Maternal exposure to antidepressants and psychiatric outcomes among offspring in a national birth cohort.

我们寻求利用庞大的全国出生队列的资源来解决基本的、新的问题 旨在为临床医生提供妊娠期抑郁症的治疗指导。最新进展 我们对妊娠期选择性5-羟色胺再摄取抑制剂(SSRI)安全性的了解对 人口健康。在美国，大约6%的孕妇使用SSRI，总计超过20万 接触过的后代每年的出生量。由于5-羟色胺(5-羟色胺)在早期大脑发育中起着关键作用， 在此期间，控制5-羟色胺水平可能会产生持久的行为后果。在一个大的国家 在芬兰的出生队列中，跟踪到14岁，我们证明了母亲接触SSRI与 与母亲无关的子代抑郁和其他不良精神后果的风险增加 诊断。然而，在我们对母婴的长期影响的理解上有许多重大差距。 SSRIs和后代精神障碍。这项研究有几个优点，包括特征很好的 出生队列，大样本大小，以及将母亲SSRI使用与后代精神结果联系起来的能力 跨越了二十多年。 本研究的主要目的是解决关于母亲SSRI暴露和 后代的精神结果，包括抑郁和焦虑障碍，自闭症谱系障碍，以及 注意缺陷多动障碍。为此，我们将使用前瞻性出生队列研究设计。 并调查暴露于和未暴露于核辐射的子代在21岁以下的精神后果发生率 SSRIs在子宫内，并利用全面的全国孕产妇数据库的登记联系 抗抑郁药的使用、子女的精神结果、研究评估和其他相关变量。 这些数据几乎可以在所有芬兰居民中获得，他们有权享受全民医疗保险。 具体地说，我们将：1)检查之前观察到的抑郁症风险的急剧上升是否 母亲在青春期早期接触SSRI的后代继续进入老年群体；2)评估，使用 基于研究的采访，子代抑郁是否与产前接触SSRI有关比 在未接触过的母亲的后代中；3)消除与母亲SSRI的歧义使用母亲的贡献 疾病严重程度、家庭负担和出生后母亲的精神病理对子女精神结局的影响；4) 解决母亲接触SSRI后后代结局的易感性因素，包括妊娠 暴露时间、抗抑郁药物特征和后代性别；以及5)评估新生儿 SSRI停药引起的并发症在SSRI和子代结局之间起中介作用。这个 这项研究的发现，与其他小组的研究相结合，有望提供信息--这 目前还不足以帮助临床医生和患者在使用SSRIs时做出更明智的决定 在怀孕期间，可能会减少有害后果，同时还会降低复发的可能性。

We seek to leverage the resources of a large national birth cohort to address essential, novel questions aimed at providing guidance to clinicians on the management of depression during pregnancy. Advances in our knowledge of the safety of selective serotonin reuptake inhibitors (SSRIs) during pregnancy is critical to population health. In the U.S., approximately 6% of pregnant women use SSRIs, amounting to over 200,000 births per year of exposed offspring. Since serotonin (5-HT) plays a key role in early brain development, manipulation of 5-HT levels during this period can have lasting behavioral consequences. In a large national birth cohort in Finland, followed to age 14, we demonstrated that maternal SSRI exposure is associated with an increased risk of offspring depression and other adverse psychiatric outcomes independent of maternal diagnosis. However, there are many significant gaps in our understanding of the long-term effects of maternal SSRIs and offspring psychiatric disorders. The study has several strengths including the well-characterized birth cohort, a large sample size, and the capacity to link maternal SSRI use to offspring psychiatric outcomes spanning more than 2 decades. The main aim of the present study is to address novel questions on maternal SSRI exposure and offspring psychiatric outcomes, including depressive and anxiety disorders, autism spectrum disorders, and attention deficit hyperactivity disorder. For this purpose, we will use a prospective birth cohort study design and investigate the incidence of psychiatric outcomes up to age 21 in offspring exposed and unexposed to SSRIs in utero and capitalize on registry linkages of comprehensive nationwide databases on maternal antidepressant use, offspring psychiatric outcomes, research assessments, and other relevant variables. These data can be acquired in virtually all Finnish residents, who are entitled to universal health insurance. Specifically, we shall: 1) examine whether the sharp rise in risk of depression previously observed among maternal SSRI-exposed offspring in early adolescence continues into older age groups; 2) assess, using a research-based interview, whether offspring depression related to prenatal SSRI exposure is more severe than in offspring of unexposed mothers; 3) disambiguate from maternal SSRI use the contributions of maternal illness severity, familial loading, and postnatal maternal psychopathology on offspring psychiatric outcomes; 4) address vulnerability factors for offspring outcomes following maternal SSRI exposure, including gestational timing of exposure, antidepressant characteristics, and offspring sex; and 5) evaluate whether neonatal complications from SSRI withdrawal mediates associations between SSRIs and offspring outcomes. The findings of this study, in concert with research from other groups, are expected to provide information—which is insufficient at present—to help clinicians and patients make more informed decisions on the use of SSRIs during pregnancy, potentially diminishing harmful consequences while also reducing likelihood of relapse.