Review ArticleTherapeutic Drug Monitoring in PregnancyMatsui, Doreen M. MD, FRCPAuthor Information Department of Pediatrics and Medicine, Children's Hospital, London Health Sciences Centre, Child Health Research Institute, University of Western Ontario, London, Canada. Correspondence: Doreen M. Matsui, MD, FRCP, Department of Pediatrics and Medicine, Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada N6A 5W9 (e-mail: [email protected]). The author declares no conflicts of interest. Received August 5, 2011 Accepted May 25, 2012 Therapeutic Drug Monitoring: October 2012 - Volume 34 - Issue 5 - p 507-511 doi: 10.1097/FTD.0b013e318261c372 Buy Metrics Abstract Therapeutic drug monitoring (TDM) is commonly recommended to optimize drug dosing regimens of various medications. It has been proposed to guide therapy in pregnant women, in whom physiological changes may lead to altered pharmacokinetics resulting in difficulty in predicting the appropriate drug dosage. Ideally, TDM may play a role in enhancing the effectiveness of treatment while minimizing toxicity of both the mother and fetus. Monitoring of drug levels may also be helpful in assessing adherence to prescribed therapy in selected cases. Limitations exist as therapeutic ranges have only been defined for a limited number of drugs and are based on data obtained in nonpregnant patients. TDM has been suggested for anticonvulsants, antidepressants, and antiretroviral drugs, based on pharmacokinetic studies that have shown reduced drug concentrations. However, there is only relatively limited (and sometimes inconsistent) information regarding the clinical impact of these pharmacokinetic changes during pregnancy and the effect of subsequent dose adjustments. Further studies are required to determine whether implementation of TDM during pregnancy improves outcome and is associated with any benefit beyond that achieved by clinical judgment alone. The cost effectiveness of TDM programs during pregnancy also remains to be examined. © 2012 Lippincott Williams & Wilkins, Inc.