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

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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.