Mechanisms of mindfulness training to prevent hypertensive disorders of pregnancy

摘要 妊娠期高血压疾病是影响妊娠的最常见的疾病， 美国孕产妇发病率和死亡率的主要原因。妊娠高血压疾病 增加怀孕期间暴露的妇女和婴儿的终生心脏病风险 独立的，特定性别的心血管危险因素，由美国心脏协会。当前 预防妊娠期高血压疾病的干预措施极其有限，效果甚微。 基于正念的干预措施作为一种预防疾病的非药物干预措施，前景看好。 妊娠高血压疾病；以正念为基础的干预显著降低 患有高血压和高血压前期的成年人。然而，基于正念的产前临床试验 干预措施已将有妊娠高血压疾病风险的妇女排除在外，以及 还没有研究正念对母亲心血管参数的影响。我们的产前随机对照试验 对妊娠期高血压疾病高危妇女的正念训练显示为中到大 妊娠期高血压疾病危险因素对母体心血管参数的影响 动态血压和胎儿生长速度加快。然而，解释效应的机制 产前注意力训练对妊娠期高血压疾病风险指标的影响尚不清楚。 在这些有希望的初步发现的基础上，拟议的RCT将利用主观和客观 生态瞬时评估(EMA)方法(体内重复评估)与 可穿戴生物传感器技术捕捉生态有效的心理(目标1)、生理的丰富时代 (目标2)和人际(目标3)过程，通过这些过程，正念训练可能会带来改善 孕妇的心血管参数和降低妊娠高血压疾病的风险。N=150 有HDP风险的孕妇将随机接受为期8周的电话正念干预或 照常照看。对于每个参与者，我们将测量产妇的心血管参数(24小时血液 超声多普勒测量子宫动脉压力和阻力值)。所有参与者 将在RCT前后完成为期两周的EMA，以评估正念机制 关于产妇心血管参数的培训。EMA将包括基于智能手机应用程序的体验采样 心理过程；基于智能手机应用程序的环境音频采样(即电子激活的 记录器[耳朵]方法)和可穿戴腕式生物传感器监测(心率和心率变异性) 对日常经历的生理反应。结果将提供对1)影响的新见解 正念训练对妊娠期心血管参数的影响2)孕期高血压的病理生理机制 妊娠高血压疾病，以及3)预防策略的新目标。

ABSTRACT Hypertensive disorders of pregnancy are the most common medical condition affecting pregnancy and a leading cause of maternal morbidity and mortality in the Unites States. Hypertensive disorders of pregnancy increase lifetime cardiac disease risk in women and infants exposed during pregnancy and are considered an independent, gender-specific cardiovascular risk factor by the American Heart Association. Current interventions to prevent hypertensive disorders of pregnancy are extremely limited and minimally effective. Mindfulness-based interventions hold significant promise as a non-pharmacological intervention to prevent hypertensive disorders of pregnancy; mindfulness-based interventions significantly reduce blood pressure in adults with hypertension and prehypertension. However, prenatal clinical trials of mindfulness-based interventions have excluded women at risk for hypertensive disorders of pregnancy from participating, and have not examined effects of mindfulness on maternal cardiovascular parameters. Our pilot RCT of prenatal mindfulness training for women at risk for hypertensive disorders of pregnancy demonstrated medium to large effects on maternal cardiovascular parameters of risk for hypertensive disorders of pregnancy, including lower ambulatory blood pressure and accelerated fetal growth velocity. However, the mechanisms explaining effects of prenatal mindfulness training on indicators of risk for hypertensive disorders of pregnancy are unknown. Building upon these promising preliminary findings, the proposed RCT will harness subjective and objective ecological momentary assessment (EMA) methodologies (in vivo repeated assessments) in combination with wearable biosensor technology to capture rich epochs of ecologically-valid psychological (Aim 1), physiological (Aim 2), and interpersonal (Aim 3) processes through which mindfulness training may lead to improved maternal cardiovascular parameters and reduced risk for hypertensive disorders of pregnancy. N=150 pregnant women at risk for HDP will be randomized to an 8-week phone-delivered mindfulness intervention or usual care. For every participant, we will measure maternal cardiovascular parameters (24-hour blood pressure and uterine artery resistance values by ultrasound Doppler) before and after the RCT. All participants will complete EMA for 2 weeks ‘bursts’ before and after the RCT to evaluate mechanisms of mindfulness training on maternal cardiovascular parameters. EMA will include smartphone-app based experience sampling of psychological processes; smartphone-app based ambient audio sampling (i.e. the Electronically Activated Recorder [EAR] method) and wearable wrist-worn biosensor monitoring (heart rate and heart rate variability) of physiological responses to everyday experiences. Results will provide new insights into 1) effects of mindfulness training on cardiovascular parameters in pregnancy, 2) pathophysiological mechanisms of hypertensive disorders of pregnancy, and 3) new targets for prevention strategies.