Sertraline use in pregnancy and placental transfer: A pharmacokinetic prospective cohort study.

INTRODUCTION: Depression in pregnancy is common and the use of antidepressants in pregnancy, especially sertraline, is on the rise. Although sertraline is known to cross the placenta, the level of transfer to the foetus is unclear. Thus, we investigated maternal and umbilical cord blood sertraline levels following use in pregnancy. METHODS: We prospectively recruited women taking sertraline during pregnancy, who were undergoing a caesarean section birth (n = 18). Maternal and umbilical cord blood samples were collected at the time of caesarean and sertraline and desmethyl sertraline concentrations measured via liquid chromatography with tandem mass spectrometry. RESULTS: The ratio of umbilical cord to maternal plasma concentrations was calculated to determine placental transfer. Sertraline and desmethyl sertraline concentrations were consistently lower in umbilical cord blood than maternal plasma, with ratios of 0.35 for sertraline and 0.43 for desmethyl sertraline, suggesting incomplete placental transfer. Higher maternal doses and shorter intervals since the last dose correlated with higher foetal exposure. There were three preterm births (16.7%), and one baby with a major congenital abnormality (William's syndrome) among our cohort. Adverse neonatal outcomes were uncommon, with all term infants having Apgar scores > 5 at 1 and 5 min and 4 experiencing respiratory distress. CONCLUSION: Our findings suggest maternal use of sertraline in pregnancy results in moderate placental transfer and, thus, foetal exposure. Umbilical cord blood levels were influenced by maternal dose and timing of administration. These results may assist in shared decision-making for clinicians and patients when considering the initiation or continuation of psychotropic treatment in pregnancy.