Self-Management of Chronic Depressive Symptoms in Pregnancy

 描述（由申请人提供）：医学研究所关于“慢性病患者生活良好”的报告表明，抑郁症状具有很大的威胁健康的潜力，特别是如果症状进展为进一步的慢性病或与其他慢性病共病。具有慢性抑郁症状的孕妇面临着重大的治疗挑战，因为抑郁症状与产前护理依从性降低、不良健康行为（例如，减少体力活动）和不良的母婴结局。此外，关于妊娠期间抗抑郁药物的安全性，存在相互矛盾的数据。怀孕期间有抑郁症状的女性非常需要安全，廉价，非药物，可获得和有效的自我管理（SM）疗法，以提高幸福感，减轻怀孕期间和产后期间的症状负担，并预防慢性后遗症。在这项申请中，我们将进行一项试点研究，测试一项名为“运动和症状的正念”（MOMS）的SM干预措施，旨在培养女性积极应对当前抑郁症状的能力，并增强弹性，以防止未来复发。我们将对40名有抑郁症状的孕妇进行为期12周的MOMS干预的纵向试点试验，主要目的是确定MOMS干预的可行性和可接受性，次要目的是检查MOMS干预对妊娠期和产后6周的母亲心理行为结局以及婴儿出生体重的初步影响。高度创新的第三个目标将探索与怀孕期间抑郁症状有关的全基因组和基因特异性表观遗传（DNA甲基化）模式，并调查参与MOMS干预是否可能改变这些模式。对于第二个和第三个目标，我们将这些生物行为结果与最近收集的现有研究（NIMHD 2 P60 MD 002256; PI：约克）的存档对照组数据进行比较，该研究包括在大量孕妇中重复测量相同的心理行为和表观遗传纵向结果以及婴儿的出生体重。这个由护士科学家、心理学家、统计遗传学方法学家和生物统计学家组成的跨学科团队能够很好地实现这项研究的目标。这项试点研究将提供重要的初步数据，MOMS干预作为一种连续的SM方法，在一个很大程度上研究不足的人群中使用行为科学和生物标志物的方法，为未来的随机对照试验的发展提供信息。这项研究也将履行R15机制的使命，让学生广泛参与研究活动。研究的目标与资金直接相关 这是PA-13-313（学术研究增强奖）的机会公告，反映了NICHD致力于投资研究，使创新的生物行为SM干预措施的发展，以提高母婴健康。

 DESCRIPTION (provided by applicant): The Institute of Medicine report on "Living Well with Chronic Conditions" suggests that depressive symptoms carry great potential to threaten well-being, particularly if symptoms progress to further chronic illness or are comorbid with other chronic conditions. Of great public health concern, pregnant women with chronic depressive symptoms face significant treatment challenges as depressive symptoms are associated with reduced adherence to prenatal care, poor health behaviors (e.g., diminished physical activity), and poor maternal-child outcomes. Moreover, there are conflicting data regarding the safety of antidepressant medications during pregnancy. Women with depressive symptoms during pregnancy are in great need of safe, inexpensive, nonpharmacologic, accessible, and effective self-management (SM) therapies to enhance well- being, reduce the burden of symptoms both during their pregnancy and into the postpartum period, and prevent chronic sequelae. In this application, we will conduct a pilot study testing a SM intervention entitled "Mindfulness of Movement and Symptoms" (MOMS), designed to foster women's ability to actively address current depressive symptoms and enhance resilience to prevent future recurrences. We will conduct a longitudinal pilot trial of the 12-week MOMS intervention with 40 pregnant women who have depressive symptoms with the primary aim of determining feasibility and acceptability of the MOMS intervention and the secondary aim of examining preliminary effects of the MOMS intervention on maternal psychobehavioral outcomes in pregnancy and at 6-weeks postpartum and on the baby's birth weight. The highly innovative third aim will explore genome-wide and gene-specific epigenetic (DNA methylation) patterns involved in depressive symptoms during pregnancy and investigate whether participation in the MOMS intervention might alter these patterns. For the second and third aims, we will compare these bio behavioral outcomes with recently collected archival comparison group data from an existing study (NIMHD 2P60MD002256; PI: York) that includes repeated measures of the same psychobehavioral and epigenetic longitudinal outcomes, and the baby's birth weight, in a large population of pregnant women. This interdisciplinary team of nurse scientists, psychologists, a statistical genetics methodologist, and a biostatistician is well positioned to accomplish the aims of the study. This pilot study will provide important preliminary data about the MOMS intervention as an adjunctive SM approach for depressive symptoms in a largely understudied population using behavioral science and biomarker approaches to inform the development of future randomized controlled trials. This study will also fulfill the mission of the R15 mechanism to involve students extensively in research activities. The goals of the research are directly in line with the funding opportunity announcement for PA-13-313 (Academic Research Enhancement Award) and reflect NICHD's commitment to invest in research that enables the development of innovative bio behavioral SM interventions to enhance maternal-child health.