Optimizing Treatment of Mental Illness during Pregnancy:Improving Infant Outcomes

描述（由申请人提供）：重度抑郁症（MDD）在怀孕期间的患病率为12.7%，14.5%的妇女经历产后抑郁症。虽然MDD很普遍，但只有五分之一的美国人接受了任何指南一致的干预，孕妇的比例甚至低于非孕妇。与匹配的非妊娠女性相比，妊娠女性的门诊治疗和抗抑郁药处方药的降幅明显更大，并且在出生后不会恢复。心理治疗是大多数妇女的首选治疗方法，但并非在所有的实践环境中都可以随时获得，对一些母亲来说也不可行。许多医生避免对孕妇进行药物治疗，因为缺乏专业知识或法医学责任。对于大多数孕妇来说，现实情况是，可获得和可接受的心理健康治疗非常有限。低治疗率与越来越多的证据并存，这些证据表明MDD会增加孕妇和胎儿的风险。GERD与缺乏产前护理、营养不良、吸烟、酗酒和吸毒以及自杀有关。它会增加肥胖的风险， 低出生体重儿和早产。患有抑郁症的孕妇更有可能生下孤僻、易怒、过度哭泣、难以安慰的婴儿。产妇精神疾病的其他严重后果是意外伤害、虐待儿童、忽视和杀害儿童的比率增加。当抑郁母亲的孩子患上抑郁症时，发病更早，病程更严重，与非抑郁母亲的后代相比，更多的医疗和药物滥用问题并存。在怀孕期间暴露于母亲MDD的儿童在16岁时患抑郁症的可能性是没有暴露的儿童的四倍。因此，尽早对精神疾病进行干预，有可能预防父母和家庭的负面后遗症。母亲MDD和多种儿童问题之间的关系是一个连续体，往往开始于怀孕期间。拟议会议的目标是：1）提高认识，围产期精神疾病是一个非常常见和研究不足的临床问题; 2）加强跨学科的沟通和研究合作; 3）专注于优化孕妇的治疗和减少对婴儿的不良后果;和4）为新的研究人员提供培训机会。

DESCRIPTION (provided by applicant): The period prevalence of major depressive disorder (MDD) was 12.7% during pregnancy and a striking 14.5% women experience postpartum depression. Although MDD is prevalent, only 1 in 5 Americans receive any guideline-concordant intervention, and the rate is even lower in pregnant women than non-pregnant women. Women who become pregnant have a significantly greater drop in both outpatient therapy visits and antidepressant prescription claims compared to matched nonpregnant women, and they do not resume after birth. Psychotherapy is the preferred treatment of most women but it is not readily available in all practice settings nor is it feasible for some mothers. Many physicians avoid drug treatment of pregnant women because of lack of expertise or medicolegal liability. For most pregnant women, the reality is that accessible and acceptable mental health treatment is very limited. Low treatment rates are juxtaposed against mounting evidence that MDD increases risk to the pregnant woman and fetus. Gestational MDD is associated with lack of prenatal care, poor nutrition, smoking, alcohol and drug use and suicide. It incurs an increased risk for obesity, low-birth-weight infants and preterm delivery. Pregnant depressed women are more likely to have infants who are withdrawn and irritable, cry excessively and are difficult to console. Other serious sequelae of maternal mental illness are increased rates of accidental injury, child abuse, neglect, and infanticide. When children of depressed mothers develop depression, the onset is earlier, the course is more severe, and more medical and substance abuse problems coexist compared to offspring of non-depressed mothers. Children exposed to maternal MDD during pregnancy are four times more likely than those not exposed to be depressed at age 16 years. Therefore, intervention for psychiatric illnesses as early as possible has potential to prevent negative sequelae for parents and families. The relationship between maternal MDD and multiple childhood problems is a continuum that often begins during pregnancy. The goals of the proposed conference are: 1) increase recognition that perinatal mental illness is a very common and understudied clinical problem; 2) enhance interdisciplinary communication and research collaboration; 3) focus on optimizing treatment for pregnant women and reducing adverse outcomes for infants; and 4) provide training opportunities for new investigators.