Genetic and physiological factors predisposing to individual selective serotonine reuptake inhibitors exposure during pregnancy and breast feeding

Abstract

Anxiety and depression are very common during pregnancy. Post-partum period may frequently be complicated by more pro found depression due to hormonal changes, which may lead to fatal consequences for both — the mother and the child. The most commonly prescribed group of drugs for ambulatory patient care is the group of selective serotonine reuptake inhibitors (SSRIs). Absence of clinical trials where pregnant or breast-feeding women were among the participants has led to the situation when we can rule out effectiveness and safety of this drug class for pregnant and breastfeeding women based only on real-life studies. Current know ledge let us conclude that all individual group representatives have comparable efficacy and safety profile. The choice of a single agent to use may be difficult. In our paper we analyzed genetic and non-genetic factors, that may be important for individual pharmacokinetics of various SSRIs in order to reveal the most relevant for each group representative, and to determine those drugs with the most stable pharmacokinetic parameters in pregnancy. We also tried to define the drugs that may theoretically be more clinically reliable and safe for the fetus and the newborn. We considered such factors as expected changes in drug concentration during various periods in pregnancy, probable impact of pre-existing pharmacogenetic factors of individual drug exposure, potential for drug-drug interactions, and current knowledge about the extent of drug distribution in the blood of the newborns during breastfeeding