Recent Research in Women's & Reproductive Health
Maternal & Infant Effects of Treated and Untreated Depression during Pregnancy
Nashville Breast Health Study
Maternal & Infant Effects of Treated and Untreated Depression during Pregnancy
This proposal is in response to a National Institute of Mental Health program announcement on women’s mental health in pregnancy and the postpartum period and addresses several goals of the program by investigating the epidemiology, risk factors, and effects of treatment on depression during pregnancy. Ten to fifteen percent of women experience some degree of depression during pregnancy and these women are at higher risk of depression following childbirth and later in life. Maternal depression during pregnancy may have adverse effect on pregnancy and neonatal outcomes, and on-going maternal depression is known to have adverse effects on parenting and family function. To help determine the best course of treatment for depression among pregnant women, this study will analyze provider, pharmacy, and hospital claims data from the Tennessee Medicaid (TennCare) population from 1994-2003. This large population includes over half of all Tennessee births during the study period. The proposed study makes efficient use of existing data and infrastructure to study the relationship of treated and untreated depression on maternal and infant outcomes, which will help guide both future clinical research and current medical practice. The central hypothesis is that there are no measurable harmful effects of pharmacotherapy for depression during pregnancy with regards to specific pregnancy, perinatal, and depression outcomes. To determine whether women who take antidepressants during pregnancy have increased rates of adverse pregnancy and perinatal outcomes, we will perform a retrospective cohort analysis in otherwise healthy pregnant women to evaluate pregnancy and perinatal outcomes by exposure to specific antidepressant medications. We will perform a second retrospective cohort study of women with recognized depression prior to pregnancy. Women will be classified as exposed or unexposed to antidepressants and we will quantify the risks of adverse pregnancy, perinatal, and depression outcomes by antidepressant treatment status after adjusting for markers of depression severity. The second proposed retrospective cohort is an innovative analysis that will use a subset of the very large population to evaluate the relative risks of treating depression during pregnancy. Results of the proposed analysis will help women and their health care providers decide how to manage depression during pregnancy and guide future research. Understanding the impact of treated and untreated depression during pregnancy is very important to public and maternal health, specifically the well being of the mother, healthy fetal development, and the development of a healthy mother-infant relationship. Funded by the National Institute of Mental Health Investigators: Tina V. Hartert, M.D., M.P.H. (PI)
Nashville Breast Health Study
This proposal is for a population-based case-control study of breast cancer in Nashville, Tennessee. The primary hypotheses are 1) regular use of nonsteroidal anti-inflammatory drugs (NSAID) may reduce the risk of breast cancer, and this association may be modified by the genotypes of NSAID metabolizing enzymes; 2) well-done (charred) meat intake, and thus exposures to the mammary carcinogens heterocyclic amines and polycyclic aromatic hydrocarbons, may be related to an increased risk of breast cancer, particularly among women with certain genotypes of the carcinogen-metabolizing enzymes; 3) the positive association between well-done meat intake and breast cancer risk may be modified by regular NSAID use; 4) certain polymorphic genes involved in estrogen metabolism may interact with each other in the etiology of breast cancer. We propose to recruit 1,500 incident cases and 1,500 controls for this case-control study. Breast cancer cases will be identified through a rapid case-ascertainment system established for the study. Controls will be selected randomly from the general population and frequency-matched to cases by age and race. Telephone interviews will be conducted to obtain relevant exposure information. Exfoliated buccal cell samples will be collected to extract DNA for analyzing 38 polymorphisms in 14 candidate genes that are involved in the metabolism of NSAIDs, mammary carcinogens, and estrogens. DNA samples will also be stored for future studies of additional genetic factors and their interactions with lifestyle factors in the risk of breast cancer. NSAIDs are among the most commonly used medications, and high-temperature cooking has been widely used for meat preparation. Information regarding their associations with breast cancer risk could have important public health implications in the primary prevention of breast cancer. Studies investigating gene-gene and gene-environment interaction could provide valuable information in identifying high-risk individuals for designing cost-effective preventive strategies for breast cancer. Funded by the National Cancer InstituteInvestigators: Wei Zheng, M.D., Ph.D. (PI); Mark C. Kelley, M.D.; Sandy Deming, Ph.D.; Xiao Ou Shu, M.D., Ph.D.; Martha J. Shrubsole, Ph.D.; Qiuyin Cai, M.D., Ph.D.; Jirong Long, Ph.D.; Fritz F. Parl, M.D., Ph.D.; Bill Dupont, Ph.D.; David Page, M.D.