Reductions in biopsychosocial risks for pregnant Latinas and their infants: the Mastery Lifestyle Intervention

项目摘要/摘要 怀孕的墨西哥裔美国妇女(西班牙裔妇女中最大的一个亚群)，此后 被称为拉丁裔的人，面临着越来越大的心理困扰风险，这会导致不利的 出生结局，如早产(PTB，胎龄37周)和低出生体重 (2500克)。我们之前的研究，使用了心理神经免疫学(PNI)框架， 确定了心理风险因素(抑郁症状、焦虑、压力、应对)和 神经内分泌危险因素(高促肾上腺皮质激素释放激素[CRH]，低孕酮， 妊娠22-24周时较高的雌三醇)是拉丁裔妇女肺结核的强烈预测因素。新的 针对这些风险因素的干预措施需要确定并进行严格的测试。致信地址 与拉丁裔干预措施相关的差距，我们已经开发并成功地进行了试点测试 掌握生活方式干预(MLI)：一个与文化相关的、人性化的心理社会团体 整合了两种循证行为疗法的干预--接受和 承诺疗法(ACT)和问题解决疗法(PST)。MLI是为期6周的项目 旨在融入常规产前护理，以促进更全面的护理 由执业护士(NP)或注册助产士(CNM)接生。我们建议 随机对照试验的以下目标：主要目标1：确定 MLI对怀孕的拉丁裔妇女降低抑郁症状、焦虑、知觉和 从基线(14-20)开始，与常规护理(UC)相比，适应压力和改善应对能力 孕周)到治疗结束(20-26周)和6周随访(26-32周) 孕周)，以文化适应和心理灵活性为中介。探险目标 2：探讨MLI对PTB神经内分泌危险因素(CRH、孕酮、 雌三醇)与UC从基线到治疗结束。探索性目标3：探索 MLI对婴儿出生结局(胎龄、出生体重、NICU入院)的影响。对以下项目的分析 每个假设都将依赖于具有随机影响的广义线性混合建模(GLMM) 参与者和必要的时间，以说明相关观察结果。纵向分析 我会将每个结果建模为治疗组、时间和之间的交互作用的函数 治疗组和治疗时间。我们还将使用扫描电子显微镜来分析调解人。 我们期待MLI将提供一个非常需要的、新颖的、可行的和有效的 在帮助提供者改善的治疗工具箱中增加了非药理学计划 孕期健康。嵌入产前护理，它针对的是 怀孕的拉丁裔妇女，服务不足的人群。它可以极大地降低 不良的分娩结局，从而减少对母亲和婴儿的破坏性和长期影响。

Project Summary/Abstract Pregnant Mexican-American women (the largest subgroup of Hispanic women), hereafter referred to as Latinas, are at increasing risk for psychological distress which leads to adverse birth outcomes such as preterm birth (PTB, gestational age < 37 weeks) and low birthweight (LBW, <2500 grams). Our prior research, using a psychoneuroimmunology (PNI) framework, has identified psychological risk factors (depressive symptoms, anxiety, stress, coping) and neuroendocrine risk factors (high Corticotropin Releasing Hormone [CRH], lower progesterone, higher estriol) at 22-24 weeks gestation as strong predictors of PTB in Latina women. New interventions targeting these risk factors need to be identified and rigorously tested. To address the gaps related to interventions for Latinas, we have developed and successfully pilot tested the Mastery Lifestyle Intervention (MLI): a culturally-relevant, manualized psychosocial group intervention that integrates two evidence-based behavioral therapies – Acceptance and Commitment Therapy (ACT) and Problem-Solving Therapy (PST). The MLI is a 6-week program designed to be integrated into regular prenatal care to facilitate more comprehensive care delivered by a nurse practitioner (NP) or certified nurse midwife (CNM). We propose the following aims for a randomized controlled trial: Primary Aim 1: Determine the efficacy of the MLI in pregnant Latina women to decrease depressive symptoms, anxiety, perceived and acculturative stress, and to improve coping, versus usual care (UC), from baseline (14-20 weeks gestation) to end-of-treatment (20-26 weeks gestation) and at a 6 week follow-up (26-32 weeks gestation), with acculturation and psychological flexibility as mediators. Exploratory Aim 2: Explore the effect of the MLI on neuroendocrine risk factors of PTB (CRH, progesterone, and estriol) versus UC from baseline to end-of treatment. Exploratory Aim 3: Explore the effect of the MLI on infant birth outcomes (gestational age, birthweight, NICU admission). Analyses for each hypothesis will rely on generalized linear mixed modeling (GLMM) with random effects for participant and time as necessary to account for correlated observations. Longitudinal analyses will model each outcome as a function of treatment group, time, and the interaction between treatment group and time. We will also use SEM to analyze for mediators. We expect the MLI will provide a greatly needed, novel, feasible, and effective nonpharmacological program added to the toolbox of treatments assisting providers to improve health during pregnancy. Embedded into prenatal care, it targets psychological distress among pregnant Latina women, an underserved population. It may substantially reduce the risks for poor birth outcomes, thus reducing devastating and long-term effects for both mother and infant.