Effects of Perinatal Depression on PTD and LBW

围产期抑郁对 PTD 和 LBW 的影响

• 批准号: 7082226
• 负责人: Kimberly A Yonkers
• 金额: $ 105.69万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7082226
• 关键词: antidepressants; anxiety disorders; bipolar depression; clinical research; disease /disorder proneness /risk; embryo /fetus drug adverse effect; gestational age; human birth weight; human pregnant subject; interview; longitudinal human study; low birth weight infant human; major depression; medical records; mental disorder diagnosis; premature labor; prenatal growth disorder; questionnaires; women' s health

DESCRIPTION (provided by applicant): Preterm delivery (PTD) and low birth weight (LBW) complicate over 12% of deliveries annually in the U.S. About two-thirds of all infant deaths occur among neonates that are born less than 2500 gms. Studies find that women who have elevated scores on depression screening scales are at increased risk for delivering a preterm or low birth weight infant. Similarly controlled studies of women using antidepressant agents show an increased risk for delivering an infant preterm. Despite this literature, no epidemiological study has examined the effect of a depressive disorder or its pharmacological treatment on adverse perinatal outcomes. We propose to conduct a prospective cohort study to determine whether a depressive disorder increases the risk of preterm delivery (<37 weeks), early preterm delivery (<=34 weeks), low birth weight (<2500 gms) or intrauterine growth retardation (IUGR). We will: (1) use structured interviewing to diagnose depressive disorders during pregnancy rather than relying on depression screening measures; (2) determine the point at which the woman developed the disorder by conducting prospective, longitudinal assessments of psychiatric illness during pregnancy; (3) recruit an ethnically and economically broad based cohort to explore associations among depression and demographic factors; (4) collect information on antidepressant and other medication use to determine whether the illness, or its pharmacological treatment accounts for the effects on birth weight and gestational duration. The study will have at least 85% power to detect associations between depressive illnesses in each trimester of pregnancy and PTD, EPTD, LBW and IUGR. To accomplish this, we will enroll 680 women with current depression, 680 women with a history of depression in the past 5 years, but not currently depressed, and 2040 non-depressed controls. An extensive psychiatric and perinatal risk factor interview will take place at enrollment. Telephone follow up at 22 and 32 weeks gestation, and 3 months postpartum will reevaluate diagnosis, severity of depression, antidepressant use and other risk factors. The independent effect of illness and antidepressants on these outcomes will be evaluated and we will examine whether specific symptoms of depression contribute to poor perinatal outcomes. This study has critical implications. If depression increases the risk of preterm delivery, early preterm delivery, low birth weight or IUGR, clinicians will need to implement even more rigorous efforts to treat it. Further, if we determine antidepressants increase the risk of adverse perinatal outcomes, treatment with psychotherapy rather than antidepressants should be considered when recommending therapeutic options.

描述（由申请人提供）：早产（PTD）和低出生体重（LBW）使美国每年超过12%的分娩复杂化。约三分之二的婴儿死亡发生在出生时体重小于2500克的新生儿中。研究发现，在抑郁筛查量表上得分较高的妇女分娩早产儿或低出生体重儿的风险增加。对使用抗抑郁药物的妇女进行的类似对照研究显示，早产儿的风险增加。尽管有这些文献，但没有流行病学研究探讨抑郁症或其药物治疗对围产期不良结局的影响。我们建议进行一项前瞻性队列研究，以确定抑郁症是否会增加早产（<37周）、早期早产（<=34周）、低出生体重（<2500 g）或宫内发育迟缓（IUGR）的风险。我们将：（1）使用结构化访谈来诊断怀孕期间的抑郁症，而不是依赖于抑郁症筛查措施;（2）通过对怀孕期间的精神疾病进行前瞻性、纵向评估来确定女性发展障碍的时间点;（3）招募一个种族和经济基础广泛的队列，以探索抑郁症和人口因素之间的关联;（4）收集有关抗抑郁药和其他药物使用的信息，以确定疾病或其药物治疗是否对出生体重和妊娠期产生影响。该研究将有至少85%的把握检测妊娠各期抑郁症与PTD、EPTD、LBW和IUGR之间的关联。为了实现这一目标，我们将招募680名目前患有抑郁症的女性，680名过去5年有抑郁症病史但目前没有抑郁症的女性，以及2040名非抑郁症对照组。在入组时将进行广泛的精神病学和围产期风险因素访谈。在妊娠22周和32周以及产后3个月进行电话随访，将重新评估诊断，抑郁症的严重程度，抗抑郁药的使用和其他风险因素。疾病和抗抑郁药对这些结果的独立影响将被评估，我们将研究抑郁症的特定症状是否有助于围产期结局不良。这项研究具有重要意义。如果抑郁症会增加早产、早产、低出生体重或IUGR的风险，临床医生将需要实施更严格的治疗措施。此外，如果我们确定抗抑郁药会增加围产期不良结局的风险，在推荐治疗方案时应考虑心理治疗而不是抗抑郁药。