Funded Projects

Prenatal Depression: Registry, Treatment Effectiveness to Reduce Preterm Delivery

Grantee: Kaiser Foundation Hospitals
Principal Investigator: De-Kun Li
Project Number: R40MC25676
Project Date: 2/1/2013

Final Report

Prenatal Depression: Registry, Treatment Effectiveness to Reduce Preterm Delivery Final Report (PDF)

Age group(s)

• Women/Maternal
• Prenatal
• Perinatal/Infancy (0-12 months)

Abstract

Approximately 15-20% of pregnant women suffer from varying degrees of depression which has been associated with an increased risk of preterm delivery (PTD). Currently, significant confusion exists about if and how depression during pregnancy should be treated to reduce the risk of PTD due to the uncertain risk-benefit of antidepressant treatment. To determine (1) if untreated depression increases the risk of PTD, and thus should be treated, (2) if treatment is effective and beneficial, and (3) which treatment is most effective in reducing PTD, we propose to conduct a two-stage population-based prospective cohort study based on a unique infrastructure of a universal prenatal depression screening program in Kaiser Permanente Northern California (KPNC). Under this program, all pregnant women (about 33,000 annually) are screened for depression twice during pregnancy using the Patient Health Questionnaire (PHQ-9). Taking advantage of this universal screening program, we will first identify more than 66,000 pregnant women who screen for depression during the study period to build a prenatal depression registry (stage I sample). Using the information on depression status and treatment choices collected in the registry, five cohorts will then be established: (A) "Untreated cohort": those who screen positive for depression during pregnancy, but without any treatment; (B) "Psychotherapy cohort": screen positive and receive psychotherapy only; "Antidepressant cohort": screen positive and use antidepressants only; (D) "Combination treatment cohort": screen positive and use both psychotherapy and antidepressants; and "Control cohort": screen negative for depression and do not receive treatment. Comparison of Cohort A versus Cohort E will determine if untreated depression in pregnancy increases the risks of PTD. Comparisons of Cohorts B, C and D to Cohort A, respectively, will determine the effectiveness of depression treatment. Pair-wise comparisons among Cohorts B, C and D will determine the relative risk-benefit of various treatment options including antidepressants, psychotherapy, and combination therapies. We will also explore whether the proposed relationships vary by race/ethnicity. To obtain more detailed information on potential confounders, we will conduct Computer Assisted Telephone Interviews (CATI) interviews among 2,000 stage II sample (400 randomly selected from each of the five cohorts described above). Depression status and treatment options (exposures), gestational age at delivery for PTD (outcome), and potential confounders will be abstracted through both EMRs and CATI interviews. The Cox proportional hazard regression model will be used to examine the effect of untreated depression and, risk-benefit of various treatment options on PTD after controlling for underlying depression severity (confounding by indication) and other confounders. The objectives of the proposed study address MCHB Strategic Research Area 1 & 4. The findings from the study will provide answers to pressing clinical questions of whether depression in pregnancy should be treated and, if so, which option is the best treatment choice in reducing PTD and improving pregnancy outcomes. Selecting an effective treatment could lead to a reduction in PTD which remains the leading cause of infant mortality and morbidity.