The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women.
The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women.
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SMART Moms 计划：压力管理对低收入孕妇感知压力和皮质醇影响的随机试验。
DOI：
10.1016/j.psyneuen.2019.02.022
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发表时间：
2019
影响因子：
3.7
通讯作者：
Schetter,ChristineDunkel
中科院分区：
文献类型：
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作者：
UrizarJr,GuidoG;Yim,IlonaS;Rodriguez,Anthony;Schetter,ChristineDunkel
背景母亲下丘脑-垂体-肾上腺功能和最终产物皮质醇的调节异常与妊娠和产后应激相关健康并发症的风险增加有关。鉴于孕妇皮质醇可能对孕妇及其婴儿的健康产生不利影响，需要基于经验的产前干预措施，以期对高危孕妇的压力及其生物影响进行最佳管理，认知行为压力管理(CBSM)就是一个主要的例子。这项随机对照试验检测了孕期和产后早期使用CBSM干预措施对降低感知压力和调节唾液皮质醇模式[即总皮质醇排出量(曲线下面积)、皮质醇觉醒反应(CAR)、昼夜斜率]的影响，并与对照组进行了比较。方法将100名孕期低焦虑或高焦虑的低收入孕妇(71%拉丁裔；76%年收入和1t；20 K美元)随机分成两组，一组接受为期8周的CBSM组干预(n=55)，另一组为对照组(n=45)。他们在一个采集日提供了7个唾液皮质醇样本(4个上午样本，12个 PM样本，4个 PM样本和8个 PM样本)，在基线(怀孕1周和17周)、产前计划(第2个月)、晚期和产后3个月。结果接受CBSM治疗的妇女在整个怀孕和产后早期感觉到的压力水平低于对照组妇女(p=.020)。在有高度产前焦虑的妇女中，与对照组相比，CBSM组的妇女在产后三个月显示出每日皮质醇的急剧下降(p=.015)。此外，CBSM中的非拉丁裔妇女在产后三个月的CAR低于对照组中的非拉丁裔妇女(p=.025)；这些随机化组在CAR上的差异在拉丁裔妇女中没有观察到。结论这些发现为产前CBSM干预在改善低收入孕妇压力结局方面的有效性提供了初步支持，并建议需要在更大范围内测试这些干预措施的效果，以改善长期的母婴健康结局。
BackgroundDysregulations in maternal hypothalamus-pituitary-adrenal function and the end product, cortisol, have been associated with a heightened risk for stress-related health complications during pregnancy and post partum. Given the adverse health impact that maternal cortisol may have on expectant mothers and their infants, empirically-based prenatal interventions are needed to target optimal management of stress and its biological effects in at-risk pregnant women, a primary example of which is cognitive behavioral stress management (CBSM). This randomized-controlled trial examined the effects of a prenatal CBSM intervention on reduction in perceived stress and regulation of salivary cortisol patterns [i.e., overall cortisol output (area under the curve), cortisol awakening response (CAR), diurnal slope] during pregnancy and the early postpartum period, as compared to a control group.MethodsOne hundred low-income pregnant women (71% Latina; 76% annual income < $20 K) with low or high anxiety during pregnancy were randomized (stratified by anxiety) to either an eight-week CBSM group intervention (n= 55) or a control group (n= 45). They provided seven salivary cortisol samples (four am samples, 12 pm, 4 pm, and 8 pm samples on one collection day) at baseline (1sttrimester; < 17 weeks of gestation), after their prenatal program (2ndtrimester), and also in the third trimester and at three months post partum.ResultsWomen receiving CBSM had lower perceived stress levels throughout pregnancy and early post partum compared to women in the control group (p= .020). Among women with high prenatal anxiety, those in CBSM showed a steeper decline in their diurnal cortisol at three months post partum compared to those in the control group (p= .015). Further, non-Latina women in CBSM had a lower CAR at three months post partum compared to non-Latina women in the control group (p= .025); these randomization group differences on the CAR were not observed among Latina women.ConclusionsThese findings provide preliminary support for the efficacy of prenatal CBSM interventions in improving stress outcomes among low-income pregnant women and suggest the need to test the effects of these interventions on a larger scale for improving maternal and infant health outcomes long-term.