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\begin{document}

\title{Psychotropic medication in pregnancy and lactation and early development
of exposed children}



\author[1]{Anna Linda Leutritz}%
\author[1]{Lara van Braam}%
\author[2]{Katharina  Preis }%
\author[1]{Andrea Gehrmann}%
\author[3]{Maike Scherf-Clavel}%
\author[2]{Katrin  Fiedler}%
\author[4]{Stefan Unterecker}%
\author[5]{Sarah Kittel-Schneider}%
\affil[1]{University Hospital of Würzburg}%
\affil[2]{Hospital of the Goethe University Frankfurt}%
\affil[3]{Affiliation not available}%
\affil[4]{Department of Psychiatry, Psychosomatics and Psychotherapy University Hospital of Würzburg}%
\affil[5]{University Hospital of Würzburg }%


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  \date{May 27, 2024}


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\begin{abstract}
Aim There is still only little knowledge about alterations of blood
concentrations of psychotropic drugs during pregnancy, the transfer of
psychotropic drugs into breast-milk and the effects on exposed children.
Methods We investigated changes in concentrations of
psychopharmacological medication during pregnancy and lactation in serum
and breast milk at different time points in a naturalistic sample of 60
mothers and observed the development of the exposed children in the
first 12 months. Results We found a decrease in serum concentrations
from the first to the second trimester of amitriptyline, duloxetine,
escitalopram, quetiapine and sertraline. Citalopram stayed rather stable
during pregnancy, sertraline levels interestingly increased again from
the second to the third trimester. Highest concentration-by-dose-ratios
in breast milk were found for venlafaxine as well as lamotrigine, lowest
for quetiapine and clomipramine. Similarly, clomipramine and quetiapine
showed lowest milk/serum-penetration-ratios. Regarding the birth outcome
measures in children we found no significant differences between in
utero exposed compared to non-exposed new-borns. There were no
significant differences in the development in the first 12 months.
Conclusion Psychotropic medication in the peripartum needs a balancing
of risks and benefits and a continuous therapeutic drug monitoring (TDM)
can be a guidance for clinicians to monitor drug alteration patterns,
which are likely to occur due to physiological pregnancy-associated
changes in pharmacokinetics. Accordingly, TDM can optimize a medication
in pregnancy and lactation with the lowest but effective dose.%
\end{abstract}%



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