Evaluating maternal depression among adolescent and adult women in Kenya

摘要 这个F31项目旨在促进对孕产妇抑郁症的表现和轨迹的理解。 在整个怀孕期间和产后，青少年妇女（15-19岁）与成人相比， 制定风险评分，以确定不良围产期结果的高风险妊娠。约13%的 全世界的围产期妇女都报告有心理健康问题，主要是抑郁症。青春期是一段 大量的发育和激素变化，增加了生理和心理社会变化， 怀孕青少年孕妇和产后妇女抑郁症的发生率高出30% 比成年人和未怀孕的同龄人要多。青少年的围产期抑郁症尚未得到严格的 以大规模纵向研究为特征。全世界几乎所有的青少年怀孕（95%）都发生在 低收入和中等收入国家（LMIC），但很少有数据显示， 这些设置。最近的一项系统回顾发现，中低收入国家的母亲抑郁症患病率较高（16%）， 怀孕，产后20%），而不是高收入国家（HIC）。对高收入国家的几项研究表明， 抑郁症和青春期早产和低出生体重，但在理解方面仍存在重大差距， 母亲抑郁症对婴儿发病率和死亡率负担的SSA围产期结局的影响 死亡率是全世界最高的。拟议的F31研究项目利用正在进行的 在青少年和成人中进行的随机分组试验（PrIMA研究，R 01 AI 125498，MPI：John-Stewart/Baeten） 随访至产后9个月的肯尼亚孕妇（≥15岁）。我们在筛选 > 4 000名肯尼亚妇女（中位年龄：24岁，约25%年龄<20岁）纵向接受产前/产后护理 (ANC/PNC）用于抑郁症状。在目标1中，我们将使用初始ANC、6周PNC和9个月的数据 PNC纵向比较青少年与成年女性的母亲抑郁症， 预测因素、症状以及患病率和严重程度的变化，为未来的干预措施提供信息。在目标2中， 开发并验证经验性风险评分，以预测包括抑郁症在内的围产期不良结局 妊娠评分和其他母体因素（例如，青春期）。目标2的结果将有助于临床 预测工具，告知谁可能需要加强监测，以避免不良围产期结果，如早产 出生和低出生体重。这项大规模的研究纵向比较了青少年和 从怀孕到产后9个月的成年人将贡献一种新的临床预测工具， 抑郁评分预测围产期结局。该研究计划将为F31候选人提供严格的 博士前培训，包括1）纵向数据的定量分析，2）经验开发和内部 验证风险评分，以及3）孕产妇抑郁症的内容领域专业知识，这是缩小 孕产妇、青少年和儿童健康。

ABSTRACT This F31 project aims to advance understanding of the manifestation and trajectory of maternal depression among adolescent women (age 15-19) compared to adults throughout pregnancy and postpartum, and to develop a risk score to identify pregnancies at high risk for adverse perinatal outcomes. Approximately 13% of peripartum women worldwide report mental health issues, predominantly depression. Adolescence is a period of substantial developmental and hormonal changes which add to physiologic and psychosocial changes in pregnancy. Frequency of depression among adolescent pregnant and postpartum women is up to 30% higher than their adult and non-pregnant counterparts. Perinatal depression among adolescents has not been rigorously characterized in a large-scale, longitudinal study. Almost all adolescent pregnancies (95%) worldwide occur in low- and middle-income countries (LMICs), yet few data exist on maternal depression among adolescents in these settings. A recent systematic review found higher prevalence of maternal depression in LMICs (16% in pregnancy, 20% in postpartum) than in high-income country settings (HICs). Several studies in HICs have linked depression and adolescence to preterm birth and low birthweight, yet critical gaps remain in understanding implications of maternal depression on perinatal outcomes within SSA where the burden of infant morbidity and mortality is highest worldwide. The proposed F31 research project leverages data collected in an ongoing randomized cluster trial (PrIMA Study, R01AI125498, MPI: John-Stewart/Baeten) among adolescent and adult pregnant Kenyan women (≥15 years old) who are followed through 9-months postpartum. We are screening >4000 Kenyan women (median age: 24 years, ~25% age <20 years) longitudinally via antenatal/postnatal care (ANC/PNC) for depressive symptoms. In Aim 1, we will use data from initial ANC, 6 weeks PNC, and 9 months PNC to longitudinally compare maternal depression among adolescent versus adult women, identifying predictors, symptoms, and changes in prevalence and severity to inform future interventions. In Aim 2 we will develop and validate an empiric risk score to predict adverse perinatal outcomes that incorporates depressive score in pregnancy and other maternal factors (e.g., adolescent age). Results from Aim 2 will contribute a clinical prediction tool to inform who may need intensified monitoring to avert adverse perinatal outcomes like preterm birth and low birthweight. This large-scale study to longitudinally compare depression among adolescents and adults from pregnancy through 9 months postpartum will contribute a novel clinical prediction tool using depression score to predict perinatal outcomes. This research plan will provide the F31 candidate rigorous predoctoral training including 1) quantitative analysis of longitudinal data, 2) experience developing and internally validating a risk score, and 3) content-area expertise in maternal depression, an area critical to closing gaps in maternal, adolescent, and child health.