Pharmacopsychiatry 2014; 47 - A3_2
DOI: 10.1055/s-0034-1386815

Therapeutic Drug Monitoring in maternal serum, amniotic fluid and umbilical cord blood during pregnancy and delivery

M Paulzen 1, T Veselinovic 1, N Frergsen 2, T Goecke 2, C Hiemke 3, G Gründer 1
  • 1Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA – Translational Brain Medicine, Germany
  • 2Department of Gynaecology and Obstetrics – Perinatalcenter Level I, RWTH Aachen University
  • 3Neurochemical Laboratory, Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Germany

Treatment of psychiatric diseases during pregnancy is complicated by the concern for the safety of the unborn child because all psychotropic medications more or less cross the placenta. Fetal outcome is influenced by various factors and – among others – the effects of a specific drug itself depend on the concentration in maternal and fetal serum as well as on its concentration in amniotic fluid.

The present study is a naturalistic prospective investigation of different psychotropic drug concentrations in maternal serum and amniotic fluid of 22 women and umbilical cord blood of 14 newborns. The women were treated with different doses of psychotropic drugs such as antidepressants, antipsychotics, anticonvulsants and others.

Patients received thirteen different psychotropic drugs. Results are available for five antidepressants (citalopram, paroxetine, sertraline, fluoxetine and venlafaxine), 3 anticonvulsants (valproic acid, levetiracetam, lamotrigine), 2 benzodiazepines (diazepam, clobazam), as well as for olanzapine, quetiapine, methadone and methylphenidate. Concentrations of different psychotropic drugs were found in maternal plasma, amniotic fluid and umbilical cord blood in highly variable concentrations.

Obviously fetal exposure is continual and may occur through a variety of paths accounting for increased fetal exposure.