Mechanisms of mindfulness training to prevent hypertensive disorders of pregnancy

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PROJECT SUMMARY/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. Importantly, hypertensive disorders of pregnancy contribute to maternal health disparities; Black and Latina women have higher rates of hypertensive disorders, present with more severe disease, experience more critical complications (stroke, fetal demise, heart failure), and have higher mortality rates compared to non-Hispanic white women. Thus, interventions to prevent hypertensive disorders are urgently needed that are feasible, acceptable, and effective across minoritized populations. 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, Black and Latinx adults in the United States are less likely to engage in mindfulness training than white adults, and there has been low racial and ethnic diversity in prior RCTs of mindfulness-based interventions. Barriers to mindfulness participation including cultural factors, stigma, religious beliefs, time constraints, and caregiving responsibilities. Barriers are likely magnified in the perinatal period, yet no studies have developed culturally tailored mindfulness interventions for the prenatal period. In this administrative supplement, we propose to investigate 1) barriers and facilitators to participation in prenatal mindfulness training interventions, and 2) the stress buffering effects of mindfulness training on race-related stress and cardiovascular markers of risk for hypertensive disorders among Black and Latina pregnant women. We will examine these questions within an ongoing RCT of phone-delivered mindfulness training vs usual care among a racially diverse sample of pregnant patients who are at risk to develop hypertensive disorders of pregnancy (R01HL157288). Quantitative surveys will probe for experiences of discrimination and race-related vigilance prior to and during pregnancy. Qualitative interviews will identify barriers and facilitators of participation in prenatal mindfulness training among participants across racial and ethnic categories. Our investigative team is perfectly suited to execute this administrative supplement given our complementary expertise in culturally tailored mind-body interventions, women’s cardiovascular behavioral health, and qualitative study methods. Results from this study will lead to refinement of the prenatal phone-delivered mindfulness intervention to reduce cultural barriers to mindfulness participation and promote stress-buffering effects of mindfulness training prior to future dissemination of the intervention.