Impact of Antenatal Depression, Anxiety, and Stress on Fetal

项目1将侧重于母亲压力、抑郁和焦虑对胎儿和产科的影响 孕期更好地为临床决策提供信息的信息可能会影响超过400，000名妇女， 美国每年。对孕妇在怀孕期间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性。 最近，有报道称“抗抑郁药新生儿戒断”， 注意潜在的致畸作用（例如，腹侧间隔缺损）。可惜 产妇压力、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。关于母亲精神疾病影响的现有文献通常使用单一的 产妇抑郁和焦虑的点评估（主要是在怀孕中期到晚期）。虽然这种 研究表明，胎儿活动、胎心率的改变以及产科出血的增加， 并发症（低出生体重、早产、早产），他们只是猜测 基于横截面评估的机制。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将利用核心项目B中特征鲜明的妇女填补这些空白。康贝特人将以 产妇抑郁和焦虑的影响，在任何情况下，对生物指标的压力（包括急性和 累积）以及这些测量和母体症状与子宫血流、胎儿 活动，胎心率，产科结局，新生儿结局。中心设计允许盲 这些关系的评估-一个增量的进步，在以前的调查。专注于A 临床人群将提供暴露于抗抑郁药的孕妇队列。述调节性 抗抑郁药对我们的结果变量的影响（如果有的话）是未知的。产科盲态评估 和新生儿结局将直接解决最近报道的许多问题。的潜在影响 暴露量（如脐带血中的ng/ml）将纳入数据分析。 项目1产生的新数据将作为项目2的候选表型， 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.