Effects of Perinatal Depression on PTD and LBW

描述(申请人提供)：早产(PTD)和低出生体重(LBW)使美国每年超过12%的分娩变得复杂。大约三分之二的婴儿死亡发生在出生体重低于2500克的新生儿中。研究发现，在抑郁症筛查量表上得分较高的女性生下早产或低出生体重婴儿的风险更高。对使用抗抑郁剂的妇女进行的类似对照研究表明，早产的风险增加。尽管有这些文献，但还没有流行病学研究检验抑郁障碍或其药物治疗对不良围产儿结局的影响。我们建议进行一项前瞻性队列研究，以确定抑郁症是否会增加早产(37周)、早产(34周)、低出生体重(2500克)或胎儿宫内发育迟缓(IUGR)的风险。我们将：(1)使用结构化访谈来诊断妊娠期抑郁障碍，而不是依赖抑郁筛查措施；(2)通过对怀孕期间精神疾病进行前瞻性、纵向评估，确定妇女患抑郁症的时间点；(3)招募具有广泛种族和经济基础的队列，以探索抑郁与人口统计因素之间的关联；(4)收集有关抗抑郁药和其他药物使用的信息，以确定疾病或其药物治疗是否可解释出生体重和孕期的影响。这项研究将至少有85%的能力来检测怀孕每三个月的抑郁疾病与PTD、EPTD、LBW和IUGR之间的关系。为了实现这一目标，我们将招募680名患有抑郁症的女性，680名在过去5年内有抑郁症史但目前没有抑郁症的女性，以及2040名非抑郁症对照组。在注册时将进行广泛的精神病学和围产期风险因素面试。在妊娠22周和32周以及产后3个月进行电话随访，将重新评估诊断、抑郁的严重程度、抗抑郁药物的使用和其他危险因素。我们将评估疾病和抗抑郁药物对这些结局的独立影响，并检查抑郁的特定症状是否会导致不良的围产期结局。这项研究具有重要意义。如果抑郁症增加了早产、早产、低出生体重或IUGR的风险，临床医生将需要采取更严格的措施来治疗它。此外，如果我们确定抗抑郁药物会增加不良围产期结局的风险，在推荐治疗方案时，应该考虑心理治疗而不是抗抑郁药物。

DESCRIPTION (provided by applicant): Preterm delivery (PTD) and low birth weight (LBW) complicate over 12% of deliveries annually in the U.S. About two-thirds of all infant deaths occur among neonates that are born less than 2500 gms. Studies find that women who have elevated scores on depression screening scales are at increased risk for delivering a preterm or low birth weight infant. Similarly controlled studies of women using antidepressant agents show an increased risk for delivering an infant preterm. Despite this literature, no epidemiological study has examined the effect of a depressive disorder or its pharmacological treatment on adverse perinatal outcomes. We propose to conduct a prospective cohort study to determine whether a depressive disorder increases the risk of preterm delivery (<37 weeks), early preterm delivery (<=34 weeks), low birth weight (<2500 gms) or intrauterine growth retardation (IUGR). We will: (1) use structured interviewing to diagnose depressive disorders during pregnancy rather than relying on depression screening measures; (2) determine the point at which the woman developed the disorder by conducting prospective, longitudinal assessments of psychiatric illness during pregnancy; (3) recruit an ethnically and economically broad based cohort to explore associations among depression and demographic factors; (4) collect information on antidepressant and other medication use to determine whether the illness, or its pharmacological treatment accounts for the effects on birth weight and gestational duration. The study will have at least 85% power to detect associations between depressive illnesses in each trimester of pregnancy and PTD, EPTD, LBW and IUGR. To accomplish this, we will enroll 680 women with current depression, 680 women with a history of depression in the past 5 years, but not currently depressed, and 2040 non-depressed controls. An extensive psychiatric and perinatal risk factor interview will take place at enrollment. Telephone follow up at 22 and 32 weeks gestation, and 3 months postpartum will reevaluate diagnosis, severity of depression, antidepressant use and other risk factors. The independent effect of illness and antidepressants on these outcomes will be evaluated and we will examine whether specific symptoms of depression contribute to poor perinatal outcomes. This study has critical implications. If depression increases the risk of preterm delivery, early preterm delivery, low birth weight or IUGR, clinicians will need to implement even more rigorous efforts to treat it. Further, if we determine antidepressants increase the risk of adverse perinatal outcomes, treatment with psychotherapy rather than antidepressants should be considered when recommending therapeutic options.