Development of a lifestyle physical activity intervention to reduce risk for perinatal cannabis use

孕妇吸食大麻（CU）的比例正在急剧增加。相当大的比例 产前使用大麻的妇女表现出临床水平的痛苦（例如抑郁和焦虑）、状况 这已经增加了不良结果的风险。事实上，一些女性可能会使用大麻，因为它被认为是 与抑郁症和焦虑症的精神药物治疗相比，风险更小，或更容易接受。 与怀孕相关的身体症状（例如恶心）也被确定为 CU 的动机。然而，不利 与围产期 CU 相关的母亲和儿童的结局已有记录。尽管医疗 建议避免在怀孕期间使用大麻，目前尚无经过实证检验的有效方法 帮助孕妇这样做的干预措施。我们团队的试点数据以及其他人的研究结果表明 许多在产前继续使用 CU 的女性对其使用有矛盾的感受，并遇到挑战 随着退出的过程。在怀孕后能够戒除 CU 的女性中，复发率 这种情况并不少见，尤其是在分娩后。满足使用大麻的围产期妇女需求的干预措施 女性——迫切需要缓解痛苦（抑郁、焦虑）和身体症状（恶心、疼痛）。 体力活动 (PA) 干预措施可能作为痛苦孕妇的替代应对策略发挥关键作用 女性——从而减少 CU。我们的团队在开发孕妇 PA 干预措施方面拥有悠久的历史 妇女和有成瘾行为的个人。我们是第一批开发和测试生活方式的身体 活动（LPA）方法治疗抑郁症孕妇，以及针对抑郁症妇女的酒精治疗。 LPA 干预措施是简单的低成本方法，由简短的咨询和活动支持 监视器（例如 Fitbit）以促进目标设定和监控。因为 LPA 涉及短暂的活动 融入日常生活结构，孕妇可以即时进行PA来应对 负面影响或渴望作为 CU 的替代品。鉴于其作为一种有效的、可接受的和 为了减少围产期 CU，我们建议为妇女制定 LPA 干预措施 产前 CU 的高风险，并获得有关干预措施可行性和可接受性的数据。这款 R34 将具有 干预开发阶段，其中包括小型开放试点试验（N = 20），然后是试点 RCT 阶段，在此期间我们将进行一项试点随机试验 (N=50)，将 LPA Fitbit 状况与 仅 Fitbit 条件，对 CU、PA 和其他结果的多个点的评估扩展到 4 产后几周。在研究结束时，我们将开发并试点测试一种新颖的技术- 支持对产前 CU 高危孕妇进行 PA 干预。如果认为可以接受且可行， 这种干预的效果可以在随后的全功率试验中进行评估。最终，这项研究 将有助于制定女性的替代应对策略来管理她们的痛苦和症状 怀孕期间，从而减少产前 CU 并降低母婴不良结局的风险。

Rates of cannabis use (CU) among pregnant women are increasing dramatically. A sizable proportion of women who use cannabis prenatally exhibit clinical levels of distress (e.g., depression and anxiety), conditions that already raise risk for poor outcomes. Indeed, some women may use cannabis because it is perceived as less risky, or more acceptable, than psychopharmacological treatments for depression and anxiety. Pregnancy-related physical symptoms (e.g., nausea) are also identified motives for CU. However, adverse outcomes to both mother and child associated with perinatal CU have been documented. Despite medical recommendations to avoid cannabis use during pregnancy, there are currently no empirically-tested effective interventions to aid pregnant women in doing so. Our team’s pilot data, as well as others’ findings, show that many women who continue CU prenatally have conflicted feelings about their use, and experience challenges with the process of quitting. Among women who are able to quit CU when they become pregnant, relapse is not uncommon, especially after delivery. Interventions that address the needs of cannabis-using perinatal women - elevated distress (depression, anxiety) and physical symptoms (nausea, pain) are critically needed. Physical activity (PA) interventions may play a key role as an alternate coping strategy for distressed pregnant women – thus decreasing CU. Our team has a strong history of developing PA interventions for pregnant women and individuals with addictive behaviors. We were the first group to develop and test a lifestyle physical activity (LPA) approach with depressed pregnant women, and for women with depression in alcohol treatment. LPA interventions represent simple low-cost approaches that are supported by brief counseling and activity monitors (e.g., Fitbit) to facilitate goal-setting and monitoring. Because LPA involves short bouts of activity integrated into the structure of daily life, pregnant women can engage in PA in-the-moment to cope with negative affect or cravings as an alternate to CU. In light of its potential as an efficacious, acceptable, and disseminable intervention to reduce perinatal CU, we propose to develop an LPA intervention for women at high risk for prenatal CU, and obtain data on the intervention’s feasibility and acceptability. This R34 will have an intervention development phase, which will include a small open pilot trial (N=20), followed by a pilot RCT phase, during which we will conduct a pilot randomized trial (N=50) comparing the LPA+Fitbit condition to a Fitbit Only condition, with assessments of CU, PA, and other outcomes at multiple points extending to 4 weeks postpartum. At the study’s conclusion, we will have developed and pilot-tested a novel, technology- supported PA intervention for pregnant women at high risk for prenatal CU. If deemed acceptable and feasible, the efficacy of this intervention can be evaluated in a subsequent fully-powered trial. Ultimately, this research will facilitate development of an alternate coping strategy for women to manage their distress and symptoms during pregnancy, thus decreasing prenatal CU and lowering risk for adverse maternal and infant outcomes.