Reducing maternal prenatal depression to improve child cardiovascular health

项目摘要/摘要 了解健康的风险和保护因素对于优化发展成果和提供信息至关重要 预防终身不良健康行为。研究采用纵向设计，多水平 分析和试验性临床试验是必要的。心血管疾病(CVD)是导致 世界范围内的死亡。成人脑血管病的起源始于产前：高度的产前母亲抑郁症状 有力地预测后代患心血管疾病的风险。然而，关于儿童心血管疾病的风险和保护因素的知识 患有高度抑郁症状的母亲与此相关。目前还缺乏使用 随机对照试验(RCT)旨在了解导致儿童心血管疾病的潜在机制 暴露于多个级别的高度孕产妇产前抑郁症状后的风险(例如，孕产妇 和儿童行为、生理)随着时间的推移。虽然有效的干预措施可以减轻抑郁症状 在孕妇中，研究还没有调查是否可以减少产前母亲的抑郁 症状可以降低后代患心血管疾病的风险。目前的研究建议利用RCT的 有效的心理社会干预对孕产期抑郁的影响 抑郁症状改善了3-4岁儿童的心血管健康。我们假设 产前干预通过减少产前和产后抑郁症状来改善儿童 结果。这项研究将为患有高度产前抑郁的母亲的子女确定干预目标 减少心血管疾病风险的症状。这些目标将通过在RCT的基础上进行建设来实现 (R01MH109662)已建立的心理社会干预有效地减少了母亲产前 抑郁症状。我们建议利用这一独特的机会来跟踪那些 参与了这项随机对照试验，以测试这种干预是否改善了后代的心血管健康。这个项目 通过使用试验性随机对照试验设计，提高现有相关研究的严谨性。以下3项 目标将得到解决。目的1：测试减少产前抑郁症状是否能改善 母亲喂养孩子的食物质量，母亲的喂养行为，以及3岁时饮食行为的模范 好几年了。目的2：测试减少产前母亲抑郁症状是否能改善孩子的饮食、饮食 3岁时的行为、睡眠和体力活动。目标3：测试减少产前孕期产妇 抑郁症状降低了3岁和4岁儿童患心血管疾病的风险，包括体重指数、腰围、体脂、 血压和动脉僵硬。这个项目将为机械论提供迄今为止最有力的证据 孕期母亲抑郁症状对儿童心血管健康影响的模型重要的是， 该项目还将提供证据，表明是否采取有效的心理社会干预措施来减少产前孕产妇 应利用抑郁症状减轻下一代心血管疾病的负担。

PROJECT SUMMARY/ABSTRACT It is critical to understand risk and protective factors for health to optimize developmental outcomes and inform prevention of poor health behaviors across the lifespan. Research using longitudinal designs, multiple levels of analysis, and experimental clinical trials are needed. Cardiovascular disease (CVD) is the leading cause of death worldwide. The origins of adult CVD begin prenatally: High prenatal maternal depressive symptoms robustly predict offspring CVD risk. However, knowledge on risk and protective factors for CVD for offspring of mothers with high depressive symptoms has been correlational. There is a lack of experimental work using a randomized controlled trial (RCT) design to understand potential mechanisms that contribute to children's CVD risk following exposure to high maternal prenatal depressive symptoms across multiple levels (e.g., maternal and child behaviors, physiology) over time. Although efficacious interventions to diminish depressive symptoms among pregnant women exist, research has not investigated whether reducing prenatal maternal depressive symptoms can reduce offspring cardiovascular risk. The current study proposes to leverage a RCT of an effective psychosocial intervention for prenatal maternal depression to test whether reducing prenatal maternal depressive symptoms improves offspring cardiovascular health at ages 3-4 years. We hypothesize that the prenatal intervention operates by reducing both prenatal and postnatal depressive symptoms to improve child outcomes. This study will identify intervention targets for offspring of mothers with high prenatal depressive symptoms to reduce cardiovascular risk. These goals will be accomplished by building on a RCT (R01MH109662) of an established psychosocial intervention that effectively reduces maternal prenatal depressive symptoms. We propose to leverage this unique opportunity to follow up mothers and children who participated in this RCT to test whether this intervention improves offspring cardiovascular health. This project increases rigor of the existing correlational research by using an experimental RCT design. The following 3 aims will be addressed. Aim 1: To test whether reducing prenatal maternal depressive symptoms improves the quality of food the mother feeds her child, maternal feeding behaviors, and modeling of eating behaviors at 3 years. Aim 2: To test whether reducing prenatal maternal depressive symptoms improves child diet, eating behaviors, sleep, and physical activity at 3 years. Aim 3: To test whether reducing prenatal maternal depressive symptoms reduces child CVD risk at 3 and 4 years, including BMI, waist circumference, body fat, blood pressure, and arterial stiffness. This project will provide the strongest evidence to date for a mechanistic model of prenatal maternal depressive symptoms' influence on child cardiovascular health. Importantly, the project will also provide evidence for whether effective psychosocial interventions to reduce prenatal maternal depressive symptoms should be used to reduce the burden of CVD in the next generation.