An Internet-Delivered Mind-Body Program for Reducing Prenatal Maternal Stress

项目摘要。 产前母亲压力（PNMS）通常被定义为压力性生活事件的组合， 感知压力，怀孕特有的压力，以及抑郁和焦虑的症状。这是一个公认的 早产和低出生体重的风险因素，这两者都是婴儿死亡的主要原因， 以及慢性健康问题。它也是产后产妇心理健康最可靠的预测指标之一。 健康问题尽管如此，由于筛查不足， 药物安全、耻辱、获得护理的实际障碍以及缺乏循证干预措施。因此，在本发明中， 迫切需要为PNMS制定全面的干预措施， 妇女在怀孕期间。K23提案的长期目标是建立一个研究项目， 治疗PNMS的方法，这些方法对妇女的精神和身体健康具有明显的益处， 孩子本申请的总体目标是评价可行性（主要目的）、可接受性和 SMART妊娠计划的初步疗效（次要目标），一种基于多模式CBT的身心 通过视频会议提供PNMS干预。行为干预技术，如视频监控- 咨询可以最大限度地减少获得护理的实际障碍。具体目标是：第一阶段方案开发- 目标1：我们将确定治疗需求和偏好，治疗参与的障碍， 使用焦点小组方法（N = 6组，每组6-8人）制定适当的对策。数据将被合成- 规模和用于开发在线智能怀孕计划。目标2：我们将完善并最终确定治疗方案- 通过在线视频会议进行SMART妊娠方案的开放试点， ing（N = 8）。离职面谈将用于评估可及性、对需求的适应性和离职障碍。 坚持和坚持。第二阶段：项目可行性：目标1（主要）：我们将研究 进行随机对照试验，将PNMS升高的女性随机分配至在线SMART妊娠 组（n=30）或常规治疗（TAU; n=30）。我们将评估合格率，入学率和保留率。 我们预测所有3次研究随访的保留率> 75%。目标2（次要）：我们将收集治疗数据- 治疗依从性（参加的治疗次数）和初步疗效。我们预测SMART妊娠颗粒- pants将参加>75%的在线会议，并将显示更大的减少痛苦和改善， 治疗后应激调节作用优于TAU。我们还将探讨治疗对孕产妇健康的影响， 交付成果。职业发展目标包括：发展围产期压力和心理方面的专业知识 健康，学习优化干预措施的混合方法技术，并获得评估经验- 围产期健康和分娩结果的影响。一个由围产期应激方面的主要专家组成的多学科小组 （Marci Lobel博士），围产期学（大卫加里DO，MFM），身心医学和混合方法（Elyse R。 公园博士，公共卫生硕士），和granimetry/RCT的实施（亚当冈萨雷斯博士）将提供指导。

Project Summary. Prenatal Maternal Stress (PNMS) is commonly defined as the combination of stressful life-events, elevated perceived stress, pregnancy-specific stress, and symptoms of depression and anxiety. It is a well-established risk factor for preterm delivery and low birth-weight, both of which are leading causes of infant mortality, mor- bidity and chronic health problems. It is also one of the most robust predictors of postpartum maternal mental health problems. Despite this, PNMS often remains untreated due to inadequate screening, concerns about medication safety, stigma, practical barriers accessing care, and a lack of evidence based interventions. Thus, there is a critical need for the development of comprehensive interventions for PNMS that are accessible to women during pregnancy. The long-term goal of this K 23 proposal is to build a program of research focused on methods for treating PNMS that have demonstrable mental and physical health benefits for woman and children. The overall objective of this application is to evaluate the feasibility (primary aim), acceptability and preliminary efficacy (secondary aims) of the SMART-Pregnancy Program a multimodal CBT-based mind-body intervention for PNMS delivered via videoconferencing. Behavioral intervention technologies such as videocon- ferencing can minimize practical barriers to accessing care. The specific aims are: Phase 1 Program Devel- opment: Aim 1: We will identify treatment needs and preferences, barriers to treatment engagement and ap- propriate countermeasures using a focus group approach (N = 6 groups, 6-8 per group). Data will be synthe- sized and used to develop the online SMART-Pregnancy Program. Aim 2: We will refine and finalized treat- ment modifications by conducting an open pilot of the SMART-Pregnancy protocol via online videoconferenc- ing (N = 8). Exit interviews will be used to assess accessibility, goodness of fit to needs, and barriers to en- gagement and adherence. Phase 2: Program Feasibility: Aim 1 (primary): We will examine the feasibility of conducting an RCT in which women with elevated PNMS are randomized to an online SMART-Pregnancy group (n=30) or treatment as usual (TAU; n=30). We will evaluate rates of eligibility, enrollment, and retention. We predict > 75% retention through all 3 study follow-ups. Aim 2 (secondary): We will collect data on treat- ment adherence (# of sessions attended) and preliminary efficacy. We predict that SMART-Pregnancy partici- pants will attend >75% of online sessions and will display greater reductions in distress and improvements in stress regulation at post-treatment than TAU. We will also explore treatment impact on maternal health and delivery outcomes. Career development goals include: developing expertise in perinatal stress and mental health, learning mixed-methods techniques for optimizing interventions, and gaining experience in the assess- ment of perinatal health and birth outcomes. A multidisciplinary team of leading experts in perinatal stress (Marci Lobel PhD), perinatology (David Garry DO, MFM), mind-body medicine, and mixed-methods (Elyse R. Park PhD, MPH), and grantsmanship/RCT implementation (Adam Gonzalez PhD) will provide mentorship.