Effects of Perinatal Depression on PTD and LBW

Summary

Principal Investigator: KIMBERLY A contact YONKERS
Abstract: [unreadable] 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. [unreadable] [unreadable]
Funding Period: 2004-09-01 - 2010-06-30
more information: NIH RePORT

Top Publications

  1. pmc Effects of posttraumatic stress disorder on pregnancy outcomes
    Shari S Rogal
    Yale University Department of Psychiatry, USA
    J Affect Disord 102:137-43. 2007
  2. pmc Depression and serotonin reuptake inhibitor treatment as risk factors for preterm birth
    Kimberly A Yonkers
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
    Epidemiology 23:677-85. 2012
  3. pmc Does antidepressant use attenuate the risk of a major depressive episode in pregnancy?
    Kimberly A Yonkers
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
    Epidemiology 22:848-54. 2011
  4. pmc Generalized anxiety disorder: course and risk factors in pregnancy
    Anne Buist
    Dept Psychiatry, University of Melbourne, Austin Health, Heidelberg 3081, Victoria, Australia
    J Affect Disord 131:277-83. 2011
  5. pmc Do the PHQ-8 and the PHQ-2 accurately screen for depressive disorders in a sample of pregnant women?
    Megan V Smith
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
    Gen Hosp Psychiatry 32:544-8. 2010
  6. pmc Evaluation of a social support measure that may indicate risk of depression during pregnancy
    Lori Spoozak
    Department of Obstetrics and Gynecology, Columbia College of Physicians and Surgeons, USA
    J Affect Disord 114:216-23. 2009
  7. pmc Depression screening of perinatal women: an evaluation of the healthy start depression initiative
    Kimberly A Yonkers
    Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
    Psychiatr Serv 60:322-8. 2009
  8. pmc The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists
    Kimberly A Yonkers
    Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510, USA
    Gen Hosp Psychiatry 31:403-13. 2009
  9. pmc Typical somatic symptoms of pregnancy and their impact on a diagnosis of major depressive disorder
    Kimberly Ann Yonkers
    Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
    Gen Hosp Psychiatry 31:327-33. 2009
  10. pmc The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists
    Kimberly A Yonkers
    Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510, USA
    Obstet Gynecol 114:703-13. 2009

Detail Information

Publications12

  1. pmc Effects of posttraumatic stress disorder on pregnancy outcomes
    Shari S Rogal
    Yale University Department of Psychiatry, USA
    J Affect Disord 102:137-43. 2007
    ....
  2. pmc Depression and serotonin reuptake inhibitor treatment as risk factors for preterm birth
    Kimberly A Yonkers
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
    Epidemiology 23:677-85. 2012
    ..Studies that have attempted to separate effects of illness from treatment have been inconclusive. We sought to explore the separate effects of SRI use and major depressive episodes in pregnancy on risk of preterm birth...
  3. pmc Does antidepressant use attenuate the risk of a major depressive episode in pregnancy?
    Kimberly A Yonkers
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
    Epidemiology 22:848-54. 2011
    ..We sought to estimate differences in the risk of developing a new major depressive episode among pregnant and postpartum women with recurrent illness who either did or did not use antidepressants...
  4. pmc Generalized anxiety disorder: course and risk factors in pregnancy
    Anne Buist
    Dept Psychiatry, University of Melbourne, Austin Health, Heidelberg 3081, Victoria, Australia
    J Affect Disord 131:277-83. 2011
    ..There are limited studies of generalized anxiety disorder (GAD) across pregnancy...
  5. pmc Do the PHQ-8 and the PHQ-2 accurately screen for depressive disorders in a sample of pregnant women?
    Megan V Smith
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
    Gen Hosp Psychiatry 32:544-8. 2010
    ..Based upon studies documenting high sensitivity and specificity on the PHQ-8 and PHQ-2 in the general adult population, we hypothesized that both instruments would be effective in this population...
  6. pmc Evaluation of a social support measure that may indicate risk of depression during pregnancy
    Lori Spoozak
    Department of Obstetrics and Gynecology, Columbia College of Physicians and Surgeons, USA
    J Affect Disord 114:216-23. 2009
    ..Our aim was to replicate the psychometric properties of the Kendler Social Support Interview modified for use in pregnant women and to establish the inventory's relationship to depression in pregnancy...
  7. pmc Depression screening of perinatal women: an evaluation of the healthy start depression initiative
    Kimberly A Yonkers
    Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
    Psychiatr Serv 60:322-8. 2009
    ..This study evaluated the Healthy Start depression initiative to assess whether it resulted in diminished rates of depressive symptoms and increased rates of detection, referral, and treatment among pregnant and postpartum women...
  8. pmc The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists
    Kimberly A Yonkers
    Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510, USA
    Gen Hosp Psychiatry 31:403-13. 2009
    ..To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management...
  9. pmc Typical somatic symptoms of pregnancy and their impact on a diagnosis of major depressive disorder
    Kimberly Ann Yonkers
    Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
    Gen Hosp Psychiatry 31:327-33. 2009
    ..We sought to determine whether trimester of pregnancy influences the ability to diagnose major depressive disorder (MDD)...
  10. pmc The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists
    Kimberly A Yonkers
    Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510, USA
    Obstet Gynecol 114:703-13. 2009
    ..To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management...
  11. pmc Prenatal hazardous substance use and adverse birth outcomes
    Odayme Quesada
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
    J Matern Fetal Neonatal Med 25:1222-7. 2012
    ..Assess the relative effects of a variety of illicit and licit drugs on risk for adverse birth outcomes...