Personalized care for prenatal stress reduction and preterm birth prevention

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PROJECT ABSTRACT This project addresses the critical barrier of solutions for preterm birth (PTB) by deploying a deploying a novel, personalized, comprehensive 3-tier PTB prevention program (UNC PTBCARE+) to reduce perinatal stress. There are significant PTB disparities; Black pregnant patients are 49% more likely to deliver preterm, have a higher risk of PTB at earlier gestational ages, report higher perceived stress, and have higher allostatic loads compared to patients of other races. UNC PTBCARE+ addresses stress and related mechanistic underpinnings of PTB. Our long-term goal is to refine and widely deploy an evidence-based intervention to mitigate stress during pregnancy and reduce PTB. The objective is to test, in a randomized controlled trial that will enroll 1,509 pregnant patients, whether our UNC PTBCARE+ program that provides a specific stress reduction toolkit and a PTB Care Coordinator (Tier 1, all patients randomized to UNC PTBCARE+), Enhanced Psychosocial support (Tier 2a level support, subset of patients who screen positive at randomization), Financial support (Tier 2b level support, subset of patients who screen positive at randomization), or both (Tier 3 level support) is associated with stress reduction (assessed subjectively by validated surveys and objectively by biomarkers), and PTB <35 weeks. Further, we will examine which interventions are most helpful, and will evaluate whether results vary by race. Our central hypothesis is that enrollment in our personalized, comprehensive PTB care program (UNC PTBCARE+) is associated with reduced stress, stress-related gene expression, allostatic load, and rates of PTB <35 weeks. We further hypothesize that UNC PTBCARE+ will most benefit non-White patients due to racism-associated stress, and that biologic analyses will provide key objective insight into the mechanisms underlying stress-related PTB and the impact of the intervention. This hypothesis is based upon our preliminary data indicating: (a) pregnant patients at UNC at high risk for PTB have high rates of stress and life stressors (e.g., financial insecurity, extreme racism), (b) biologic stress markers including gene transcript levels differ by PTB status in mid-pregnancy blood, (c) reduced stress among patients receiving specialty PTB prenatal care in a NC cohort. Building upon our prior work and that of others, this exciting proposal will identify which aspects of the UNC PTBCARE+ program are most critical for stress-related PTB reduction. We test our hypothesis through the following aims: Aim 1- Evaluate the effects of the UNC PTBCARE+ program on perceived stress and resilience in pregnant patients at high risk for PTB; Aim 2- Quantify the extent to which the UNC PTBCARE+ program is associated with improved biologic stress measures during pregnancy; Aim 3- Determine the effects of the UNC PTBCARE+ program on PTB <35 weeks. This study provides tangible, personalized solutions to the major public health problem of PTB and carries enormous potential to provide generalizable, low-risk strategies to reduce PTB and PTB related disparities.