Impact of Antenatal Depression, Anxiety, and Stress on Fetal

产前抑郁、焦虑和压力对胎儿的影响

基本信息

批准号：
7931866
负责人：
ZACHARY N STOWE
金额：
$ 49.71万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-01 至 2012-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7931866
关键词：
Accounting Acute Address Adverse effects Affect Alcohols Antidepressive Agents Anxiety Area Under Curve Arteries Attention Behavior Biological Blinded Blood flow CRH gene Caffeine Clinical Conceptions Coupling Data Data Analyses Development Dimensions Doppler Ultrasound Environment Equipment and supply inventories Exposure to Fetal Heart Rate Fetal Movement Fetus Follow-Up Studies Frequencies Genes Genetic Polymorphism Goals Hamilton Rating Scale for Depression Heart Rate Heart Septal Defects Hydrocortisone Individual Infant Investigation Literature Low Birth Weight Infant Measures Mediating Mediator of activation protein Mental disorders Metabolic Metabolism Movement Neonatal Neurosecretory Systems Nicotine Outcome Pathway interactions Perinatal Perinatal Exposure Pharmaceutical Preparations Phenotype Population Pregnancy Pregnant Women Premature Birth Premature Labor Psychometrics Reporting Resistance Rest Safety Salivary Severities Stimulus Stress Symptoms Time Tobacco Toxic Environmental Substances Translating Umbilical Cord Blood Umbilical cord structure United States Withdrawal Woman base cohort depression design fetal impression indexing infant outcome maternal depression maternal serum maternal stress neonate novel prospective reproductive response trait

项目摘要

Project 1 will focus on the fetal and obstetrical consequences of maternal stress, depression, and anxiety during pregnancy. Information that better informs the clinical decision potentially affects >400,000 women in the United States annually. The treatment of maternal depression and anxiety during pregnancy continues to stimulate vigorous debate with the emphasis on the reproductive safety of antidepressant medications. Recently, there have been reports of purported "antidepressant neonatal withdrawal", and a renewed attention with respect to potential teratogenic effects (e.g. ventral septal defects). Unfortunately, the potential impact of maternal stress, depression, and anxiety on the fetus and obstetrical outcome is seldom included in these reports. The extant literature on the impact of maternal mental illness typically uses single point assessments (predominantly in mid to late pregnancy) of maternal depression and anxiety. While such studies have demonstrated alterations in fetal activity, fetal heart rate, and an increase in obstetrical complications (low birth weight, preterm labor, preterm delivery), they have only speculated about the mechanisms based on cross sectional assessment. Similarly, these investigations have failed to account for other exposures that may influence outcome (medications, tobacco, etc). Project 1 will fill these gaps utilizing the well characterized women from Core B. We will determine the impact of maternal depression and anxiety, in any, on biological indices of stress (both acute and cumulative) and the relationship of these measures and maternal symptoms with uterine blood flow, fetal activity, fetal heart rate, obstetrical outcome, neonatal outcome. The center design permits blinded assessments of these relationships - an incremental advance over previous investigations. The focus on a clinical population will provide a cohort of pregnant women with antidepressant exposure. The modulatory effects, if any, of antidepressants on our outcome variables are unknown. Blinded assessment of obstetrical and neonatal outcome will directly address many of the concerns recently reported. The potential impact of exposure (e.g. ng/ml in cord blood) will be included in data analysis. The novel data generated from Project 1 will serve as candidate phenotypes for Project 2, and additional potential moderators of infant outcome in Project 3.

项目 1 将重点关注母亲压力、抑郁和焦虑对胎儿和产科的影响怀孕期间。更好地为临床决策提供信息的信息可能会影响超过 400,000 名女性美国每年。孕期母亲抑郁和焦虑的治疗仍在继续激发激烈的争论，重点是抗抑郁药物的生殖安全。最近，有报道称“抗抑郁新生儿戒断”，并重新启动注意潜在的致畸作用（例如腹间隔缺损）。不幸的是，母亲的压力、抑郁和焦虑对胎儿和产科结果的潜在影响很少包括在这些报告中。现有关于孕产妇精神疾病影响的文献通常使用单一的对母亲抑郁和焦虑的点评估（主要是在怀孕中后期）。虽然这样研究表明胎儿活动、胎儿心率的改变以及产科的增加并发症（低出生体重、早产、早产），他们只是推测基于横断面评估的机制。同样，这些调查也未能解释其他可能影响结果的暴露（药物、烟草等）。项目 1 将利用核心 B 中特征鲜明的女性来填补这些空白。我们将确定母亲抑郁和焦虑对压力生物学指标（急性和压力）的影响累积）以及这些措施与母体症状与子宫血流量、胎儿的关系活动、胎心率、产科结局、新生儿结局。中心设计允许盲区对这些关系的评估——比以前的调查取得了渐进的进展。重点关注一个临床人群将提供一组接受抗抑郁药物治疗的孕妇。调节性抗抑郁药对我们的结果变量的影响（如果有的话）尚不清楚。产科盲法评估新生儿结局将直接解决最近报告的许多问题。的潜在影响暴露量（例如脐带血中的 ng/ml）将包含在数据分析中。项目 1 生成的新数据将作为项目 2 的候选表型，以及其他项目 3 中婴儿结局的潜在调节因素。