Randomized Trial of Mindfulness for African American Mothers with a Preterm/Low-Birth Weight Infant (MAAPI).

分娩早产/低出生体重(LBW)婴儿的女性患心理行为障碍的风险更高 症状(压力、抑郁症状、焦虑、睡眠不佳、创伤后应激和疲劳)。此外， 围产期抑郁症状升高在处于不利地位的非裔美国妇女中更为常见 (AAW)，与全国平均水平相比，AAW产后患病的可能性几乎是AAW的四倍 创伤后应激障碍。此外，AAW生LBW婴儿的可能性是前者的两倍，分娩的可能性是后者的1.6倍 早产，与非西班牙裔白人妇女相比。因此，早产儿/低出生体重儿的AAW增加 有心理行为症状和母婴亲和力受损的风险。这一至关重要的公共卫生 差异是我长期职业目标的动力：减少少数族裔的心理行为症状 早产/低出生体重儿的母亲。我的K23培训目标是：1)开发和实施有效的临床 与早产儿/低出生体重儿接触并保留AAW的试验，2)获得高级实验室领导力和 了解，3)获得研究临床试验方法学和高级统计分析方面的培训，4) 获得成功竞争R01资金的技能和科学基础，从而实现 作为一名临床研究人员的独立性。我提议的研究的总体目标是评估一个文化上的 对AAW伴早产/低出生体重儿的适应性正念干预(MAAPI)以减少母亲的心理问题 行为症状和改善母婴亲和力。基于正念的压力减轻(MBSR)有 已被证明通过提供技能来减少心理行为反应，从而使其他应激人群受益 压力很大的生活经历。2019年为AAW推荐了适应文化的正念策略 然而，很少有研究评估患有NICU婴儿的母亲的MBSR，而且MBSR还没有为NOR量身定做 在AAW进行了检测，他们有一名新生儿在NICU。这项研究将使用随机临床试验来解决这一差距。 试验，评估MAAPI与教育项目(积极对照组)的比较。在卡巴特的指引下- Zinn的MBSR计划，MAAPI将通过借鉴AAW的著作/艺术作品，在文化上适应AAW 表达和灵性，使用讲故事和培养自我赋权来发展正念技能。 MAAPI将使用混合格式(五次虚拟Zoom会议和三次面对面会议)交付，以 满足新妈妈的限制。具体目标是：1)确定MAAPI改进的程度 早产儿和低出生体重儿AAW的心理行为症状与母婴亲和力的关系 MAAPI对促炎症细胞因子和催产素的影响先前的工作表明压力会增加 促炎症细胞因子，但降低催产素水平。恢复这些生物标志物的平衡可能是 MAAPI减轻母体心理行为症状和改善的生物学机制 母婴纽带。MAAPI可能通过提供可扩展的正念来减少围产期健康差距 指导处于危险中的AAW母亲，她们还没有被现有的正念计划适当地瞄准。

Women who deliver a preterm/low birthweight (LBW) infant are at elevated risk for psycho-behavioral symptoms (stress, depressive symptoms, anxiety, poor sleep, posttraumatic stress, and fatigue). Moreover, elevated perinatal depressive symptoms are more common among disadvantaged African American women (AAW), compared to the national average, and AAW are almost four times as likely to have postpartum posttraumatic stress. Further, AAW are twice as likely to have a LBW infant and 1.6 times more likely to deliver preterm, compared to non-Hispanic White women. As a result, AAW with preterm/LBW infants are at increased risk for psycho-behavioral symptoms, and impaired mother/infant bonding. This critical public health disparity is the impetus for my long-term career goal: To reduce psycho-behavioral symptoms in minority mothers with preterm/LBW infants. My K23 training goals are; 1) develop and implement an effective clinical trial that engages and retains AAW with preterm/LBW infants, 2) acquire advanced laboratory leadership and understanding, 3) obtain training in research clinical trial methodology and advanced statistical analysis, 4) acquire the skills and scientific foundation to compete successfully for R01 funding, thereby achieving independence as a clinical investigator. The overall objective of my proposed study is to evaluate a culturally adapted Mindfulness Intervention for AAW with Preterm/LBW Infants (MAAPI) to reduce maternal psycho- behavioral symptoms and to improve mother/infant bonding. Mindfulness-based stress reduction (MBSR) has been shown to benefit other stressed populations by providing skills to reduce the psycho-behavioral response to stressful life experiences. In 2019 culturally adapted mindfulness strategies for AAW were recommended Yet few studies have evaluated MBSR for mothers with NICU infants, and MBSR has not been tailored for nor tested in AAW, who have a newborn in the NICU. This study will address this gap, using a randomized clinical trial, to assess MAAPI compared to an Educational Program (active comparison group). Guided by Kabat- Zinn’s MBSR program, MAAPI will be culturally adapted for AAW, by drawing upon AAW writings/artistic expressions and spirituality, using storytelling, and fostering self-empowerment to develop mindfulness skills. MAAPI will be delivered using a hybrid format (five virtual Zoom sessions and three face-to-face sessions) to meet constraints of new mothers. The Specific Aims are: 1) Determine the extent to which MAAPI improves psycho-behavioral symptoms and mother/infant bonding of AAW with preterm/LBW infants, 2) Explore the effects of MAAPI on proinflammatory cytokines and oxytocin. Prior work demonstrates stress to increase proinflammatory cytokines, but to decrease oxytocin levels. Restoring balance of these biomarkers may be a biological mechanism whereby MAAPI reduces maternal psycho-behavioral symptoms and improves mother/infant bonding. MAAPI may reduce perinatal health disparities by providing scalable mindfulness instruction to at risk AAW mothers, who have yet to be suitably targeted by existing mindfulness programs.