Article date: May 2008
By: Irwin Law, Kenneth F. Ilett, L. Peter Hackett, Madhu Page‐Sharp, Francesca Baiwog, Servina Gomorrai, Ivo Mueller, Harin A. Karunajeewa, Timothy M. E. Davis, in Volume 65, Issue 5, pages 674-679
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
AIMS
To investigate the transfer of chloroquine and its major bioactive metabolite desethylchloroquine across the placenta and into breast milk.
METHODS
In Papua New Guinea, chloroquine (CQ; 25 mg base kg−1) is recommended for prophylaxis of malaria during pregnancy, and at the Alexishafen Health Centre women are routinely prescribed CQ at the time of delivery. Fetal‐cord and maternal serum samples were collected at delivery (n = 19) and milk samples were collected from day 3 to day 17–21 after delivery (n = 16). CQ and its primary active metabolite desethylchloroquine (DECQ) were quantified by high‐performance liquid chromatography. For both CQ and DECQ cord/maternal ratios (C/M) were calculated to characterize placental transfer, and infant exposure via milk was estimated by standard methods.
RESULTS
The median (interquartile range) C/M was 1.1 (0.9, 1.6) for CQ and 1.2 (0.5, 1.8) for DECQ. The average concentration in milk over the time of sampling was 167 μg l−1 (27, 340) for CQ and 54 μg l−1 (22, 106) for DECQ. Estimated absolute and relative infant doses were 34 μg kg−1 day−1 (7, 50) and 15 μg kg−1 day−1 (4, 26), and 2.3% (0.5, 3.6) and 1.0% (0.4, 2.0) for CQ and DECQ (as CQ equivalents), respectively.
CONCLUSION
Infant exposure to CQ and DECQ during pregnancy will be similar to that in the maternal circulation, and dependent on maternal dose and frequency. The median CQ + DECQ relative infant dose of 3.2% (as CQ equivalents) was low, confirming that use of CQ during lactation is compatible with breastfeeding.
DOI: 10.1111/j.1365-2125.2008.03111.x
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