Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int Breastfeed J. 2023 Apr 14;18(1):21. doi: 10.1186/s13006-023-00559-z.
Mothers requiring the antiarrhythmic agent flecainide are often advised not to breastfeed, because of the lack of data concercing neonatal effects and flecainide plasma concentrations following maternal exposure as well as via lactation. This is the first report on combined maternal, fetal, neonatal and breastmilk flecainide concentrations in a breastfed infant of a mother requiring flecainide treatment.
A 35-year old Gravida 2 Para 1, known with ventricular arrhythmia, was referred to our tertiary center at 35 + 4 weeks of gestation. Because of an increase of ventricular ectopy, oral metoprolol 11.9 milligrams once daily was switched to oral flecainide 87.3 milligrams twice daily. Weekly collected maternal flecainide plasma trough concentrations fell within the therapeutic range of 0.2 to 1.0 mg/L and no further clinically significant arrhythmias occurred during the study period. A healthy son was born at 39 weeks of gestation and had a normal electrocardiogram. The fetal to maternal flecainide ratio was 0.72 and at three different timepoints, the flecainide concentration was higher in breastmilk than in maternal plasma. The relative infant dose received via breastmilk compared to maternal dose was 5.6%. Neonatal plasma concentrations were not detectable, despite the flecainide passage into breastmilk. All electrocardiograms to assess the neonatal antiarrhytmic effect were normal.
Our results assume that flecainide can be prescribed safely to lactating mothers. Quantification of drug concentrations in neonatal blood in addition to measurements in maternal and fetal blood, and breastmilk, are helpful to evaluate the effects and safety of maternal medication use during pregnancy and lactation.
由于缺乏关于母体暴露和通过哺乳后新生儿的影响以及氟卡尼血浆浓度的数据，因此经常建议需要抗心律失常药物氟卡尼的母亲不要进行母乳喂养。这是首例关于需要氟卡尼治疗的母亲的母乳喂养婴儿的母体、胎儿、新生儿和母乳中氟卡尼浓度的综合报告。
一位 35 岁的 Gravida 2 Para 1 患者，已知患有室性心律失常，在 35+4 孕周时被转诊至我们的三级中心。由于室性异位增加，将每日口服美托洛尔 11.9 毫克改为每日口服氟卡尼 87.3 毫克。每周采集的母体氟卡尼血浆谷浓度均在 0.2 至 1.0mg/L 的治疗范围内，在研究期间没有发生进一步的临床显著心律失常。一名健康的男婴于 39 孕周出生，心电图正常。胎儿与母体氟卡尼比值为 0.72，在三个不同时间点，母乳中的氟卡尼浓度均高于母体血浆。通过母乳喂养接受的相对婴儿剂量与母体剂量相比为 5.6%。尽管氟卡尼进入了母乳，但新生儿血浆浓度仍无法检测到。所有用于评估新生儿抗心律失常作用的心电图均正常。
我们的结果表明，氟卡尼可安全用于哺乳期母亲。除了测量母体和胎儿血液以及母乳中的药物浓度外，定量检测新生儿血液中的药物浓度有助于评估妊娠和哺乳期母亲用药的效果和安全性。
