SSRI Exposure and Ventricular Development from Bench to Bedside: A Prospective Study to Determine if Maternal Depression Treatment Impacts Offspring Cardiac Development

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ABSTRACT The broad goal of this translational study is to determine if maternal depression treatment affects ventricular development through comprehensive echocardiography measurements immediately after birth and over time. The decision to medically treat maternal depression is challenging and includes careful consideration of the risks versus benefits. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants currently prescribed to 10-13% of pregnant women. Interpersonal psychotherapy (IPT) is an alternative non-pharmacologic treatment that has shown efficacy in mild to severe depression. Treatment of maternal depression is not only critical for the health of the mother and fetus but may impact overall health as research has shown that a deleterious intrauterine environment can predispose individuals to cardiovascular disease. To date, we have demonstrated both short- and long-term effects from SSRI exposure on ventricular size and cardiac function in mice and zebrafish where maternal depression is eliminated as a contributing factor. Epidemiologic reports continue to be conflicting if SSRIs influence cardiac development and maternal depression remains a confounding factor. Thus, it is critical to determine if these ventricular findings after SSRI exposure in animal models translate to humans and if similar findings are noted with non-pharmacologic treatment for maternal depression. To address these issues, a collaborative team of experts in pediatrics (neonatal hemodynamics, cardiology, and cardiac critical care) and psychiatry will recruit mothers without depression and with maternal depression treated with SSRIs or IPT and their offspring. We will apply advanced echocardiography techniques which have been validated in the newborn and pediatric populations to pursue two specific aims: (1) Measure the impact of maternal depression and its treatment on offspring ventricular size immediately after birth, at 1 week, and at 1 year of age; and (2) Quantify the impact of maternal depression and its treatment on offspring ventricular function following birth, at 1 week, and at 1 year of age. Because heart size and ventricular function are important predictors of outcomes in many adult and pediatric diseases, this study will provide important answers to a timely, highly-relevant clinical question.