Comparing the Effects of Prenatal Depression and its Treatment on Developmental Outcomes of the Offspring

比较产前抑郁症及其治疗对后代发育结果的影响

• 批准号: 10703372
• 负责人: Lyndsay Ammon Avalos
• 金额: $ 65.24万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10703372
• 关键词: 5 year old; 8 year old; Address; Age; Animal Model; Area; Attention deficit hyperactivity disorder; Behavior Disorders; Behavioral; Birth; Brain; Brain imaging; California; Categories; Child; Childhood; Clinical; Code; Cognition Disorders; Cognitive; Cohort Studies; Communication; Communication impairment; DSM-V; Depression screen; Development; Developmental Delay Disorders; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Early Intervention; Education; Electronic Health Record; Epidemiology; Fathers; Fetal Development; Fetus; Health; High Prevalence; Hospitals; Human; Impairment; Infant; Intellectual functioning disability; Interview; Knowledge; Link; Literature; Long-Term Effects; Measures; Medical Records; Mental Depression; Methodology; Monitor; Mothers; Motor; Neurodevelopmental Disorder; Neurodevelopmental Impairment; Outcome; Parents; Patients; Performance; Persons; Pharmacological Treatment; Population; Postpartum Depression; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Prevalence; Problem Solving; Process; Psychotherapy; Public Health; Questionnaires; Recording of previous events; Research; Risk; Risk Factors; Sampling; Selective Serotonin Reuptake Inhibitor; Services; Severities; Structure; Testing; Time; Woman; antepartum depression; autism spectrum disorder; boys; clinical diagnosis; cohort; design; emotional behavior; epidemiology study; fetal; girls; imaging study; instrument; motor disorder; motor impairment; offspring; peripartum depression; prenatal; prenatal testing; primary outcome; psychologic; public health relevance; recruit; screening; screening program; secondary analysis; sex; skills; social; treatment effect

ABSTRACT The risk associated with both untreated depression and selective serotonin reuptake inhibitors (SSRIs) treatment has presented a significant dilemma to the 20% of pregnant women suffering from prenatal depression and their clinicians. Both prenatal depression and SSRIs have been found to adversely impact fetal brain development. However, the limited epidemiologic research on neurodevelopmental outcomes of the offspring suffers severe methodological limitations and thus, the literature is inconclusive. The proposed study addresses these methodological limitations and leverages Kaiser Permanente Northern California’s (KPNC’s) unique universal perinatal depression screening program to assemble a longitudinal birth cohort of >320,000 children from 0 to 8 years of age born between 2013-2020. As part of standard prenatal care, women are screened for depression twice during pregnancy (at the first prenatal visit and 26-28 weeks) providing a large cohort of women with depression and its severity measures throughout pregnancy. In addition, KPNC’s universal childhood developmental screening program provides systematic screening for neurodevelopmental disorders. The primary outcomes will be six neurodevelopmental disorder diagnoses defined in the DSM 5: intellectual disability, global developmental delay, motor disorders, communication disorder, autism spectrum disorder, and attention-deficit/hyperactivity disorder (ADHD); corresponding diagnosis codes will be ascertained from KPNC’s electronic health records (EHR) and supplemented through linkage to California’s Department of Developmental Services. We will use KPNC EHRs to ascertain information on important confounders and link to the father’s medical records to ascertain information on psychiatric history. We will test the hypothesis that the underlying prenatal depression and SSRIs are independent risk factors for adverse neurodevelopmental outcomes and may differ by infant sex. We will evaluate the effect of untreated prenatal depression, compared to no prenatal depression on the six neurodevelopmental outcomes of the offspring, after adjusting for confounders. We will also assess the effects of treatment with SSRIs during pregnancy on neurodevelopmental outcomes of the offspring compared to both untreated prenatal depression and treatment with psychotherapy only, while taking into account depression severity and other confounders. Finally, to examine their impact on less severe neurodevelopmental outcomes we will recruit a subsample of 2,000 5- year old children (500 randomly chosen from each of four exposure categories: no prenatal depression, untreated prenatal depression, treatment with SSRIs, treatment with psychotherapy only) to ascertain information through parent interview on neurodevelopmental outcomes that may not meet the criteria of a clinical diagnosis, but may suggest a need to monitor and/or provide early interventions. Findings from this study will have significant public health and clinical implications by providing information that can be immediately used by pregnant women and clinicians making treatment decisions.

抽象的 与未经治疗的抑郁症和选择性5-羟色胺再摄取抑制剂（SSRIS）相关的风险 治疗对患有产前的20％的孕妇呈现了严重的困境 抑郁及其临床医生。已经发现产前抑郁症和SSRI都对胎儿产生不利影响 大脑发育。但是，关于神经发育结果的流行病学研究有限 后代受到严重的方法论上的限制，因此文献尚无定论。拟议的研究 解决这些方法论上的局限 独特的通用围产期抑郁筛查计划，纵向出生队列> 320,000 从2013 - 2020年间出生的0至8岁的儿童。作为标准产前护理的一部分，女性是 在怀孕期间两次（在第一次产前访问和26-28周）筛查抑郁症 在整个怀孕期间，患有抑郁症的女性及其严重程度的措施。此外，KPNC的 通用儿童发育筛查计划为神经发育提供系统筛查 疾病。主要结果将是DSM 5中定义的六个神经发育障碍诊断： 智力残疾，全球发育延迟，运动障碍，沟通障碍，自闭症谱系 障碍和注意力缺陷/多动症（ADHD）；相应的诊断代码将是 从KPNC的电子健康记录（EHR）确定，并通过与加利福尼亚的链接进行补充 发展服务部。我们将使用KPNC EHR确定有关重要的信息 混淆者并链接到父亲的病历，以确定有关精神病史的信息。我们将测试 潜在的产前抑郁症和SSRI是不利的独立危险因素的假设 神经发育结果，可能因婴儿性别而有所不同。我们将评估未经治疗的产前的效果 抑郁症，与后代的六个神经发育结局没有产前抑郁症相比 调整了混杂因素后。我们还将评估怀孕期间SSRI治疗的影响 与未经治疗的产前抑郁和治疗相比，后代的神经发育结果 仅考虑到抑郁症的严重程度和其他混杂因素，仅使用心理治疗。最后，到 检查它们对不太严重的神经发育结果的影响，我们将招募2,000个子样本5-- 年龄的儿童（从四个暴露类别中随机选择了500个：没有产前抑郁症， 未经治疗的产前抑郁症，SSRI治疗，仅使用心理治疗治疗）以确定 通过父母访谈的信息有关神经发育结果的信息可能不符合一个标准 临床诊断，但可能建议需要监测和/或提供早期干预措施。从中的发现 研究将通过提供可以是的信息具有重大的公共卫生和临床意义 孕妇和临床医生立即使用治疗决定。

项目成果

Racial and ethnic differences in perinatal depression and anxiety.

围产期抑郁和焦虑的种族和民族差异。

• DOI: 10.1016/j.jad.2023.04.123
• 发表时间: 2023
• 期刊: Journal of affective disorders
• 影响因子: 6.6
• 作者: Sujan,AyeshaC;Nance,Nerissa;Quesenberry,Charles;Ridout,Kathryn;Bhalala,Mibhali;Avalos,LyndsayA
• 通讯作者: Avalos,LyndsayA