Antidepressant medications like fluvoxamine are sometimes prescribed to pregnant and breastfeeding women to manage mental health conditions like depression and anxiety. Understanding the safety and potential risks associated with these medications is crucial to ensure that pregnant and postpartum women receive appropriate treatment for their mental health needs.
In a recent Frontiers in Psychiatry publication, the authors share the results from a case study conducted within the ConcePTION project, of two women and their infants, that provide insights into the safety of using fluvoxamine, a common antidepressant (SSRI), during pregnancy and breastfeeding. The study found that fluvoxamine exhibited limited transfer to the foetus and in human milk.
The authors address a critical issue in maternal and infant healthcare, helping to balance the benefits of mental health treatment for mothers with the safety of their infants during pregnancy and breastfeeding. It underscores the importance of evidence-based decision-making in healthcare, especially in situations involving vulnerable populations like pregnant and breastfeeding women and their babies.
The researchers looked at how much of a medication called fluvoxamine gets from a pregnant woman’s bloodstream to her baby through the umbilical cord, referred to as cord-to-plasma concentration ratio. The cord-to-plasma concentration ratio, assessed in two women, ranged from 0.48 to 0.62, consistent with prior research. According to them, this evidence supports a low risk of exposure for breastfed infants. They also found that the levels of fluvoxamine in a mother’s blood were higher than in her breast milk, which means there’s a low chance that breastfed babies will be exposed to a lot of the medication.
The Relative Infant Dose calculations in this study provide valuable information about the level of exposure infants may experience when their mothers take fluvoxamine. This information is vital for assessing the risk of adverse effects in breastfed infants and making informed decisions about medication use during breastfeeding.
In the two case studies presented by the authors, the relative infant doses, calculated at 1- and 4-weeks post-partum, consistently remained below 1%. And interestingly, there was more of the medication in the hindmilk (the milk that comes later in a breastfeeding session) compared to the foremilk (the milk at the beginning of a session). This means that even though there’s a tiny amount of the medication in breast milk, it’s a bit more concentrated in the milk that comes later when breastfeeding.
Only one of the infants was breastfed. This child displayed no adverse effects associated with maternal fluvoxamine treatment and exhibited normal neurodevelopment during follow-ups. These findings align with previous case reports, offering reassurance regarding the safety of fluvoxamine use during breastfeeding.
“Pregnant and breastfeeding women often face decisions about medicine use for mental health conditions. Postpartum depression or PTSD from traumatic deliveries can be one cause. But pregnant and breastfeeding women also struggle with depression and anxiety to the same extent as everyone else. With this study, we provide evidence that will help women and their healthcare providers to make more informed decisions on the safety of one of the most common antidepressants,” says Anaëlle Monfort, a PhD student at the University of Montreal, and one of the researchers involved in the study.
By Anna Holm Bodin
Monfort A, Cardoso E, Eap CB, Fischer Fumeaux CJ, Graz MB, Morisod Harari M, Weisskopf E, Gandia P, Allegaert K, Nordeng H, Hascoët J-M, Claris O, Epiney M, Csajka C, Guidi M, Ferreira E and Panchaud A (2023) Infant exposure to Fluvoxamine through placenta and human milk: a case series – A contribution from the ConcePTION project. Frontiers in Psychiatry 14:1167870. doi: 10.3389/fpsyt.2023.1167870