Relapse risk after Discontinuation of Antidepressants during Pregnancy (R-DAP study)

怀孕期间停用抗抑郁药后复发的风险（R-DAP 研究）

• 批准号: 10569044
• 负责人: Veerle Bergink
• 金额: $ 55.2万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-02 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10569044
• 关键词: Adverse effects; Antidepressive Agents; Anxiety Disorders; Bipolar Disorder; Birth; Child; Conceptions; Decision Making; Depressive disorder; Emotions; Endocrine; Event; Exposure to; Fathers; Female; Fetal Development; Fetus; General Population; Genetic; Genetic Predisposition to Disease; Genetic study; Goals; Health; Immune; Investigation; Life; Long-Term Effects; Mental Depression; Mental Health; Mental disorders; Mood Disorders; Moods; Mothers; Outcome; Outpatients; Perinatal; Pharmaceutical Preparations; Physiology; Population; Postpartum Period; Pregnancy; Pregnant Women; Process; Psychiatric therapeutic procedure; Relapse; Reporting; Residual state; Resources; Risk; Risk Factors; Risk Reduction; Sample Size; Sampling; Schizophrenia; Self-Injurious Behavior; Severities; Siblings; Sleep Deprivation; Suicide; Suicide attempt; Time; Woman; Work; aged; antidepressant effect; genetic information; health of the mother; in utero; interest; maternal depression; men; offspring; perinatal period; peripartum depression; pharmacologic; polygenic risk score; population based; predictive modeling; prenatal exposure; relapse risk; reproductive; secondary outcome; tool; unborn child

Project Summary Over the past decades, the use of antidepressants (ADs) as first-line treatment for both depressive and anxiety disorders has increased exponentially, with females in their reproductive years using ADs twice as often as men. Prior to conception or during pregnancy, approximately 50% of women on ADs (200,000 pregnant women in the US each year) decide to discontinue their medication. While the wish to avoid in utero AD exposure to the fetus is understandable, discontinuation of medication might lead to relapse, which can have a profound negative impact on the health of mother and child. Unfortunately, general information on relapse risks after AD discontinuation cannot be used during pregnancy and the postpartum period given the enormous changes in physiology and emotion. Further, women discontinue AD prior to or during pregnancy regardless of their mood stability, which has an impact on relapse risk. Only three small studies in highly selected populations have investigated relapse risks during pregnancy and not a single study on AD discontinuation during pregnancy has investigated the relapse risk postpartum. This study will quantify the relapse risk during pregnancy and postpartum after AD discontinuation, for the first time, in a large and representative population sample. We will use the unique Danish national longitudinal registers covering medication use since 1995 in the entire female population giving birth aged 15-49 years (N=1,098,137). With our sample size, we will be able to identify both pregnancy specific and non-pregnancy specific risk factors for relapse and timing to relapse. We will determine to which extent the perinatal period is different in terms of relapse risks after AD discontinuation compared to other periods in a woman’s life. In addition, we will explore if women with high genetic susceptibility for mood-disorders are more vulnerable for relapse after AD discontinuation. In our last aim we will determine the long-term effects (up to 24 years) of maternal relapse during pregnancy and the postpartum period on the offspring. We will conduct a sibling comparison, in which we compare the health outcomes in children exposed to maternal relapse to their siblings not exposed to maternal relapse in the perinatal period. We will explore if polygenic risk scores of the children influence the association between their exposure to maternal relapse and their long-term psychiatric outcome, considering in utero exposure to AD medication.

项目摘要 在过去的几十年里，使用抗抑郁药(ADS)作为抑郁症和焦虑症的一线治疗 疾病呈指数级增长，处于生育年龄段的女性使用广告的频率是男性的两倍。 在怀孕前或怀孕期间，约50%的妇女服用ADS(美国 美国)决定停止他们的药物治疗。虽然希望避免在子宫内暴露于AD胎儿 可以理解的是，停药可能会导致复发，这可能会产生深远的负面影响 对母婴健康的影响。不幸的是，AD后复发风险的一般信息 停药不能在怀孕期间和产后使用，因为 生理和情绪。此外，女性在怀孕前或怀孕期间停止服用AD，无论她们的情绪如何 稳定性，这对复发风险有影响。只有三项在高度选择的人群中进行的小规模研究 研究了怀孕期间的复发风险，没有一项关于怀孕期间停止使用AD的研究 调查产后复发风险。 这项研究将量化AD停药后孕期和产后的复发风险， 第一次，在一个大而有代表性的人口样本中。我们将使用独一无二的丹麦民族纵向 自1995年以来在15-49岁分娩的所有女性人口中使用药物的登记 (n=1,098,137)。根据我们的样本大小，我们将能够识别特定于怀孕和非怀孕的 复发的具体风险因素和复发的时机。我们将确定围产期的程度 与女性生活中的其他时期相比，停用AD后的复发风险有所不同。在……里面 此外，我们将探索情绪障碍遗传易感性高的女性是否更容易患上 AD停药后复发。在我们的最后一个目标中，我们将确定长期影响(长达24年) 母亲在怀孕期间和产后对后代的复发。我们将举行一次兄弟会 比较，我们比较母亲复发的儿童与他们的兄弟姐妹的健康结果 在围产期不暴露于母体复发。我们将探讨儿童的多基因风险评分 影响她们接触母亲复发和她们的长期精神结果之间的联系， 考虑在子宫内暴露于AD药物。