Relapse risk after Discontinuation of Antidepressants during Pregnancy (R-DAP study)

怀孕期间停用抗抑郁药后复发的风险（R-DAP 研究）

基本信息

批准号：
10334499
负责人：
Veerle Bergink
金额：
$ 55.2万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-02 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10334499
关键词：
Adverse effects Antidepressive Agents Anxiety Disorders Bipolar Disorder Birth Child Conceptions Conflict (Psychology)Decision Making Depressive disorder Emotions Endocrine Event Exposure to Fathers Female Fetal Development Fetus General Population Genetic Genetic Predisposition to Disease Genetic study Goals Health Immune Investigation Lead Life Long-Term Effects Mental Depression Mental Health Mental disorders Mood Disorders Moods Mothers Outcome Outpatients Perinatal Pharmaceutical Preparations Pharmacology Physiology Population Postpartum Period Pregnancy Pregnant Women Process Psychiatric therapeutic procedure Relapse Reporting Residual state Resources Risk Risk Factors Sample Size Sampling Schizophrenia Self-Injurious Behavior Severities Siblings Sleep Deprivation Suicide Suicide attempt Time Woman Work aged antidepressant effect base genetic information health of the mother in utero interest maternal depression men offspring perinatal period peripartum depression polygenic risk score population based predictive modeling prenatal exposure relapse risk reproductive secondary outcome tool unborn child

Adverse effects Antidepressive Agents Anxiety Disorders Bipolar Disorder Birth Child Conceptions Conflict (Psychology)Decision Making Depressive disorder Emotions Endocrine Event Exposure to Fathers Female Fetal Development Fetus General Population Genetic Genetic Predisposition to Disease Genetic study Goals Health Immune Investigation Lead Life Long-Term Effects Mental Depression Mental Health Mental disorders Mood Disorders Moods Mothers Outcome Outpatients Perinatal Pharmaceutical Preparations Pharmacology Physiology Population Postpartum Period Pregnancy Pregnant Women Process Psychiatric therapeutic procedure Relapse Reporting Residual state Resources Risk Risk Factors Sample Size Sampling Schizophrenia Self-Injurious Behavior Severities Siblings Sleep Deprivation Suicide Suicide attempt Time Woman Work aged antidepressant effect base genetic information health of the mother in utero interest maternal depression men offspring perinatal period peripartum depression polygenic risk score population based predictive modeling prenatal exposure relapse risk reproductive secondary outcome tool unborn child

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项目摘要

Project Summary Over the past decades, the use of antidepressants (ADs) as first-line treatment for both depressive and anxiety disorders has increased exponentially, with females in their reproductive years using ADs twice as often as men. Prior to conception or during pregnancy, approximately 50% of women on ADs (200,000 pregnant women in the US each year) decide to discontinue their medication. While the wish to avoid in utero AD exposure to the fetus is understandable, discontinuation of medication might lead to relapse, which can have a profound negative impact on the health of mother and child. Unfortunately, general information on relapse risks after AD discontinuation cannot be used during pregnancy and the postpartum period given the enormous changes in physiology and emotion. Further, women discontinue AD prior to or during pregnancy regardless of their mood stability, which has an impact on relapse risk. Only three small studies in highly selected populations have investigated relapse risks during pregnancy and not a single study on AD discontinuation during pregnancy has investigated the relapse risk postpartum. This study will quantify the relapse risk during pregnancy and postpartum after AD discontinuation, for the first time, in a large and representative population sample. We will use the unique Danish national longitudinal registers covering medication use since 1995 in the entire female population giving birth aged 15-49 years (N=1,098,137). With our sample size, we will be able to identify both pregnancy specific and non-pregnancy specific risk factors for relapse and timing to relapse. We will determine to which extent the perinatal period is different in terms of relapse risks after AD discontinuation compared to other periods in a woman’s life. In addition, we will explore if women with high genetic susceptibility for mood-disorders are more vulnerable for relapse after AD discontinuation. In our last aim we will determine the long-term effects (up to 24 years) of maternal relapse during pregnancy and the postpartum period on the offspring. We will conduct a sibling comparison, in which we compare the health outcomes in children exposed to maternal relapse to their siblings not exposed to maternal relapse in the perinatal period. We will explore if polygenic risk scores of the children influence the association between their exposure to maternal relapse and their long-term psychiatric outcome, considering in utero exposure to AD medication.

项目摘要在过去的几十年中，使用抗抑郁药（AD）作为抑郁和焦虑的一线治疗疾病呈指数增长，女性在复制年份使用广告的频率是男性的两倍。在概念之前或怀孕期间，大约50％的妇女在广告中（200,000名孕妇我们每年）决定停止使用药物。虽然希望避免在子宫广告中暴露于胎儿是可以理解的，停用药物可能会导致退休，这可能会产生深刻的负面影响对母子健康的影响。不幸的是，广告后有关救济风险的一般信息鉴于怀孕期间和产后期间不能使用停用生理和情感。此外，无论心情如何稳定性，对救济风险有影响。在高度选择人群中只有三个小研究在怀孕期间调查了继电器风险，而不是一项关于怀孕期间AD中断的研究调查了产后救济风险。这项研究将量化AD中断后怀孕期间和产后的救济风险，因为第一次，在大型和代表性的人群样本中。我们将使用独特的丹麦民族纵向自1995年以来，涵盖用药使用的登记册中的整个女性人口，分娩15-49岁（n = 1,098,137）。有了我们的样本量，我们将能够识别特定于妊娠和非怀孕救济和释放时机的特定风险因素。我们将确定围产期的多大程度与女性一生中的其他时期相比，在停产后的救济风险方面不同。在此外，我们还将探索是否对情绪疾病易感性较高的女性更容易受到伤害广告中断后复发。在我们的最后一个目标中，我们将确定长期影响（长达24年）怀孕期间和后代产后时期的母亲继电器。我们将进行兄弟姐妹比较，在其中比较暴露于母校的儿童的健康状况与兄弟姐妹在围产期未暴露于孕产妇的救济。我们将探讨儿童的多基因风险得分是否影响他们接触母校接力与长期精神病结果之间的关联，考虑在子宫内暴露于AD药物中。