ANTIDEPRESSANT USE DURING PREGNANCY

育龄妇女是重度抑郁症（MDD）的高危人群。 社区样本中MDD的终生风险在女性中为10- 25%，患病率高峰在25-44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是有限的。 美国精神病学协会精神病学治疗研究委员会将妊娠期间的MDD确定为产生治疗建议的优先领域。 除了将暴露于药物的影响与暴露于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更频繁地发生轻微的身体异常，2）如果母体体重增加和婴儿出生体重受到药物暴露的影响，3）重复研究行为致畸性，（4）降低新生儿毒性的管理策略。 获得这些信息是这项赠款申请的动力。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年的前瞻性自然调查，目的是研究SSRI对孕妇的治疗效果。 在研究的前三年，将招募三组母亲，并在出生后24个月内对她们和她们的孩子进行随访。 孕妇：1）接受SSRI治疗的非抑郁症患者，2）未接受SSRI治疗的MDD患者，3）未接受MDD或SSRI治疗的患者。 这项调查的数据将增加我们在怀孕期间做出风险-受益决策的复杂性。

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.