Impact of a Cognitive Behavioral Stress Management Intervention on Cortisol Regul

描述（由申请人提供）：越来越多的研究表明，怀孕期间经历的压力会导致母亲和婴儿的长期健康问题。在怀孕和产后期间，压力荷尔蒙皮质醇增加了女性患压力相关健康并发症的风险，这是一种已被确定的生物学机制。然而，调节皮质醇以优化母婴健康结果的最佳方法却很少受到关注。拟议研究的目的是进行一个双臂；本研究旨在测试产前认知行为压力管理（CBSM）干预对低收入孕妇皮质醇和压力水平的调节效果。共有100名妇女将被随机分配到以小组为基础的8周产前CBSM组（即认知应对和放松技能训练）或标准护理对照组（即通常的产前和产后护理），以检查接受CBSM干预的妇女是否会显着降低皮质醇输出和压力水平，相对于随机分配到标准护理对照组的妇女。本研究还将探讨皮质醇和压力水平的降低是否通过行为改变过程（例如，提高自我效能和使用认知应对和放松技巧）来调节。这一假设是根据主要研究者和研究合作者收集的初步数据制定的。通过形成性研究，本试点工作将开发并实证检验一种针对低收入孕妇的产前CBSM压力管理干预措施，供当地产前中心使用。拟议的工作结果具有重大的公共卫生影响，并有望推进我们对孕妇如何有效地使用这些认知应对和放松技能来采用健康行为并产生可以积极影响其健康的变化的理解，以及他们的婴儿。此外，拟议的研究将产生一种CBSM干预措施，可以很容易地在社区环境中提供，可扩展，成本相对较低。最后，这些结果将有助于确定那些孕妇的亚组，这些亚组可能在这些创新的压力管理方法中做得特别好（或不好）。这对于根据个人需求和偏好定制CBSM课程具有重要意义。

DESCRIPTION (provided by applicant): As demonstrated by a growing number of studies, stress experienced during pregnancy can lead to significant long-term health problems for mothers and their infants. One biological mechanism that has been identified in heightening a woman's risk for developing stress-related health complications during pregnancy and the postpartum period is the stress hormone cortisol. However, the best methods for regulating cortisol, in order to optimize maternal and infant health outcomes, have received little attention. The objective of the proposed research is to conduct a two- arm; pilot randomized controlled study to test the efficacy of a prenatal cognitive behavioral stress management (CBSM) intervention in regulating cortisol and stress levels among low-income pregnant women. A total of 100 women will be randomized to either a group-based, 8-week prenatal CBSM arm (i.e., cognitive coping and relaxation skills training) or a standard-of-care comparison arm (i.e., usual pre- and postnatal care) to examine whether women receiving the CBSM intervention will have significantly lower cortisol output and stress levels, relative to women randomized to the standard-of-care comparison arm. This study will also examine whether these decreases in cortisol and stress levels are mediated through behavior change processes (e.g., increased self- efficacy and use of cognitive coping and relaxation skills). This hypothesis has been formulated on the basis of preliminary data collected by the principal investigator and study collaborators. Through formative research, this pilot work will develop and empirically test a prenatal CBSM stress management intervention among low-income pregnant women for use in local prenatal centers. The results of the proposed work have substantial public health implications and are expected to advance our understanding of how pregnant women effectively use these cognitive coping and relaxation skills to adopt healthy behaviors and produce change that can positively impact their health, as well as that of their infant. Further, the proposed research will yield a CBSM intervention that can be readily delivered in community settings, is scalable, and is relatively low cost. Finally, these results will help identify those subgroups of pregnant women that may do particularly well (or poorly) with these innovative approaches to stress management. This has important implications for the tailoring of CBSM programs to individual needs and preferences. PUBLIC HEALTH RELEVANCE: As demonstrated by a growing number of studies, experiencing high levels of stress during pregnancy, including elevated levels of the stress hormone cortisol, can lead to significant long-term health problems for mothers and their infants. The objective of the proposed research is to test whether an innovative stress management intervention, offered during pregnancy, is effective in reducing stress and cortisol levels among low-income pregnant women. The results of the proposed work have substantial public health implications in helping to prevent the onset of stress-related health complications among mothers and their infants.