎硫平浓度除以母体浓度。对 7 例患者计算了每日剂量、母体血清和脐血浓度之间的相关性，而对于羊水，仅可计算 6 对母婴的相关性。
奎硫平的中位日剂量为 300mg（Q1：300mg，Q3：600mg，范围 200-800mg）。母体血清和脐血浓度之间存在很强且显著的相关性（r=0.893，p=0.007）。进入胎儿循环的中位穿透率为 0.18（Q1：0.16，Q3：0.32；范围 0.13-0.42），提示穿透率较低。进入羊水的中位穿透率为 0.44（Q1：0.15，Q3：0.96；范围 0.09-1.70）。
羊水和脐血中的奎硫平浓度表明，奎硫平持续不断地进入胎儿体内，穿透率相对较低。母体血清和脐血浓度之间的高度相关性突出了定量母体血清中药物浓度对于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支持高度脆弱人群的精神药理学治疗策略的疗效和安全性方面的重要作用。
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