Helping Us Grow Stronger (HUGS/Abrazos): COVID-19 in pregnancy and reducing toxic stress in mother-infant dyads

项目摘要 怀孕和幼儿时期是一个独特的时期，两个人的生活可能会受到 产妇压力因素的存在，如经济不稳定、精神健康状况不佳和社会不平等， 而COVID-19疫情又进一步加剧了这一问题。COVID大流行也与 种族主义和孕产妇死亡率在美国蔓延，已经造成了不成比例的影响- 在大波士顿地区被边缘化的黑人和拉丁裔孕妇。在缺乏保护的情况下， 缓冲，长期暴露于过度逆境（“有毒压力”）可能导致健康状况不佳， 母亲和婴儿。采取有效干预措施，改善孕产妇心理健康，减少社会决定因素 因此，迫切需要对妊娠期COVID-19患者的健康状况进行评估。 帮助我们变得更强大（HUGS/Abrazos）是一个基于社区的计划，在2009年设计和推出。 新冠疫情。HUGS/Abrazos结合了紧急救援、患者导航和直接行为健康 支持培养复原力，减轻新冠肺炎相关毒性压力对孕妇和 产后妇女及其家庭。参加马萨诸塞州总医院COVID-19的参与者 如果SARS-CoV-2检测呈阳性，妊娠生物储存库将被转介到HUGS/Abrazos项目。 使用经过验证的调查工具，我们将评估该计划在多大程度上改善了产妇压力， 焦虑，抑郁，生活质量，粮食不安全，以及种族主义和歧视的经验，在这个高风险的 怀孕人口。我们还将评估母体COVID-19相关炎症对 使用来自参与者的库存血清样品的细胞因子分析的行为健康结果。这一紧迫 R 01的竞争性修订“母体肥胖中的胎儿脑-胎盘免疫激活”与 R 01的长期转化目标：了解子宫内暴露于母体炎症的方式， 免疫激活影响胎儿编程，以创造有针对性的干预措施，可以改善短期- 以及孕产妇暴露对孕产妇和儿童健康的长期影响。这项工作将产生 关于一种新的基于社区的干预措施的有效性的关键知识， 母亲SARS-CoV-2感染对母婴二分体的影响，并改善代际结局。

PROJECT SUMMARY Pregnancy and early childhood mark a unique period when two lives can be permanently impacted by the presence of maternal stressors such as economic instability, poor mental health, and social inequities, all of which have been amplified by the COVID-19 pandemic. The COVID pandemic has also collided with the epidemics of racism and maternal mortality plaguing the United States, to disproportionately impact already- marginalized Black and Latinx pregnant individuals in the greater Boston area. In the absence of protective buffers, prolonged exposure to excessive adversity (“toxic stress”) can lead to poor health outcomes for both mothers and infants. Effective interventions to improve maternal mental health and mitigate social determinants of health in individuals with COVID-19 in pregnancy are therefore urgently needed. Helping Us Grow Stronger (HUGS/Abrazos) is a community-based program, designed and launched during the COVID pandemic. HUGS/Abrazos combines emergency relief, patient navigation, and direct behavioral health support to foster resilience and mitigate the negative impacts of COVID-related toxic stress on pregnant and postpartum women and their families. Participants enrolled in Massachusetts General Hospital’s COVID-19 Pregnancy Biorepository will be referred to the HUGS/Abrazos program if they test positive for SARS-CoV-2. Using validated survey instruments, we will assess the extent to which the program improves maternal stress, anxiety, depression, quality of life, food insecurity, and experiences of racism and discrimination in this high-risk pregnant population. We will also assess the impact of maternal COVID-19-associated inflammation on behavioral health outcomes using cytokine analysis of banked serum samples from the participants. This urgent competitive revision of the R01 “Fetal Brain-Placental Immune Activation in Maternal Obesity” is aligned with the R01’s long-term translational goals: to understand how in utero exposure to maternal inflammation and immune activation impacts fetal programming, in order to create targeted interventions that can improve short- and long-term maternal and child health outcomes in the face of maternal exposures. This work will generate key knowledge about the efficacy of a novel community-based intervention to reduce the adverse impact of maternal SARS-CoV-2 infection on the mother-infant dyad, and improve transgenerational outcomes.