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SSRIs during breastfeeding: spotlight on milk-to-plasma ratio

Summary

Objective: To investigate the usefulness of the milk-to-plasma (M/P) ratio for assessing the risks for the breastfed infant associated with the maternal use of SSRIs.

Data sources: Medline, Toxnet, Embase, Current Contents, and PsycInfo indexed articles from 1980 to September 2006.

Study selection and data extraction: All studies reporting the M/P ratio in mothers taking SSRIs while breastfeeding or studies which such an information could be calculated from data reported in the article.

Data synthesis: Higher M/P ratios were rarely associated with a clinically significant impact on the babies during the early phases of breastfeeding.

Conclusions: So far no evidence-based information seems to support the hypothesis that SSRIs characterized by a M/P ratio <1.0 should be preferred. Hence, physicians should consider different parameters when attempting to choose the safest SSRI for the breastfeeding woman. These parameters might be represented by the number of well-documented published adverse event reports and the tendency of each SSRI of inducing in the infants serum concentrations that are elevated above 10% of average maternal serum levels. In any case, if the mother wishes to breastfeed her infant while taking a SSRI, the baby should be closely monitored in order to promptly detect any iatrogenic event.

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Gentile, S., Rossi, A. & Bellantuono, C. SSRIs during breastfeeding: spotlight on milk-to-plasma ratio. Arch Womens Ment Health 10, 39–51 (2007). https://doi.org/10.1007/s00737-007-0173-0

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  • Keywords: Breastfeeding; lactation; milk/plasma ratio; safety; SSRIs.