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Although citalopram\/escitalopram is the second most frequently prescribed antidepressant for pregnant people, information about its pharmacokinetics in pregnancy is limited. We investigated plasma <jats:italic>(S)<\/jats:italic>\u2010citalopram concentration to dose (C\/D) ratios across pregnancy and postpartum and the effect of pharmacogenetics on its elimination. This prospective observational cohort study enrolled 30 participants with a singleton pregnancy who chose to continue citalopram\/escitalopram during pregnancy for a prior diagnosis of major depression. Monthly blood samples were obtained 24\u2009hours post\u2010dose across pregnancy and twice postpartum for measurement of plasma citalopram, desmethylcitalopram, and didesmethylcitalopram enantiomer concentrations. Compared with the 36\u2010week reference, <jats:italic>(S)<\/jats:italic>\u2010citalopram C\/D ratios were not significantly different throughout pregnancy. However, the mean <jats:italic>(S)<\/jats:italic>\u2010citalopram C\/D ratio was elevated by 63% (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) 6 to 8\u2009weeks after delivery before it decreased to a mean C\/D ratio in the later post\u2010birth period that was marginally different than at 36\u2009weeks (1.20\u2009\u00b1\u20090.64 vs. 0.92\u2009\u00b1\u20090.46, respectively; <jats:italic>P<\/jats:italic>\u2009=\u20090.06). Analyzing the results by cytochrome P 450 (CYP) 2C19 phenotype, the mean late postpartum <jats:italic>(S)<\/jats:italic>\u2010citalopram concentration to dose ratio in intermediate metabolizers was approximately twice that in extensive, rapid, or ultrarapid metabolizers. However, at the 36\u2010week reference point, the mean concentration to dose ratio in pregnant CYP2C19 intermediate metabolizers was 35.7% lower than the distant postpartum ratio, while the ratios in extensive and rapid\/ultrarapid metabolizers were 15.4% and 18.5% lower, respectively. Without dose adjustment, people with intermediate or poor CYP2C19 activity may be at risk for subtherapeutic <jats:italic>S\u2010<\/jats:italic>citalopram concentrations during pregnancy.<\/jats:p>","DOI":"10.1002\/cpt.3642","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T07:39:38Z","timestamp":1742283578000},"page":"106-117","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Changes in <i>S<\/i>\u2010Citalopram Plasma Concentrations Across Pregnancy and Postpartum"],"prefix":"10.1002","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7186-1877","authenticated-orcid":false,"given":"Catherine S.","family":"Stika","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Avram","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3993-966X","authenticated-orcid":false,"suffix":"Jr.","given":"Alfred L.","family":"George","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Yang","sequence":"additional","affiliation":[{"name":"AYANALYTICS LLC  Westmont Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jody D.","family":"Ciolino","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyunyoung","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Industrial and Molecular Pharmaceutics Purdue University  West Lafayette Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raman","family":"Venkataramanan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences University of Pittsburgh School of Pharmacy  Pittsburgh Pennsylvania USA"},{"name":"Department of Pathology University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2169-0712","authenticated-orcid":false,"given":"Steve N.","family":"Caritis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences University of Pittsburgh, Magee\u2010Womens Hospital  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4076-469X","authenticated-orcid":false,"given":"Maged M.","family":"Costantine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Ohio State University Wexner Medical Center  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine L.","family":"Wisner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences and Pediatrics, Developing Brain Institute Children's National Hospital, George Washington University School of Medicine and Health Sciences  Washington, D.C. USA"},{"name":"Department of Obstetrics and Gynecology George Washington University School of Medicine and Health Sciences  Washington, D.C. USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"e_1_2_11_1_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.0069"},{"key":"e_1_2_11_2_1","unstructured":"Trost S.B.J. Chandra G. Njie F. Berry J. Harvey A.&Goodman D.A.Pregnancy\u2010related deaths: data from Maternal Mortality Review Committees in 38 U.S. States 2020(2024). Centers for Disease Control and Prevention U.S. Department of Health and Human Services; <https:\/\/www.cdc.gov\/maternal\u2010mortality\/media\/pdfs\/Pregnancy\u2010Related\u2010Deaths\u2010Data\u2010MMRCs\u20102017\u20102019\u2010H.pdf>. 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Forest Laboratories Ireland Ltd. <https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/1998\/20822lbl.pdf> Accessed July 24 2024."},{"key":"e_1_2_11_13_1","unstructured":"LEXAPRO (escitalopram oxalate) labeling.Approval 2002. Most recent revision 2024. 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