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计划公告，并通过调查流行病学，风险因素和治疗对怀孕期间抑郁症的影响来解决该计划的几个目标。10%至15%的妇女在怀孕期间经历过某种程度的抑郁症，这些妇女在分娩后和以后的生活中患抑郁症的风险更高。母亲在怀孕期间的抑郁可能对怀孕和新生儿的结果产生不利影响，并且已知持续的母亲抑郁对养育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（TennCare）人群的提供者、药房和医院索赔数据。这个庞大的人口包括在研究期间所有田纳西州出生的一半以上。这项研究有效地利用了现有的数据和基础设施来研究治疗和未治疗的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。中心假设是，没有可测量的有害影响，药物治疗抑郁症在怀孕期间就特定的怀孕，围产期，抑郁症的结果。为了确定在妊娠期间服用抗抑郁药的女性是否会增加不良妊娠和围产期结局的发生率，我们将对其他健康孕妇进行回顾性队列分析，以评估暴露于特定抗抑郁药物的妊娠和围产期结局。我们将进行第二项回顾性队列研究，研究对象是妊娠前患有抑郁症的女性。妇女将被分类为暴露或未暴露于抗抑郁药，我们将量化不良妊娠，围产期和抑郁症的风险结果抗抑郁治疗状态后，调整抑郁症的严重程度标志物。第二个建议的回顾性队列是一个创新的分析，将使用一个非常大的人群的子集，以评估在怀孕期间治疗抑郁症的相对风险。拟议分析的结果将帮助妇女及其医疗保健提供者决定如何管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未治疗抑郁症的影响对公共卫生非常重要，特别是母亲的健康，健康的胎儿发育以及健康的母婴关系的发展。

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.