Self-Management of Chronic Depressive Symptoms in Pregnancy



 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.