Comparison of human transplacental transfer of escitalopram, sertraline and paroxetine: an ex vivo cotyledon perfusion study.

INTRODUCTION

Depression is common in pregnant women and the decision to treat must consider potential risk to the fetus. Since data on the transplacental transfer of serotonin reuptake inhibitors (SSRIs) remain sparse, we aimed to characterize and compare the transplacental transfer of three commonly used SSRIs in pregnant women: escitalopram, sertraline and paroxetine.

METHODS

Ex vivo human placental perfusions in dual recirculating configuration were performed for these three antidepressants with and without albumin over 3 h of perfusion. Antidepressants were quantified by liquid chromatography-mass spectrometry (LC-MS) in maternal and fetal compartments.

RESULTS

Our results showed that the three drugs crossed the placental barrier. In presence of albumin, we determined a median [IQR] fetal transfer rate (FTR) of 48.2 % [46.2-49.2] for escitalopram, 43.4 % [32.7-45.2] for paroxetine and 33.2 % for sertraline [30.7-36.9]. Thus, escitalopram crossed the placenta significantly more than sertraline (p = 0.008). Paroxetine had an intermediate placental transfer rate, but this was not statistically different from the other two drugs. Based on fetal transfer rate values, the transplacental transfer of antidepressants seemed to be increased in presence of albumin, but this effect was significant only for sertraline (p = 0.009).

CONCLUSIONS

The present study is the first one that compared the human placental transfer of escitalopram, sertraline and paroxetine, using the same conditions of ex vivo perfusion. Our results are consistent with in vivo data, confirming the relevance of ex vivo placental perfusion for evaluating transplacental transfer, and highlighting the importance of adding albumin to the perfusion medium, particularly for highly protein-bound drugs.