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Comparing the Effects of Prenatal Depression and its Treatment on Developmental Outcomes of the Offspring

比较产前抑郁症及其治疗对后代发育结果的影响

基本信息

批准号：
10120323
负责人：
Lyndsay Ammon Avalos
金额：
$ 67.6万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-25 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10120323
关键词：
5 year old 8 year old Address Age Animal Model Area Attention deficit hyperactivity disorder Behavior Disorders Behavioral Birth Brain Brain imaging California Categories Child Childhood Clinical Code Cognition Disorders Cognitive Cohort Studies Communication Communication impairment DSM-V Depression screen Development Developmental Delay Disorders Diagnosis Diagnostic and Statistical Manual of Mental Disorders Early Intervention Electronic Health Record Epidemiology Fathers Fetal Development Fetus Health High Prevalence Hospitals Human Impairment Infant Intellectual functioning disability Interview Knowledge Link Literature Long-Term Effects Measures Medical Records Mental Depression Methodology Monitor Mothers Motor Neurodevelopmental Disorder Neurodevelopmental Impairment Outcome Parents Patients Persons Pharmacological Treatment Population Postpartum Depression Postpartum Period Pregnancy Pregnant Women Prenatal care Prevalence Problem Solving Process Psychotherapy Public Health Questionnaires Recording of previous events Research Risk Risk Factors Sampling Selective Serotonin Reuptake Inhibitor Services Severities Structure Testing Time Woman antepartum depression autism spectrum disorder base boys clinical Diagnosis cohort design emotional behavior epidemiology study fetal girls imaging study instrument motor disorder motor impairment offspring peripartum depression prenatal prenatal testing primary outcome psychologic public health relevance recruit screening screening program secondary analysis sex skills social treatment effect

项目摘要

ABSTRACT The risk associated with both untreated depression and selective serotonin reuptake inhibitors (SSRIs) treatment has presented a significant dilemma to the 20% of pregnant women suffering from prenatal depression and their clinicians. Both prenatal depression and SSRIs have been found to adversely impact fetal brain development. However, the limited epidemiologic research on neurodevelopmental outcomes of the offspring suffers severe methodological limitations and thus, the literature is inconclusive. The proposed study addresses these methodological limitations and leverages Kaiser Permanente Northern California’s (KPNC’s) unique universal perinatal depression screening program to assemble a longitudinal birth cohort of >320,000 children from 0 to 8 years of age born between 2013-2020. As part of standard prenatal care, women are screened for depression twice during pregnancy (at the first prenatal visit and 26-28 weeks) providing a large cohort of women with depression and its severity measures throughout pregnancy. In addition, KPNC’s universal childhood developmental screening program provides systematic screening for neurodevelopmental disorders. The primary outcomes will be six neurodevelopmental disorder diagnoses defined in the DSM 5: intellectual disability, global developmental delay, motor disorders, communication disorder, autism spectrum disorder, and attention-deficit/hyperactivity disorder (ADHD); corresponding diagnosis codes will be ascertained from KPNC’s electronic health records (EHR) and supplemented through linkage to California’s Department of Developmental Services. We will use KPNC EHRs to ascertain information on important confounders and link to the father’s medical records to ascertain information on psychiatric history. We will test the hypothesis that the underlying prenatal depression and SSRIs are independent risk factors for adverse neurodevelopmental outcomes and may differ by infant sex. We will evaluate the effect of untreated prenatal depression, compared to no prenatal depression on the six neurodevelopmental outcomes of the offspring, after adjusting for confounders. We will also assess the effects of treatment with SSRIs during pregnancy on neurodevelopmental outcomes of the offspring compared to both untreated prenatal depression and treatment with psychotherapy only, while taking into account depression severity and other confounders. Finally, to examine their impact on less severe neurodevelopmental outcomes we will recruit a subsample of 2,000 5- year old children (500 randomly chosen from each of four exposure categories: no prenatal depression, untreated prenatal depression, treatment with SSRIs, treatment with psychotherapy only) to ascertain information through parent interview on neurodevelopmental outcomes that may not meet the criteria of a clinical diagnosis, but may suggest a need to monitor and/or provide early interventions. Findings from this study will have significant public health and clinical implications by providing information that can be immediately used by pregnant women and clinicians making treatment decisions.

摘要