ANTIDEPRESSANT USE DURING PREGNANCY

育龄妇女患重度抑郁症（MDD）的风险很高。在社区样本中，女性患重度抑郁症的终生风险从10- 25%不等，发病率在25-44岁之间达到高峰。尽管如此，指导妇女和医生在怀孕期间考虑使用抗抑郁药的信息还是有限的。美国精神病学协会精神病学治疗研究委员会确定怀孕期间重度抑郁症是产生治疗建议的优先领域。除了将药物暴露的影响与MDD暴露的影响分离之外，工作组还确定了急需数据的领域：1)药物暴露婴儿是否更频繁地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受到药物暴露的损害，3)研究行为致畸性的唯一研究的复制，以及4)减少新生儿毒性的管理策略。获得这些信息是这项资助申请的动力。要研究的抗抑郁药是血清素特异性再摄取抑制剂（SSRI），因为这些药物已经成为重度抑郁症的一线治疗药物。该研究是一项为期5年的前瞻性、自然的调查，目的是研究使用SSRI治疗孕妇的效果。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的24个月里接受跟踪调查。孕妇：1)接受SSRI治疗但无抑郁；2)患有重度抑郁症但不服用SSRI； 3)未接受重度抑郁症或SSRI治疗。这项调查的数据将增加我们在怀孕期间做出风险-利益决定的复杂性。

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.