Randomized Trial of Mindfulness for African American Mothers with a Preterm/Low-Birth Weight Infant (MAAPI).

分娩早产/低出生体重（LBW）婴儿的妇女， 症状（压力、抑郁症状、焦虑、睡眠不佳、创伤后压力和疲劳）。此外，委员会认为， 围产期抑郁症状升高在处于不利地位的非裔美国妇女中更常见 (AAW)，与全国平均水平相比，AAW的产后死亡率几乎是全国平均水平的四倍。 创伤后压力此外，AAW有两倍的可能性有一个LBW婴儿和1.6倍更有可能提供 早产，与非西班牙裔白色女性相比。因此，早产儿/LBW婴儿的AAW增加 精神行为症状的风险，以及母亲/婴儿联系受损。这一关键的公共卫生 差异是我长期职业目标的动力：减少少数民族的心理行为症状 早产儿/LBW婴儿的母亲。我的K23培训目标是：1）制定和实施有效的临床 参与并保留早产/LBW婴儿AAW的试验，2）获得先进的实验室领导地位， 理解，3）获得研究临床试验方法和高级统计分析方面的培训，4） 获得成功竞争R 01资金的技能和科学基础，从而实现 作为临床研究者的独立性。我提出的研究的总体目标是评估一个文化 适应性正念干预早产儿/低出生体重儿（MAAPI），以减少产妇的心理， 行为症状和改善母亲/婴儿的联系。正念减压（MBSR） 通过提供减少心理行为反应的技能， 紧张的生活经历。在2019年，建议了AAW的文化适应正念策略 然而，很少有研究对NICU婴儿的母亲进行MBSR评估，MBSR既不适合也不适合 在AAW进行测试，他们在NICU有一个新生儿。本研究将采用随机临床试验， 试验，以评估MAAPI与教育计划（积极对照组）相比。以卡巴特为向导， 津恩的MBSR计划，MAAPI将文化适应AAW，通过借鉴AAW的著作/艺术 表达和灵性，使用讲故事，并促进自我赋权，以发展正念技能。 MAAPI将使用混合格式（五个虚拟Zoom会议和三个面对面会议）提供， 满足新妈妈的需求。具体目标是：1）确定MAAPI改进的程度 AAW与早产儿/LBW婴儿的心理行为症状和母亲/婴儿联系，2）探索 MAAPI对促炎细胞因子和催产素的影响。先前的工作表明压力增加 促炎细胞因子，但降低催产素水平。恢复这些生物标志物的平衡可能是一种 MAAPI减少母体心理行为症状并改善 母子情深MAAPI可以通过提供可扩展的正念来减少围产期健康差异 指导有风险的AAW母亲，他们还没有被现有的正念计划适当地瞄准。

Women who deliver a preterm/low birthweight (LBW) infant are at elevated risk for psycho-behavioral symptoms (stress, depressive symptoms, anxiety, poor sleep, posttraumatic stress, and fatigue). Moreover, elevated perinatal depressive symptoms are more common among disadvantaged African American women (AAW), compared to the national average, and AAW are almost four times as likely to have postpartum posttraumatic stress. Further, AAW are twice as likely to have a LBW infant and 1.6 times more likely to deliver preterm, compared to non-Hispanic White women. As a result, AAW with preterm/LBW infants are at increased risk for psycho-behavioral symptoms, and impaired mother/infant bonding. This critical public health disparity is the impetus for my long-term career goal: To reduce psycho-behavioral symptoms in minority mothers with preterm/LBW infants. My K23 training goals are; 1) develop and implement an effective clinical trial that engages and retains AAW with preterm/LBW infants, 2) acquire advanced laboratory leadership and understanding, 3) obtain training in research clinical trial methodology and advanced statistical analysis, 4) acquire the skills and scientific foundation to compete successfully for R01 funding, thereby achieving independence as a clinical investigator. The overall objective of my proposed study is to evaluate a culturally adapted Mindfulness Intervention for AAW with Preterm/LBW Infants (MAAPI) to reduce maternal psycho- behavioral symptoms and to improve mother/infant bonding. Mindfulness-based stress reduction (MBSR) has been shown to benefit other stressed populations by providing skills to reduce the psycho-behavioral response to stressful life experiences. In 2019 culturally adapted mindfulness strategies for AAW were recommended Yet few studies have evaluated MBSR for mothers with NICU infants, and MBSR has not been tailored for nor tested in AAW, who have a newborn in the NICU. This study will address this gap, using a randomized clinical trial, to assess MAAPI compared to an Educational Program (active comparison group). Guided by Kabat- Zinn’s MBSR program, MAAPI will be culturally adapted for AAW, by drawing upon AAW writings/artistic expressions and spirituality, using storytelling, and fostering self-empowerment to develop mindfulness skills. MAAPI will be delivered using a hybrid format (five virtual Zoom sessions and three face-to-face sessions) to meet constraints of new mothers. The Specific Aims are: 1) Determine the extent to which MAAPI improves psycho-behavioral symptoms and mother/infant bonding of AAW with preterm/LBW infants, 2) Explore the effects of MAAPI on proinflammatory cytokines and oxytocin. Prior work demonstrates stress to increase proinflammatory cytokines, but to decrease oxytocin levels. Restoring balance of these biomarkers may be a biological mechanism whereby MAAPI reduces maternal psycho-behavioral symptoms and improves mother/infant bonding. MAAPI may reduce perinatal health disparities by providing scalable mindfulness instruction to at risk AAW mothers, who have yet to be suitably targeted by existing mindfulness programs.