Therapy for Prenatal Depression:Maternal & Fetal Effects

描述（由申请人提供）：历史上，一种未经证实的观点认为怀孕是预防抑郁症的保护因素。现在的数据与这一观点大相径庭。大约10-15%的孕妇患有抑郁症，这使她们和她们的孩子面临产后抑郁症的有害影响。此外，新的数据表明，产前抑郁甚至可能在出生前就对孩子产生不利影响。尽管产前抑郁及其负面影响的患病率很高，但很少有对照研究测试了怀孕期间心理治疗的疗效。没有人研究过成功治疗抑郁症对胎儿和新生儿的影响。这项申请是在NIMH R34探索性干预研究机制下提交的，目的是确定产前抑郁症的干预是否能改善女性产前和产后的情绪，并改善胎儿和新生儿的功能。具体来说，在一项研究中，80名抑郁症妇女被随机分配到两种治疗方案中的任何一种，40名精神健康的孕妇，我们假设抑郁症孕妇接受群体版本的人际心理治疗与标准精神病学治疗将导致：(a)改善产前情绪，(b)减少产后抑郁，(c)胎儿和新生儿的神经行为

DESCRIPTION (provided by applicant): Historically, an unsubstantiated view held that pregnancy was a protective factor against depression. Data now dramatically contradict this view. Approximately 10-15% of pregnant women are depressed, which puts them -- and their children ---at risk for the deleterious affects of postpartum depression. Moreover, new data indicate that prenatal depression also may adversely affect the child even before birth. Despite the high prevalence rates of prenatal depression and its negative consequences, few controlled studies have tested the efficacy of psychotherapy during pregnancy. None has examined the effects of successfully treated depression on the fetus and newborn. The goal of this application -- submitted under the NIMH R34 mechanism for exploratory intervention research -- is to determine if an intervention for prenatal depression can enhance women's pre- and postpartum moods and improve fetal and newborn functioning. Specifically, in a study of 80 depressed women randomly assigned to either of two treatment options and 40 psychiatrically-healthy pregnant women, we hypothesize that depressed pregnant women treated with a group version of Interpersonal Psychotherapy versus standard psychiatric care will result in: (a) improved prenatal mood, (b) less postpartum depression and (c) fetal and newborn neurobehavioral profiles similar to healthy women's offspring. In past work we have shown that fetuses of depressed women have altered heart rate responses suggestive of risk for future stress-based psychopathology. Women's mood will be assessed using standard rating scales. Fetal heart rate and movement will be assessed while women undergo a laboratory stressor. Newborn heart rate will be assessed during an orthostatic challenge. This study has the potential to alter the clinical approach to perinatal mood disorders by demonstrating that we can (1) prevent postpartum depression before it occurs and (2) positively influence the child's development by limiting their exposure to women's pre- and postpartum depression.