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

降低拉丁裔孕妇及其婴儿的生物心理社会风险：掌握生活方式干预

基本信息

批准号：
10579896
负责人：
Roberta Jeanne Ruiz
金额：
$ 62.72万
依托单位：
MICROGEN, LLC
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-08 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10579896
关键词：
Acculturation Address Admission activity American Anxiety Behavior Therapy Biological Birth Birth Weight Caproates Cervical Cerclage Child Clinical Cognitive Therapy Comprehensive Health Care Corticotropin-Releasing Hormone Depressed mood Diagnosis Discipline of obstetrics Estriol Gestational Age Gynecology Health Hispanic Hormonal Hydroxyprogesterone Infant Intervention Latina Latina Population Long-Term Effects Low Birth Weight Infant Manuals Mediating Mediator Medical Mental Depression Mexican Americans Mission Modeling Mothers National Institute of Child Health and Human Development Neurosecretory Systems Nurse Midwives Nurse Practitioners Outcome Participant Pharmaceutical Preparations Pilot Projects Population Postpartum Depression Pregnancy Premature Birth Prenatal care Progesterone Provider Psychological Stress Psychoneuroimmunology Public Health Randomized, Controlled Trials Reporting Research Risk Risk Factors Risk Reduction Stress Subgroup Testing Time Underserved Population United States Woman Work adverse birth outcomes antepartum depression anxiety reduction biopsychosocial care providers college coping depressive symptoms design early pregnancy effectiveness testing efficacy evaluation evidence base flexibility follow-up group intervention health disparity improved innovation intervention participants lifestyle intervention longitudinal analysis novel perceived stress pilot test pregnant premature prenatal health prevent problem solving therapy programs psychologic psychological distress psychosocial response screening treatment as usual treatment group

项目摘要

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.

项目总结/文摘