Impact of a Cognitive Behavioral Stress Management Intervention on Cortisol Regul

描述（由申请人提供）：越来越多的研究表明，怀孕期间经历的压力可能会导致母亲及其婴儿严重的长期健康问题。已经确定的一种生物机制是压力荷尔蒙皮质醇，它增加了妇女在怀孕和产后期间患上与压力有关的健康并发症的风险。然而，调节皮质醇的最佳方法，以优化产妇和婴儿的健康结果，很少受到关注。拟议研究的目的是进行一项两组试验性随机对照研究，以测试产前认知行为压力管理（CBSM）干预在调节低收入孕妇皮质醇和压力水平方面的疗效。总共100名妇女将被随机分配到基于组的8周产前CBSM组（即，认知应对和放松技能训练）或标准护理比较组（即，通常的产前和产后护理），以检查接受CBSM干预的妇女是否会有显着降低皮质醇输出和压力水平，相对于随机分配到标准护理比较组的妇女。这项研究还将检查皮质醇和压力水平的这些降低是否通过行为改变过程（例如，提高自我效能和使用认知应对和放松技能）。该假设是根据主要研究者和研究合作者收集的初步数据制定的。通过形成性研究，这项试点工作将开发和实证测试产前CBSM压力管理干预低收入孕妇在当地产前中心使用。拟议工作的结果具有重大的公共卫生意义，预计将促进我们对孕妇如何有效地利用这些认知应对和放松技能来采取健康行为并产生积极影响的变化的理解，以及他们的婴儿的健康。此外，拟议的研究将产生CBSM干预，可以很容易地在社区环境中提供，是可扩展的，是相对较低的成本。最后，这些结果将有助于确定那些可能对这些创新的压力管理方法做得特别好（或不好）的孕妇亚组。这对于根据个人需求和偏好定制CBSM方案具有重要意义。 公共卫生相关性：越来越多的研究表明，怀孕期间经历高水平的压力，包括压力激素皮质醇水平升高，可能会导致母亲及其婴儿的严重长期健康问题。这项研究的目的是测试在怀孕期间提供的创新压力管理干预措施是否能有效降低低收入孕妇的压力和皮质醇水平。拟议工作的结果在帮助预防母亲及其婴儿出现与压力有关的健康并发症方面具有重大的公共卫生意义。

DESCRIPTION (provided by applicant): As demonstrated by a growing number of studies, stress experienced during pregnancy can lead to significant long-term health problems for mothers and their infants. One biological mechanism that has been identified in heightening a woman's risk for developing stress-related health complications during pregnancy and the postpartum period is the stress hormone cortisol. However, the best methods for regulating cortisol, in order to optimize maternal and infant health outcomes, have received little attention. The objective of the proposed research is to conduct a two- arm; pilot randomized controlled study to test the efficacy of a prenatal cognitive behavioral stress management (CBSM) intervention in regulating cortisol and stress levels among low-income pregnant women. A total of 100 women will be randomized to either a group-based, 8-week prenatal CBSM arm (i.e., cognitive coping and relaxation skills training) or a standard-of-care comparison arm (i.e., usual pre- and postnatal care) to examine whether women receiving the CBSM intervention will have significantly lower cortisol output and stress levels, relative to women randomized to the standard-of-care comparison arm. This study will also examine whether these decreases in cortisol and stress levels are mediated through behavior change processes (e.g., increased self- efficacy and use of cognitive coping and relaxation skills). This hypothesis has been formulated on the basis of preliminary data collected by the principal investigator and study collaborators. Through formative research, this pilot work will develop and empirically test a prenatal CBSM stress management intervention among low-income pregnant women for use in local prenatal centers. The results of the proposed work have substantial public health implications and are expected to advance our understanding of how pregnant women effectively use these cognitive coping and relaxation skills to adopt healthy behaviors and produce change that can positively impact their health, as well as that of their infant. Further, the proposed research will yield a CBSM intervention that can be readily delivered in community settings, is scalable, and is relatively low cost. Finally, these results will help identify those subgroups of pregnant women that may do particularly well (or poorly) with these innovative approaches to stress management. This has important implications for the tailoring of CBSM programs to individual needs and preferences. PUBLIC HEALTH RELEVANCE: As demonstrated by a growing number of studies, experiencing high levels of stress during pregnancy, including elevated levels of the stress hormone cortisol, can lead to significant long-term health problems for mothers and their infants. The objective of the proposed research is to test whether an innovative stress management intervention, offered during pregnancy, is effective in reducing stress and cortisol levels among low-income pregnant women. The results of the proposed work have substantial public health implications in helping to prevent the onset of stress-related health complications among mothers and their infants.