ANTIDEPRESSANT USE DURING PREGNANCY

育龄妇女患严重抑郁障碍的风险很高。社区样本中MDD的终生风险在女性中从10%到25%不等，流行高峰在25岁到44岁之间。尽管有这些事实，指导妇女和医生考虑在怀孕期间使用抗抑郁药的信息有限。美国精神病学协会精神病学治疗研究委员会将妊娠期MDD确定为生成治疗建议的优先领域。除了将接触药物的影响与接触MDD的影响分开之外，工作组还确定了迫切需要数据的领域：1)暴露于药物的婴儿是否以更高的频率发生轻微的身体异常，2)母亲体重增加和婴儿出生体重是否因药物暴露而受损，3)重复解决行为致畸的唯一研究，以及4)减少新生儿毒性的管理策略。获得这些信息是这次拨款申请的动力。有待研究的抗抑郁药是5-羟色胺特异性再摄取抑制剂(SSRI)，因为这些药物已成为MDD的一线治疗药物。这项研究是一项为期5年的前瞻性、自然主义的研究，旨在探讨SSRI对孕妇的治疗效果。在研究的前三年，将招募三组母亲，她们和她们的孩子将在出生后24个月内接受跟踪调查。孕妇：1)接受SSRI治疗的非抑郁患者，2)患有MDD的不服用SSRI的孕妇，3)不接受MDD或SSRI治疗的孕妇。这项调查的数据将增加我们在怀孕期间做出风险-收益决定的复杂性。

Women of childbearing age are at high risk for major depressive disorder (MDD). The lifetime risk for MDD in community samples has varied from 10-25 percent for women, with peak prevalence between 25-44 years of age. Despite these facts, information to guide women and physicians through a consideration of antidepressant use during pregnancy is limited. The American Psychiatric Association Committee on Research on Psychiatric Treatments identified MDD during pregnancy as a priority area for generation of treatment recommendations. In addition to separation of the effects of exposure to drug from exposure to MDD less than the work group identified areas in which data are urgently needed: 1) whether minor physical anomalies occur with greater frequency in drug-exposed infants, 2) if maternal weight gain and infant birth weight are compromised by drug exposure, 3) replication of the sole study which addresses behavioral teratogenicity, and 4) management strategies to reduce neonatal toxicity. Obtaining this information is the impetus for this grant application. The antidepressants to be investigated are the serotonin specific reuptake inhibitors (SSRI), because these agents have become first-line treatments for MDD. The study is a 5-year prospective, naturalistic investigation of the effects of treatment of pregnant women with SSRI. Three groups of mothers will be recruited over the first three years of the study and they and their children will be followed for 24 months post-birth. The pregnant women: 1) treated with an SSRI who are nondepressed, 2) with MDD who do not take SSRI, and 3) without MDD or SSRI treatment. Data from this investigation will increase our sophistication in making risk-benefit decisions during pregnancy.