Project 2: Maternal history of childhood sexual abuse and adverse perinatal outcomes: Harnessing novel ecological methods to understand mechanisms

项目摘要/摘要 在产科护理的妇女中，每5人中就有1人在童年经历过性虐待。有儿童性行为史的女性 虐待的人患妊娠期高血压疾病(HDP)的可能性要高出2倍，这是 美国的孕产妇和胎儿发病率和死亡率。每年花费21.8亿美元用于治疗 受影响的母亲和婴儿在产后一年。此外，HDP会增加终生心脏病风险 2-4倍，被美国心脏协会认为是独立的、特定于性别的心血管危险因素 协会。确定预防HDP的治疗目标在以下方面具有巨大的希望 预防晚年心血管疾病。儿童性虐待的母亲病史被假设为 通过应激诱导的自主神经系统的激活，增加患HDP的风险。常规产前检查 经历，包括产前护理预约、怀孕症状和胎儿移动，可能是一种 对于有儿童性虐待史的妇女来说，这是一个重要的压力来源 令人不安的前性虐待事件。因此，身体感觉的知觉(即，内感)， 可能在儿童性虐待妇女中触发自主应激反应并增加HDP的风险 历史。相反，与压力缓冲模型一致，支持性的社会背景可能会打断 对有儿童性虐待史的妇女来说，感觉间知觉和自主神经激活减少。这个 本研究的目的是描述产前的内感和自主神经反应的特征。 在有和没有CSA病史的女性中作为HDP途径的经历，并检查缓和 社会背景的作用。我们将使用一种新的方法，将EMA、动态生物识别 可穿戴技术和电子激活记录器(EAR)方法严格评估日常工作 怀孕期间对产前经历的感觉间和自主神经反应。这一领域的结果 预计研究将对该领域产生重要的积极影响，因为可能会使用新的知识 选择有意义的干预目标，以调节血压和HDP的发展，并 在以后的生活中预防心血管疾病。

PROJECT SUMMAY / ABSTRACT 1 in 5 women in obstetric care experienced sexual abuse in childhood. Women with histories of child sexual abuse are 2x more likely to experience hypertensive disorders of pregnancy (HDP), a leading cause of maternal and fetal morbidity and mortality in the United States. $2.18 billion is spent annually on treatment of affected mothers and infants in the year after delivery. In addition, HDP increases lifetime cardiac disease risk by 2-4X and is considered an independent, gender-specific cardiovascular risk factor by the American Heart Association. Identification of treatment targets for the prevention of HDP holds tremendous promise in the prevention of cardiovascular diseases later in life. Maternal history of child sexual abuse is hypothesized to increase risk for HDP through stress-induced activation of the autonomic nervous system. Routine prenatal experiences, including prenatal care appointments, pregnancy symptoms, and fetal movements, may be a significant source of stress for women with child sexual abuse histories as these experiences can serve as disturbing reminders of previous sexual abuse. Therefore, perceptions of bodily sensations (i.e., interoception), may trigger autonomic stress responses and increase risk for HDP among women with child sexual abuse histories. Conversely, consistent with the stress buffering model, supportive social context may interrupt interoceptive perceptions and decrease autonomic activation for women with child sexual abuse histories. The objective of the proposed study is to characterize interoceptive and autonomic responses to prenatal experiences as pathways to HDP in women with and without CSA histories, and to examine the moderating role of social context. We will use a novel methodological approach by integrating EMA, ambulatory biometric wearable technology, and electronically activated recorder (EAR) methods to rigorously assess daily interoceptive and autonomic responses to prenatal experiences across gestation. Results from this area of research are expected to have an important positive impact on the field because new knowledge may be used to select meaningful targets for interventions to regulate blood pressure and the development of HDP, and to prevent cardiovascular illness later in life.