Maternal and Infant Effects of Treated and Untreated Depression During Pregnancy

描述（由申请人提供）：本提案是为了响应NIMH关于怀孕和产后妇女心理健康的项目公告，并通过调查怀孕期间抑郁症的流行病学、风险因素和治疗效果来实现该项目的几个目标。10%到15%的女性在怀孕期间会经历某种程度的抑郁，这些女性在分娩后和以后的生活中患抑郁症的风险更高。怀孕期间的母亲抑郁可能对怀孕和新生儿结局产生不利影响，而持续的母亲抑郁已知会对养育子女和家庭功能产生不利影响。为了帮助确定孕妇抑郁症的最佳治疗方案，本研究将分析1994-2003年田纳西州医疗补助计划（TennCare）人口的提供者、药房和医院索赔数据。在研究期间，这个庞大的人口包括田纳西州所有新生儿的一半以上。该研究有效利用现有数据和基础设施，研究治疗和未治疗抑郁症对母婴结局的关系，这将有助于指导未来的临床研究和当前的医疗实践。研究的中心假设是，在怀孕期间，药物治疗对特定的怀孕、围产期和抑郁结果没有可测量的有害影响。为了确定怀孕期间服用抗抑郁药物的妇女是否会增加不良妊娠和围产期结局的发生率，我们将对健康孕妇进行回顾性队列分析，通过暴露于特定抗抑郁药物来评估妊娠和围产期结局。我们将对怀孕前患有抑郁症的妇女进行第二次回顾性队列研究。妇女将被分为暴露于抗抑郁药物或未暴露于抗抑郁药物，我们将在调整抑郁严重程度标记后，通过抗抑郁药物治疗状况量化不良妊娠、围产期和抑郁结局的风险。第二个提出的回顾性队列是一个创新的分析，它将使用非常大的人群中的一个子集来评估怀孕期间治疗抑郁症的相对风险。拟议的分析结果将帮助妇女和她们的医疗保健提供者决定如何处理怀孕期间的抑郁症，并指导未来的研究。了解怀孕期间治疗和不治疗抑郁症的影响对公众健康非常重要，特别是对母亲的健康、胎儿的健康发育和健康母婴关系的发展。

DESCRIPTION (provided by applicant): This proposal is in response to an NIMH program announcement on women's mental health in pregnancy and the postpartum period and addresses several goals of the program by investigating the epidemiology, risk factors, and effects of treatment on depression during pregnancy. Ten to fifteen percent of women experience some degree of depression during pregnancy and these women are at higher risk of depression following childbirth and later in life. Maternal depression during pregnancy may have adverse effect on pregnancy and neonatal outcomes, and on-going maternal depression is known to have adverse effects on parenting and family function. To help determine the best course of treatment for depression among pregnant women, this study will analyze provider, pharmacy, and hospital claims data from the Tennessee Medicaid (TennCare) population from 1994-2003. This large population includes over half of all Tennessee births during the study period. The proposed study makes efficient use of existing data and infrastructure to study the relationship of treated and untreated depression on maternal and infant outcomes, which will help guide both future clinical research and current medical practice. The central hypothesis is that there are no measurable harmful effects of pharmacotherapy for depression during pregnancy with regards to specific pregnancy, perinatal, and depression outcomes. To determine whether women who take antidepressants during pregnancy have increased rates of adverse pregnancy and perinatal outcomes, we will perform a retrospective cohort analysis in otherwise healthy pregnant women to evaluate pregnancy and perinatal outcomes by exposure to specific antidepressant medications. We will perform a second retrospective cohort study of women with recognized depression prior to pregnancy. Women will be classified as exposed or unexposed to antidepressants and we will quantify the risks of adverse pregnancy, perinatal, and depression outcomes by antidepressant treatment status after adjusting for markers of depression severity. The second proposed retrospective cohort is an innovative analysis that will use a subset of the very large population to evaluate the relative risks of treating depression during pregnancy. Results of the proposed analysis will help women and their health care providers decide how to manage depression during pregnancy and guide future research. Understanding the impact of treated and untreated depression during pregnancy is very important to public health, specifically the well being of the mother, healthy fetal development, and the development of a healthy mother-infant relationship.