Reducing maternal prenatal depression to improve child cardiovascular health

项目总结/摘要 了解健康的风险和保护因素，以优化发育结果并为儿童提供信息， 预防整个生命周期的不良健康行为。研究采用纵向设计，多水平 分析和实验性临床试验是必要的。心血管疾病（CVD）是导致死亡的主要原因 国际吧成人心血管疾病的起源开始于产前：产前母亲抑郁症状高， 预测后代CVD风险。然而，母亲的后代对心血管疾病的风险和保护因素的认识 与高抑郁症状有相关性。目前缺乏使用随机 对照试验（RCT）设计，以了解导致儿童CVD风险的潜在机制， 在多个水平上暴露于高母体产前抑郁症状（例如，妇幼 行为、生理学）。虽然有效的干预措施，以减少抑郁症状， 孕妇存在，研究还没有调查是否减少产前产妇抑郁症状 可以降低后代的心血管风险。目前的研究建议利用一项有效的RCT， 心理社会干预对产前抑郁产妇的影响 抑郁症状可改善3-4岁子女的心血管健康。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的健康状况。 结果。本研究将为产前抑郁症高发母亲的后代确定干预目标 减少心血管疾病风险。这些目标将通过建立在随机对照试验基础上来实现 （R 01 MH 109662）一种既定的心理社会干预措施，有效地减少孕产妇产前 抑郁症状我们建议利用这一独特的机会，跟踪那些 参加了这项随机对照试验，以测试这种干预是否能改善后代的心血管健康。这个项目 通过使用实验RCT设计增加了现有相关性研究的严谨性。以下三个目标 将得到解决。目标1：测试减少产前孕产妇抑郁症状是否能提高质量 母亲喂养孩子的食物，母亲的喂养行为，以及3岁时的饮食行为模型。 目的2：测试减少产前母亲抑郁症状是否会改善儿童饮食，饮食行为， 睡眠和身体活动在3年。目的3：测试是否减少产前母亲抑郁症状 降低3岁和4岁儿童CVD风险，包括BMI、腰围、体脂、血压， 动脉僵硬该项目将提供最有力的证据，迄今为止的一个机制模型产前 母亲抑郁症状对儿童心血管健康的影响重要的是，该项目还将提供 是否有效的心理社会干预，以减少产前产妇抑郁症状的证据 应用于减少下一代CVD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.