Alvarez Ingrid, Tötterman Katarina, Honkaniemi Emma, Sarman Ihsan, Bäck Karin, Forsberg Lisa, Heinonen Essi Whaites, Svedenkrans Jenny
Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
Acta Paediatr. 2025 Feb;114(2):346-354. doi: 10.1111/apa.17432. Epub 2024 Sep 20.
We aimed to investigate plasma lamotrigine concentrations and clinical effects in infants exposed to lamotrigine through breastfeeding.
This was a retrospective study of mother-infant dyads in a clinical follow-up programme in Stockholm, Sweden. Data were collected from medical records.
We included 47 breastfed infants, born from 2011 to 2021, with a median gestational age of 39 + 6 weeks/days and a median birth weight of 3420 g. The median lamotrigine concentration in the infants' plasma was 2.5 (range 2.5-14.0) μmol/L. These concentrations correlated significantly with both the maternal plasma concentrations and the maternal doses (R = 0.79, p < 0.001 versus R = 0.54, p < 0.001). During the follow up, lamotrigine concentrations within the reference range for epilepsy treatment were detected in six (14%) infants and one had clinical symptoms that were probably related to lamotrigine exposure. Liver transaminases were elevated in three of 21 infants. All infants whose mothers had a dose of 150 mg or less had undetectable plasma concentrations and no symptoms during follow up.
Infants exposed to lamotrigine through breastfeeding had a low risk of toxic effects. All infants whose mothers had low lamotrigine doses had unmeasurable plasma concentrations and no symptoms of lamotrigine exposure. These low-risk infants might be offered a simplified follow up.
我们旨在研究通过母乳喂养接触拉莫三嗪的婴儿的血浆拉莫三嗪浓度及临床效果。
这是一项对瑞典斯德哥尔摩临床随访项目中的母婴二元组进行的回顾性研究。数据从医疗记录中收集。
我们纳入了47名2011年至2021年出生的母乳喂养婴儿，中位胎龄为39 + 6周/天，中位出生体重为3420克。婴儿血浆中拉莫三嗪的中位浓度为2.5（范围2.5 - 14.0）μmol/L。这些浓度与母亲血浆浓度和母亲剂量均显著相关（R = 0.79，p < 0.001；与R = 0.54，p < 0.001相比）。在随访期间，6名（14%）婴儿检测到癫痫治疗参考范围内的拉莫三嗪浓度，1名婴儿有可能与拉莫三嗪暴露相关的临床症状。21名婴儿中有3名肝转氨酶升高。所有母亲剂量为150毫克或更低的婴儿在随访期间血浆浓度未检测到且无症状。
通过母乳喂养接触拉莫三嗪的婴儿出现毒性作用的风险较低。所有母亲拉莫三嗪剂量低的婴儿血浆浓度无法测量且无拉莫三嗪暴露症状。这些低风险婴儿可能可以进行简化随访。
