The effects of pregnancy on post traumatic symptoms and fear physiology in traumatized African American women

修改后的项目摘要/摘要部分 在城市低社会经济地位的非裔美国人(AA)社区，重复创伤暴露的累积比率更大。这种累积的创伤暴露与抑郁和创伤后症状(PTS)增加以及失调的恐惧反应有关。虽然受到创伤的女性比男性更容易患抑郁症和焦虑症，但增加荷尔蒙诱导的影响改变易感性的因素尚不清楚。对于孕妇来说尤其如此，尽管有证据表明PTS在怀孕期间会发生变化，但她们在创伤研究中受到的关注很少。然而，妊娠对PTS影响的具体性质一直是模棱两可的。由于怀孕的AA妇女经历了不成比例的累积创伤暴露和PTS，因此了解遭受创伤的AA妇女怀孕期间的激素波动如何影响PTS和恐惧心理生理学对于母亲在分娩前和分娩后的健康至关重要。 考虑到我们从创伤高危人群中招募怀孕的再障妇女，拟议的纵向研究很好地解决了这一知识差距。这项拟议的研究将结合临床访谈和恐惧生理学方法，研究怀孕每三个月和产后一个月雌激素、孕酮和皮质醇的变化如何影响PTS和恐惧抑制缺陷。此外，由于研究表明产前应激暴露会导致胎儿皮质醇暴露增加，成年后不良分娩结果(即低出生体重)和负面身心健康结果的风险增加，因此我们将通过评估胎盘DNA甲基化和胎儿通过脐带接触糖皮质激素来确定孕前累积的母体创伤和妊娠期PTS如何传递给后代，从而影响对不利结果的易感性。

Modified Project Summary/Abstract Section The cumulative rate of repeated trauma exposure is greater in African American (AA) communities of urban, low socioeconomic status. This cumulative trauma exposure is associated with increased depressive and posttraumatic symptoms (PTS), and dysregulated fear responses. While traumatized women are more at risk for depression and anxiety compared to men, the factors that increase vulnerability to hormone-induced alterations in affect remain unclear. This is especially true for pregnant women, who have received minimal focus in trauma research even though there is evidence that suggests that PTS are altered during pregnancy. However, the specific nature of the effect of pregnancy on PTS has been equivocal. Because pregnant AA women experience disproportionately higher rates of cumulative trauma exposure and PTS, understanding how hormonal fluctuations during pregnancy in traumatized AA women influence PTS and fear psychophysiology is critical for the mother’s wellbeing both before and after delivery. The proposed longitudinal study is well positioned to address this gap in knowledge given our recruitment of pregnant AA women from a high trauma risk population. The proposed research will combine clinical interviews and fear physiology methods to examine how changes in estrogen, progesterone, and cortisol during each trimester of pregnancy and 1-month postpartum period influence PTS and fear inhibition deficits. Furthermore, because studies implicate prenatal stress exposure with increased fetal cortisol exposure and increased risk for adverse birth outcomes (i.e. low birth weight) and negative physical and mental health outcomes in adulthood, we will determine how cumulative maternal trauma prior to pregnancy and PTS during pregnancy are transmitted to offspring to impact vulnerability to adverse outcomes by assessing placental DNA methylation and fetal exposure to glucocorticoids via the umbilical cord.