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Placental Transfer of Antidepressant Medications: Implications for Postnatal Adaptation Syndrome

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Abstract

Seven to thirteen percent of women are either prescribed or taking (depending on the study) an antidepressant during pregnancy. Because antidepressants freely cross into the intrauterine environment, we aim to summarize the current findings on placental transfer of antidepressants. Although generally low risk, antidepressants have been associated with postnatal adaptation syndrome (PNAS). Specifically, we explore whether the antidepressants most closely associated with PNAS (paroxetine, fluoxetine, venlafaxine) cross the placenta to a greater extent than other antidepressants. We review research on antidepressants in the context of placental anatomy, placental transport mechanisms, placental metabolism, pharmacokinetics, as well as non-placental maternal and fetal factors. This provides insight into the complexity involved in understanding how placental transfer of antidepressants may relate to adverse perinatal outcomes. Ultimately, from this data there is no pattern in which PNAS is related to placental transfer of antidepressant medications. In general, there is large interindividual variability for each type of antidepressant. To make the most clinically informed decisions about the use of antidepressants in pregnancy, studies that link maternal, placental and fetal genetic polymorphisms, placental transfer rates and infant outcomes are needed.

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Acknowledgments

No authors have any conflicts of interest. This review was funded by National Institute of Mental Health Grant K23 MH092399 (principal investigator Deborah Kim) and funded by National Institute of Mental Health Grant P50 MH099910 (principal investigator C. Neill Epperson).

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Authors and Affiliations

  1. Department of Psychiatry, Penn Center for Women’s Behavioral Wellness, Perelman School of Medicine at the University of Pennsylvania, 3535 Market St., 3rd Floor, Philadelphia, PA, 19104, USA

    Grace Ewing, Yekaterina Tatarchuk, Dina Appleby & Deborah Kim

  2. Division of Maternal Fetal Medicine Hospital, University of Pennsylvania, 3400 Spruce St., 2000 Courtyard, Philadelphia, PA, 19104, USA

    Nadav Schwartz

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  1. Grace Ewing
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  2. Yekaterina Tatarchuk
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Correspondence to Grace Ewing.

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Ewing, G., Tatarchuk, Y., Appleby, D. et al. Placental Transfer of Antidepressant Medications: Implications for Postnatal Adaptation Syndrome. Clin Pharmacokinet 54, 359–370 (2015). https://doi.org/10.1007/s40262-014-0233-3

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