PTSD AND PREGNANCY: PSYCHOPHYSIOLOGY, RESPONSE TO TREATMENT & PREGNANCY OUTCOME

描述(由申请人提供)：根据DSM，部分创伤后应激障碍(PPTSD)描述与创伤相关的症状，这些症状导致痛苦和功能障碍，但不符合疾病的完全诊断标准。创伤后应激障碍症状更容易发生在年轻、低收入的女性中，部分症状在孕妇中尤其普遍(高达28.6%)。在怀孕期间经历这些症状可能会导致不良的产前护理，不良的妊娠结局，并对后代产生持久的影响。妊娠期间的荷尔蒙变化会影响患有创伤后应激障碍的女性的应激反应的表达，特别是当它与性唤醒有关时，这是创伤后应激障碍的主要症状。目前尚不清楚正常妊娠中卵巢、胎盘和下丘脑-垂体-肾上腺(HPA)轴激素是如何调节觉醒的。该项目旨在测量有创伤后应激障碍症状的孕妇、有创伤暴露但没有创伤后应激障碍症状的孕妇和未受创伤的对照组的基线自主神经反应，通过声学惊吓反应(ASR)进行评估。对于有部分创伤后应激障碍症状的女性，将测试一种新的简短心理疗法是否有可能减少创伤后应激障碍症状，我们将评估该治疗是否对通过声音惊吓范式衡量的唤醒比率有影响。参与者将从一家主要为低收入、市中心少数族裔妇女提供服务的产前诊所招募。众所周知，这一人群一生中暴露在创伤中的比例很高，他们不太可能寻求心理健康护理。所有的研究程序，包括声学惊吓范例的实施和短暂心理治疗的实施，都将在产前诊所进行。我们假设，与两个对照组的妇女相比，有部分或全部PTSD症状的孕妇(孕龄12-16周)将表现出更大的ASR程度，更高的胎盘CRF水平，以及更低的唾液皮质醇唤醒反应。我们还预计，与随机进入等待名单对照的孕妇相比，接受4个疗程的简短治疗的孕妇中将有更多的人表现出部分PTSD症状的减少。最后，我们预测，与等待名单对照组相比，参加所有4次治疗的孕妇在治疗前和治疗后ASR的幅度都会降低，而且ASR的下降幅度将与PTSD检查表测量的PTSD症状的减少相关。我们还将探讨妊娠期间的创伤后应激障碍症状和HPA轴和唤醒失调是否会增加女性发生早产、低出生体重或妊娠高血压综合征等不良妊娠结局的风险。

DESCRIPTION (provided by applicant): Partial Posttraumatic Stress Disorder (pPTSD) describes trauma-related symptoms which cause distress and functional impairment yet do not meet full diagnostic criteria for disorder according to DSM. PTSD symptoms are more likely to occur in young, low-income, females than any other group, with partial symptoms especially prevalent among pregnant women (up to 28.6%). Experiencing these symptoms during pregnancy is likely to lead to poor prenatal care, adverse pregnancy outcomes, and lasting effects in the offspring. Hormonal shifts in pregnancy can influence the expression of the stress response in women with PTSD, especially as it relates to arousal, which is a cardinal symptom of PTSD. It is not yet known how normal pregnancy changes in ovarian, placental, and hypothalamic pituitary adrenal (HPA) axis hormones modulate arousal. This project aims to measure baseline autonomic response, as assessed by the acoustic startle response (ASR), in pregnant women with PTSD symptoms, pregnant women with trauma exposure and no PTSD symptoms, and non-traumatized controls. For women with partial symptoms of PTSD, a novel brief psychotherapy will be tested for the potential to reduce PTSD symptoms, and we will evaluate whether the treatment has an effect on the arousal rates as measured by the acoustic startle paradigm. Participants will be recruited from a prenatal clinic that primarily serves low-income, inner city, minority women. This is a population known to have high rates of trauma exposure in their lifetimes and who are unlikely to seek out mental health care. All study procedures, including the administration of the acoustic startle paradigm and the delivery of the brief psychotherapy, will take place in the prenatal clinic. We hypothesize that compared to women in the two comparison groups, pregnant women (gestational age 12-16 weeks) with partial or full symptoms of PTSD will demonstrate greater magnitude of ASR, higher levels of placental CRF, and lower salivary cortisol awakening response. We also expect that significantly more pregnant women receiving 4 sessions of the brief treatment will show decreases in partial PTSD symptoms than women randomized to a wait-list control. Lastly, we predict that the magnitude of the ASR will decrease from pre to post treatment in pregnant women who participate in all 4 treatment sessions compared to women in the waitlist control and that the magnitude of the decrease in ASR will be correlated with the decrease in PTSD symptoms as measured by the PTSD Checklist. We will also explore whether PTSD symptoms during pregnancy and HPA axis and arousal dysregulation increase a woman's risk for an adverse pregnancy outcome as defined by either preterm birth, low birth weight, or pregnancy induced hypertension.