Impact of Antenatal Depression, Anxiety, and Stress on Fetal

项目1将侧重于母体压力、抑郁和焦虑对胎儿和产科的影响 在怀孕期间。更好地为临床决定提供信息的信息可能会影响英国的40万名女性 美国每年一次。孕期母亲抑郁和焦虑的治疗仍在继续 激发激烈的辩论，强调抗抑郁药物的生殖安全。 最近，有报道称“新生儿停用抗抑郁药”，并有新的 注意潜在的致畸作用(如腹侧间隔缺陷)。不幸的是， 母亲的压力、抑郁和焦虑对胎儿和产科结局的潜在影响很少。 包括在这些报告中。现有的关于母亲精神疾病影响的文献通常使用单一的 对母亲抑郁和焦虑的点数评估(主要是在怀孕中后期)。尽管如此， 研究表明，胎儿活动、胎心率的改变以及产科疾病的增加。 并发症(低出生体重、早产、早产)，他们只是猜测 基于横断面评估的机制。同样，这些调查也未能说明 其他可能影响结果的暴露(药物、烟草等)。 项目1将利用核心B中性格良好的女性填补这些空白。我们将确定 在任何情况下，母亲抑郁和焦虑对应激的生物学指标(急性和非急性)的影响 累积)以及这些测量和产妇症状与子宫血流量、胎儿 活跃度、胎心率、产科结局、新生儿结局。中心设计允许盲人 对这些关系的评估--在以往调查的基础上逐步推进。重点放在一个 临床人群将提供一组接触抗抑郁药物的孕妇。调整性 抗抑郁药对我们的结果变量的影响，如果有的话，是未知的。产科盲目评估 新生儿结局将直接解决最近报告的许多问题。潜在的影响 数据分析将包括暴露量(例如脐带血中的毫微克/毫升)。 从项目1产生的新数据将作为项目2的候选表型，并附加 项目3中婴儿结局的潜在调节因素。

Project 1 will focus on the fetal and obstetrical consequences of maternal stress, depression, and anxiety during pregnancy. Information that better informs the clinical decision potentially affects >400,000 women in the United States annually. The treatment of maternal depression and anxiety during pregnancy continues to stimulate vigorous debate with the emphasis on the reproductive safety of antidepressant medications. Recently, there have been reports of purported "antidepressant neonatal withdrawal", and a renewed attention with respect to potential teratogenic effects (e.g. ventral septal defects). Unfortunately, the potential impact of maternal stress, depression, and anxiety on the fetus and obstetrical outcome is seldom included in these reports. The extant literature on the impact of maternal mental illness typically uses single point assessments (predominantly in mid to late pregnancy) of maternal depression and anxiety. While such studies have demonstrated alterations in fetal activity, fetal heart rate, and an increase in obstetrical complications (low birth weight, preterm labor, preterm delivery), they have only speculated about the mechanisms based on cross sectional assessment. Similarly, these investigations have failed to account for other exposures that may influence outcome (medications, tobacco, etc). Project 1 will fill these gaps utilizing the well characterized women from Core B. We will determine the impact of maternal depression and anxiety, in any, on biological indices of stress (both acute and cumulative) and the relationship of these measures and maternal symptoms with uterine blood flow, fetal activity, fetal heart rate, obstetrical outcome, neonatal outcome. The center design permits blinded assessments of these relationships - an incremental advance over previous investigations. The focus on a clinical population will provide a cohort of pregnant women with antidepressant exposure. The modulatory effects, if any, of antidepressants on our outcome variables are unknown. Blinded assessment of obstetrical and neonatal outcome will directly address many of the concerns recently reported. The potential impact of exposure (e.g. ng/ml in cord blood) will be included in data analysis. The novel data generated from Project 1 will serve as candidate phenotypes for Project 2, and additional potential moderators of infant outcome in Project 3.