Project 1 will focus on the fetal and obstetrical consequences of maternal stress, depression, and anxietyduring pregnancy. Information that better informs the clinical decision potentially affects >400,000 women inthe United States annually. The treatment of maternal depression and anxiety during pregnancy continuesto 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 renewedattention with respect to potential teratogenic effects (e.g. ventral septal defects). Unfortunately, thepotential impact of maternal stress, depression, and anxiety on the fetus and obstetrical outcome is seldomincluded in these reports. The extant literature on the impact of maternal mental illness typically uses singlepoint assessments (predominantly in mid to late pregnancy) of maternal depression and anxiety. While suchstudies have demonstrated alterations in fetal activity, fetal heart rate, and an increase in obstetricalcomplications (low birth weight, preterm labor, preterm delivery), they have only speculated about themechanisms based on cross sectional assessment. Similarly, these investigations have failed to account forother 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 theimpact of maternal depression and anxiety, in any, on biological indices of stress (both acute andcumulative) and the relationship of these measures and maternal symptoms with uterine blood flow, fetalactivity, fetal heart rate, obstetrical outcome, neonatal outcome. The center design permits blindedassessments of these relationships - an incremental advance over previous investigations. The focus on aclinical population will provide a cohort of pregnant women with antidepressant exposure. The modulatoryeffects, if any, of antidepressants on our outcome variables are unknown. Blinded assessment of obstetricaland neonatal outcome will directly address many of the concerns recently reported. The potential impact ofexposure (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 additionalpotential moderators of infant outcome in Project 3.
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