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

描述（由申请人提供）：部分创伤后应激障碍（pPTSD）描述了与创伤相关的症状，这些症状会导致痛苦和功能障碍，但根据DSM尚未达到疾病的全部诊断标准。与其他人群相比，PTSD症状更可能发生在年轻、低收入的女性中，部分症状在孕妇中尤为普遍（高达28.6%）。在怀孕期间出现这些症状可能导致产前护理不良，不良妊娠结局，并对后代产生持久影响。怀孕期间的荷尔蒙变化会影响PTSD女性的应激反应表达，尤其是当它与觉醒有关时，这是PTSD的主要症状。目前尚不清楚正常妊娠期间卵巢、胎盘和下丘脑垂体肾上腺轴激素的变化是如何调节唤醒的。本项目旨在测量基线自主神经反应，通过声惊吓反应（ASR）评估有创伤后应激障碍症状的孕妇、有创伤暴露但无创伤后应激障碍症状的孕妇和无创伤对照。对于有部分PTSD症状的女性，我们将测试一种新的简短的心理治疗，以减轻PTSD症状的可能性，我们将评估这种治疗是否对用声惊吓范式测量的唤醒率有影响。参与者将从一家产前诊所招募，该诊所主要服务于低收入、内城的少数族裔妇女。这是一个已知的在他们的一生中有高创伤暴露率的人群，他们不太可能寻求精神卫生保健。所有的研究程序，包括声学惊吓范式的管理和简短心理治疗的提供，将在产前诊所进行。我们假设，与两个对照组相比，患有部分或全部PTSD症状的孕妇（胎龄12-16周）会表现出更大程度的ASR，更高水平的胎盘CRF和更低的唾液皮质醇唤醒反应。我们还预计，接受4次简短治疗的孕妇，其部分PTSD症状的减轻程度明显高于随机分配到等候名单对照组的孕妇。最后，我们预测参加所有4个疗程的孕妇的ASR的大小从治疗前到治疗后会下降，与等候名单对照组的妇女相比，ASR的减少大小将与PTSD检查表测量的PTSD症状的减少相关。我们还将探讨怀孕期间的PTSD症状、HPA轴和觉醒失调是否会增加女性发生不良妊娠结局的风险，如早产、低出生体重或妊娠高血压。

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.