PTSD and Pregnancy: Psychophysiology, Response to Treatment & Pregnancy Outcome

创伤后应激障碍（PTSD）和怀孕：心理生理学、治疗反应

• 批准号: 8700785
• 负责人: Sara L. Kornfield
• 金额: $ 14.3万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8700785
• 关键词: Acoustics; Address; African American; Aftercare; Arousal; Biological Markers; Brief Psychotherapy; Clinic; Clinical Research; Data; Development; Diagnostic; Diagnostic and Statistical Manual of Mental Disorders; Discipline of obstetrics; Disease; Distress; Drops; Electromyography; Evidence based treatment; Female; Foundations; Generations; Gestational Age; Goals; Growth; Health behavior; Healthcare; Heart Rate; Hispanics; Hormonal; Hormones; Hydrocortisone; Intervention; K-Series Research Career Programs; Knowledge; Lead; Literature; Low Birth Weight Infant; Low income; Measures; Mental Health; Mental Health Services; Mentors; Minority; Minority Groups; Mood Disorders; National Institute of Mental Health; Outcome; Ovarian; Participant; Patients; Perinatal; Physiological; Plasma; Population; Population Heterogeneity; Positioning Attribute; Post-Traumatic Stress Disorders; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prenatal care; Primary Health Care; Procedures; Psychophysiology; Public Health; Quality of life; Randomized; Recruitment Activity; Regulation; Research; Risk; Role; Salivary; Sampling; Stimulus; Strategic Planning; Stress; Symptoms; Testing; Translating; Trauma; Treatment outcome; United States National Institutes of Health; Veterans; Woman; base; biological adaptation to stress; brief intervention; care delivery; clinically relevant; comparison group; experience; fetal; functional disability; hypothalamic-pituitary-adrenal axis; improved; inner city; innovation; male; meetings; novel; offspring; pregnancy hypertension; pregnant; prenatal; programs; public health relevance; racial and ethnic; response; stem; therapy design

DESCRIPTION (provided by applicant): Partial Posttraumatic Stress Disorder (pPTSD) describes trauma-related symptoms which cause distress and functional impairment yet do not meet full diagnostic criteria for disorder according to DSM. PTSD symptoms are more likely to occur in young, low-income, females than any other group, with partial symptoms especially prevalent among pregnant women (up to 28.6%). Experiencing these symptoms during pregnancy is likely to lead to poor prenatal care, adverse pregnancy outcomes, and lasting effects in the offspring. Hormonal shifts in pregnancy can influence the expression of the stress response in women with PTSD, especially as it relates to arousal, which is a cardinal symptom of PTSD. It is not yet known how normal pregnancy changes in ovarian, placental, and hypothalamic pituitary adrenal (HPA) axis hormones modulate arousal. This project aims to measure baseline autonomic response, as assessed by the acoustic startle response (ASR), in pregnant women with PTSD symptoms, pregnant women with trauma exposure and no PTSD symptoms, and non-traumatized controls. For women with partial and full symptoms of PTSD, a novel brief psychotherapy will be tested for the potential to reduce PTSD symptoms, and we will evaluate whether the treatment has an effect on the arousal rates as measured by the acoustic startle paradigm. Participants will be recruited from a prenatal clinic that primarily serves low-income, inner city, minority women. This is a population known to have high rates of trauma exposure in their lifetimes, who are unlikely to seek out mental health care, and who frequently drop out of mental health care during pregnancy. All study procedures, including the administration of the acoustic startle paradigm and the delivery of the brief psychotherapy, will take place in the prenatal clinic. We hypothesize that compared to women in the two comparison groups, pregnant women (gestational age 12-16 weeks) with partial or full symptoms of PTSD will demonstrate greater magnitude of ASR, higher levels of placental CRF, and lower salivary cortisol awakening response. We also expect that significantly more pregnant women receiving 4 sessions of the brief treatment will show decreases in PTSD symptoms than women randomized to a contact control. Lastly, we predict that the magnitude of the ASR will decrease from pre to post treatment in pregnant women who participate in all 4 treatment sessions compared to women in the contact control and that the magnitude of the decrease in ASR will be correlated with the decrease in PTSD symptoms as measured by the PTSD Checklist. We will also explore whether PTSD symptoms during pregnancy and HPA axis and arousal dysregulation increase a woman's risk for an adverse pregnancy outcome as defined by either preterm birth, low birth weight, or pregnancy induced hypertension.

描述（由申请人提供）：部分创伤后应激障碍（pPTSD）描述了导致痛苦和功能障碍的创伤相关症状，但不符合DSM的完整诊断标准。创伤后应激障碍症状更容易发生在年轻，低收入，女性比任何其他群体，与部分症状尤其是孕妇（高达28.6%）。在怀孕期间经历这些症状可能会导致产前护理不良，不良妊娠结局以及对后代的持久影响。怀孕期间的激素变化可以影响PTSD女性的应激反应，特别是当它与觉醒有关时，这是PTSD的主要症状。目前尚不清楚正常妊娠中卵巢、胎盘和下丘脑垂体肾上腺（HPA）轴激素的变化如何调节唤醒。本项目旨在测量基线自主反应，评估声惊吓反应（ASR），在孕妇与创伤后应激障碍症状，孕妇与创伤暴露和无创伤后应激障碍症状，和非创伤对照。对于有部分和全部PTSD症状的女性，将测试一种新的简短心理治疗是否有可能减少PTSD症状，我们将评估治疗是否对通过声音惊吓范式测量的唤醒率有影响。参与者将从一家产前诊所招募，该诊所主要为低收入、市中心和少数民族妇女提供服务。这是一个已知的人口在他们的一生中有很高的创伤暴露率，他们不太可能寻求心理健康护理，并且在怀孕期间经常退出心理健康护理。所有研究程序，包括声惊吓范例的管理和简短心理治疗的提供，将在产前诊所进行。我们假设，与两个对照组的妇女相比，有部分或全部PTSD症状的孕妇（胎龄12-16周）将表现出更大的ASR，更高水平的胎盘CRF，和更低的唾液皮质醇觉醒反应。我们还预计，接受4次简短治疗的孕妇比随机分配到接触对照组的孕妇显着更多，PTSD症状会有所减轻。最后，我们预测，与接触对照组相比，参与所有4次治疗的孕妇的ASR幅度将从治疗前到治疗后降低，并且ASR降低的幅度将与PTSD症状的减少相关，如通过PTSD检查表测量的。我们还将探讨是否在怀孕期间的创伤后应激障碍症状和HPA轴和唤醒失调增加妇女的风险，为不良妊娠结局的定义是早产，低出生体重，或妊娠高血压综合征。