scholarly journals Sertraline concentrations in pregnant women are steady and the drug transfer to their infants is low

2021 ◽  
Author(s):  
E. Heinonen ◽  
M. Blennow ◽  
M. Blomdahl-Wetterholm ◽  
M. Hovstadius ◽  
J. Nasiell ◽  
...  
Keyword(s):  
Cord Blood ◽  
Pregnant Women ◽  
Plasma Concentrations ◽  
Relative Difference ◽  
Interindividual Variation ◽  
Therapeutic Drug ◽  
Cytochrome P450 Enzyme ◽  
Second Trimester ◽  
P450 Enzyme ◽  
Placental Passage

Abstract Purpose Sertraline, a selective serotonin reuptake inhibitor (SSRI), is one of the most commonly used antidepressant during pregnancy. Plasma sertraline concentrations vary markedly between individuals, partly explained by variability in hepatic drug metabolizing cytochrome P450-enzyme activity. Our purpose was to study the variability in the plasma concentrations in pregnant women and the passage to their infants. Method Pregnant women with moderate untreated depression were recruited in 2016–2019 in Stockholm Region and randomized to treatment with sertraline or placebo. All received Internet-based cognitive behavior therapy as non-medical treatment. Sertraline plasma concentrations were measured around pregnancy weeks 21 and 30, at delivery, 1-month postpartum, in cord blood and at 48 h of age in the infant. The clinical course of the infants was followed. Results Nine mothers and 7 infants were included in the analysis. Median dose-adjusted sertraline concentration in second trimester was 0.15(ng/mL) /(mg/day), in third trimester and at delivery 0.19 and 1-month postpartum 0.25, with a 67% relative difference between second trimester and postpartum. The interindividual variation was 10-fold. Median concentrations in the infants were 33% and 25% of their mothers’, measured in cord blood, and infant plasma, respectively. Only mild and transient adverse effects were seen on the infants. Conclusion Placental passage of sertraline to the infant is low. However, the interindividual variation in maternal concentrations during pregnancy is huge, why therapeutic drug monitoring might assist in finding the poor metabolizers at risk for adversity and increase the safety of the treatment. Trial registration The trial was registered at clinicaltrials.gov July 9, 2014 with TRN: NCT02185547.

scholarly journals Pharmacokinetics of Prophylactic Cefazolin in Parturients Undergoing Cesarean Delivery

2014 ◽  
Vol 58 (6) ◽  
pp. 3504-3513 ◽  
Author(s):  
Mohammed H. Elkomy ◽  
Pervez Sultan ◽  
David R. Drover ◽  
Ekaterina Epshtein ◽  
Jeffery L. Galinkin ◽  
...  
Keyword(s):  
Cord Blood ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Plasma Concentrations ◽  
Maternal Blood ◽  
Blood Samples ◽  
Elective Cesarean ◽  
Neonatal Blood ◽  
The Impact ◽  
Maternal Administration

ABSTRACTThe objectives of this work were (i) to characterize the pharmacokinetics of cefazolin in pregnant women undergoing elective cesarean delivery and in their neonates; (ii) to assess cefazolin transplacental transmission; (iii) to evaluate the dosing and timing of preoperative, prophylactic administration of cefazolin to pregnant women; and (iv) to investigate the impact of maternal dosing on therapeutic duration and exposure in newborns. Twenty women received 1 g of cefazolin preoperatively. Plasma concentrations of total cefazolin were analyzed from maternal blood samples taken before, during, and after delivery; umbilical cord blood samples obtained at delivery; and neonatal blood samples collected 24 h after birth. The distribution volume of cefazolin was 9.44 liters/h. The values for pre- and postdelivery clearance were 7.18 and 4.12 liters/h, respectively. Computer simulations revealed that the probability of maintaining free cefazolin concentrations in plasma above 8 mg/liter during scheduled caesarean surgery was <50% in the cord blood when cefazolin was administered in doses of <2 g or when it was administered <1 h before delivery. Therapeutic concentrations of cefazolin persisted in neonates >5 h after birth. Cefazolin clearance increases during pregnancy, and larger doses are recommended for surgical prophylaxis in pregnant women to obtain the same antibacterial effect as in nonpregnant patients. Cefazolin has a longer half-life in neonates than in adults. Maternal administration of up to 2 g of cefazolin is effective and produces exposure within clinically approved limits in neonates.

scholarly journals PREVENTION OF PREECLAMPSIA IN WOMEN WITH MULTIPLE PREGNANCY AFTER ASSISTED REPRODUCTION

2020 ◽  
Vol 73 (3) ◽  
pp. 494-497
Author(s):  
Tamara G. Romanenko ◽  
Olha M. Sulimenko
Keyword(s):  
Pregnant Women ◽  
Biochemical Markers ◽  
Preventive Measures ◽  
Risk Group ◽  
Plasma Concentrations ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
High Risk Group ◽  
Prospective Analysis ◽  
Second Trimester

The aim: To reduce the frequency and severity of preeclampsia, to improve obstetrical and perinatal outcomes in women with multiple pregnancy after assisted reproduction by the development and implementation of the preventive algorithm with biochemical markers of endothelial dysfunction prospective analysis. Materials and methods: Clinical and laboratory prospective analysis of 54 cases of twins in women, treated from infertility with assisted reproductive technologies (ART), using the method of intracytoplasmic sperm injection (ICSI) and frozen embryos transfer, have been made. It was proven, that women with multiple pregnancy are always in a high risk group of placental dysfunction (PD) and preeclampsia (PE). Depending on the treatment algorithm and preventive measures, 2 groups of patients were formed. Group I included 29 pregnant women with twins, managed in accordance with developed recommendations. We didn’t find evidence-based European guidelines, that would recommend routine prescription of progesterone to improve chorion invasion and further placentation in such group of patients, but in order to prevent endothelial dysfunction and to decrease the incidence and severity of preeclampsia, placental abnormalities and intrauterine growth restriction (IUGR), we proposed the following algorithm: – micronized progesterone 200 mg vaginally (PV), as soon as pregnancy was diagnosed by positive hCG-test, till 16 weeks of pregnancy, angioprotector diosmin 600 mg once daily orally (PO), 2 courses: from 8 till 12 and from 16 till 20 weeks of gestation, antiaggregant – acetylsalicylic acid 150 mg from 12 till 36 weeks of gestation. Group II included 25 pregnant women with twins after the same ART procedures, who have not received above mentioned treatment. Plasma concentrations of PlGF, sFlt-1 and the ratio of sFlt-1/PlGF in the second trimester were investigated in both groups of women in order to assess the effectiveness of proposed preventive measures. Results: Usage of preventive algorithm has shown the reduction of PE incidences in 26%, PD in 28.1%, IUGR in 35%, prematurity by 23% and fetal distress in 18%, that led to improvement of obstetrical and perinatal outcomes in I group of women with multiple pregnancies after ART-treated infertility, compared with group II (p<0.05). The evaluation of PlGF, sFlt-1 plasma concentrations and the ratio of sFlt-1/PlGF in the second trimester of pregnancy reflected the effectiveness of our method in women with twins after ART. The level of PlGF in the study group was higher (186.5 ± 12 vs 154.2 ± 10.7; p<0.05), and the level of sFlt-1 was lower (1523.1 ± 40.3 vs 1835.3 ± 33.6; p <0.05). Results of sFlt-1/PlGF ratio analysis in the I group also showed effectiveness of the method proposed (20.3 ± 3.1 vs 28.1 ± 2.2; p<0.05). Conclusions: The observed results suggest, that pregnant women with twins after ART-treated infertility are in a high-risk group of PE, PD and IUGR of one or both fetuses. Implementation of the proposed preventive algorithm allows to reduce the incidence of PE, obstetrical and perinatal complications in this group of patients, and can be widely used in clinical practice. Evaluation and prospective assessment of biochemical markers, such as PlGF, sFlt-1 and sFlt-1/PIGF ratio, in the second trimester of pregnancy in the target groups may likely predict the development of PE and its severity.

Use of antidepressants in a modern globalized society

2010 ◽  
Vol 7 (03) ◽  
pp. 162-168 ◽  
Author(s):  
T. Haslemo ◽  
L. Tanum
Keyword(s):  
Treatment Outcome ◽  
Genetic Factors ◽  
Enzyme System ◽  
Therapeutic Drug ◽  
Cytochrome P450 Enzyme ◽  
Relevant Factor ◽  
The World ◽  
P450 Enzyme ◽  
Cytochrome P450 Enzyme System ◽  
Cytochrome P 450

SummaryDepression is a highly prevalent condition throughout the world. Ethnicity is reported to influence treatment outcome with antidepressants in a number of ways, including both cultural and genetic factors. Non-genetic factors such as the type of diet, beliefs about depression and attitudes towards treatment with antidepressants are proposed to directly influence medication adherence and the rate of remission. Genetic factors are mainly expressed through inter-individual variance in drug metabolism and must be born in mind when antidepressants are prescribed in a multi-ethnic society. Recent advances in molecular biology have revealed substantial variance in the Cytochrome-P450 enzyme system, which is considered to be the most important and relevant factor for ethnic variance in the metabolism. This underscores the usefulness of therapeutic drug monitoring and individualization of treatment in clinical practice. This paper will briefly review factors related to ethnicity that may be of potential importance for treatment outcome and with a special emphasis on the ethnical diversity of cytochrome P-450 enzyme systems.

Treatment of maternal hyperthyroidism with antithyroid agents and changes in thyrotrophin and thyroxine in the newborn

1981 ◽  
Vol 97 (2) ◽  
pp. 186-195 ◽  
Author(s):  
B.-A. Lamberg ◽  
E. Ikonen ◽  
K. Teramo ◽  
G. Wägar ◽  
K. Österlund ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Cord Blood ◽  
Pregnant Women ◽  
Newborn Infants ◽  
Antithyroid Drug ◽  
Clinical Indication ◽  
Antithyroid Drugs ◽  
Serum Thyroxine ◽  
Antithyroid Agents ◽  
Serum Tsh

Abstract. Eleven pregnant women with concomitant hyperthyroidism were treated with antithyroid drugs. At monthly intervals serum thyroxine (T4) and triiodothyronine (T3) were measured with radioimmunoassay, the Sephadex uptake of radioactive triiodothyronine (T3U) determined and the free T4 and T3 indices calculated (FT4I, FT3I). TSH-binding inhibiting immunoglobulins (TBII) were determined by the radiomembrane assay. Serum TSH and T4 were measured at delivery from cord blood and/or from the newborn infants some days after birth. Serum TSH was significantly elevated in one infant. There was an inadequate post-partal rise in serum T4 concentration in this child and in another who showed only a marginal elevation of TSH. The mothers of these infants were given carbimazole in doses of 30 and 25 mg/day, respectively, at the time of delivery. No significant changes were seen in other infants, the daily doses being 20 mg of carbimazole or less. There was no clinical indication of hypo- or hyperthyroidism in any of the newborn. The TBII were positive in most patients and there was a trend of normalization during treatment. No relationship between the dose of antithyroid drug and the level of TBII could be seen. During treatment the dose was adjusted according to the FT3I values. This seems to be an adequate laboratory test for this purpose.

Does Active Smoking Influence the Second Trimester Biochemical Markers Concentrations?

2017 ◽  
Vol 68 (10) ◽  
pp. 2234-2236
Author(s):  
Dan Navolan ◽  
Florin Birsasteanu ◽  
Adrian Carabineanu ◽  
Octavian Cretu ◽  
Diana Liana Badiu ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Pregnant Women ◽  
Cigarette Smoke ◽  
Chorionic Gonadotropin ◽  
Reference Values ◽  
Biochemical Markers ◽  
Smoking Status ◽  
Active Smoking ◽  
Second Trimester ◽  
Harmful Effects

Cigarette smoke contains over 7000 different substances some of them exerting harmful effects on embryo and pregnant woman. Nowadays 15 % of adult people and around 10-15% of pregnant women smoke. Previous studies showed that cigarette smoke compounds could exert pharmacodinamic effects and influence some of the second trimester biochemical markers concentration. Therefore there is a need to adjust the reference values of second trimester markers depending of the smoker status. The aim of our study was to analyse which of the markers are influenced by smoking and whether the software used to calculate the risk for aneuploidies is able to counterbalance this influence. Alpha-fetoprotein (AFP), chorionic gonadotropin hormone (hCG) and free estriol (uE3) values were measured in second trimester sera of 1242 pregnant women: 1089 non-smokers and 153 smokers. Only hCG second trimester values were influenced by smoking whereas AFP and uE3 values were not. The correction of medians according to the smoking status was able to counterbalance this effect.

Is there a Need for Own Median Calculation in the Second Trimester Biochemical Markers Screening?

2017 ◽  
Vol 68 (5) ◽  
pp. 1070-1072
Author(s):  
Dan Navolan ◽  
Mirela Nicolov ◽  
Simona Vladareanu ◽  
Ioana Ciohat ◽  
Marius Craina ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Biochemical Markers ◽  
Biochemical Marker ◽  
Second Trimester ◽  
Established Method ◽  
Crown Rump Length ◽  
The Difference ◽  
Fetal Aneuploidies ◽  
Singleton Pregnancies

Screening of fetal aneuploidies in early pregnancy is a well-established method in the materno-fetal medicine. The aim of our study was to analyze if the medians recommended by the manufacturers are adequate to perform an accurate screening or if there is a need for own laboratory medians calculation in second trimester biochemical marker screening.Sera were collected between 14 wp and 22 wp from 3374 singleton pregnancies. We analyzed three second trimester biochemical markers (AFP, hCG and free Estriol) concentration in all pregnant women and in a subgroup of pregnant women in which gestational age was determined based on crown-rump length. Our results showed that for all biochemical markers the difference between the manufacturer and the own calculated median was lower than 10% excepting the hCG value in the group of pregnant women in which the gestational age was determined on basis of crown-rump-length. Our results show it is recommended to replace the values of the median for hCG measurement with the own laboratory calculated medians. This does not seem to be necessary in the case of AFP and free Estriol measurement.

Evaluation of plasma free amino acid and carnitine levels in patients with cesarean scar pregnancy

2020 ◽  
Vol 23 ◽  
Author(s):  
Omer Tammo ◽  
Hacer Uyanikoglu ◽  
İsmail Koyuncu
Keyword(s):  
Amino Acid ◽  
Pregnant Women ◽  
Free Amino Acid ◽  
Free Amino ◽  
Plasma Concentrations ◽  
Myometrial Invasion ◽  
Controlled Study ◽  
Control Group ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar

Aim and Objective: This study aimed to explore the plasma free amino acid (FAA) and carnitine levels in pregnant women with cesarean scar pregnancy (CSP), and to compare them with those of healthy pregnant women. Materials and Methods: This prospective and randomized controlled study was conducted in patients admitted to Harran University Medical Faculty Hospital Obstetrics Clinic between January 2018 and January 2019. A total of 60 patients were included in the study, and the patients were divided into two groups: CSP group (n = 30) and healthy pregnant group as the control group (n = 30). The blood samples were taken from the participants between 7 - 12 weeks of gestation. Twentyseven carnitines and their esters and 14 FAAs were analysed by liquid chromatography – mass spectrometry (LC-MS/MS). Results: The mean plasma concentrations of some carnitines, including C2, C5, C5-OH, C5-DC, C6, C8-1, C12, C14, C14- 1, C14-2, C16, C16-1, C18, and C18-1 were significantly higher in CSP group than in the control group. However, other carnitines, including C0, C3, C4, C4-DC, C5-1, C6-DC, C8, C8-DC, C10, C10-1, C18-1-OH, and C18-2 were similar in both groups. The plasma levels of some FAAs, including Methyl Glutaryl, Leu, Met, Phe, Arg, Orn, and Glu values were significantly higher in CSP group than in the control group. However, there was no statistically significance in other FAA levels, including Val, Asa, Tyr, Asp, Ala, Cit, and Gly between the two groups. Additionally, Pearson’s correlation analysis showed that there were significantly positive correlations between many FAA and carnitine values. Conclusion: Since several plasma carnitine and FAA levels were higher in CSP group than in the control group, we think that scar pregnancy increases metabolic need for myometrial invasion. Also, we think that these results may be useful in clinical practice for CSP diagnosis.

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