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Sertraline and breastfeeding: review and meta-analysis

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Abstract

We examined the risk-benefit profile of sertraline treatment during breastfeeding, summarized the available literature on sertraline use, presented previously unpublished data, and performed a correlation-based meta-analysis of sertraline serum levels in mother-infant pairs. We conducted a search of PubMed and the National Library of Medicine LactMed database. We performed a meta-analysis to examine correlations between maternal and infant serum sertraline levels in the existing literature and in previously unpublished data. Of 167 available infant sertraline levels, 146 (87.4 %) were below the limit of detection, and the meta-analysis found no significant relationship between maternal and infant sertraline concentrations. Of 150 infant desmethylsertraline levels, 105 (70.0 %) were below the limit of detection. The correlation analysis revealed a significant relationship between maternal and infant desmethylsertraline concentrations, but this metabolite has only a fraction of the activity of sertraline. A significant relationship was also found for the sum of sertraline and desmethylsertraline, which stems primarily from the contribution of desmethylsertraline. Sertraline is a first-line drug for breastfeeding women due to documented low levels of exposure in breastfeeding infants and very few adverse events described in case reports. Based on the current literature, neither routine serum sampling nor genotyping is warranted for breastfeeding mothers taking sertraline and/or their infants. Routine pediatric care is appropriate monitoring for breastfed infants of women who take sertraline monotherapy.

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Authors and Affiliations

  1. Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1000, Chicago, IL, 60611, USA

    Emily Pinheiro, Denada Hoxha & Katherine L. Wisner

  2. Department of Pediatrics, University of Pittsburgh School of Medicine, 3420 Fifth Ave., Pittsburgh, PA, 15213, USA

    Debra L. Bogen

  3. Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA

    Jody D. Ciolino

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  1. Emily Pinheiro
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  2. Debra L. Bogen
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  3. Denada Hoxha
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  4. Jody D. Ciolino
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  5. Katherine L. Wisner
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Correspondence to Emily Pinheiro.

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Pinheiro, E., Bogen, D.L., Hoxha, D. et al. Sertraline and breastfeeding: review and meta-analysis. Arch Womens Ment Health 18, 139–146 (2015). https://doi.org/10.1007/s00737-015-0499-y

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