Mechanisms of mindfulness training to prevent hypertensive disorders of pregnancy

项目总结/摘要 妊娠期高血压疾病是影响妊娠的最常见的医学疾病， 这是美国孕产妇发病率和死亡率的主要原因。妊娠高血压疾病 增加妇女和婴儿在怀孕期间接触的终生心脏病风险， 独立的，性别特异性心血管危险因素由美国心脏协会。重要的是， 妊娠期高血压疾病导致产妇健康差异;黑人和拉丁裔妇女 高血压疾病的发生率越高，疾病越严重， 并发症（中风，胎儿死亡，心力衰竭），并有较高的死亡率相比，非西班牙裔 白色女人。因此，迫切需要可行的预防高血压疾病的干预措施， 在少数群体中是可接受的和有效的。基于正念的干预具有重要意义 承诺作为一种非药物干预，以防止妊娠高血压疾病;正念- 基于基础的干预措施可显著降低高血压和高血压前期成人的血压。 然而，美国的黑人和拉丁裔成年人不太可能参加正念训练， 白色成年人，并且在之前的基于正念的RCT中种族和民族多样性很低。 干预措施。正念参与的障碍包括文化因素，耻辱，宗教信仰，时间 约束和责任。在围产期，这些障碍可能会被放大，但没有研究表明， 已经为产前时期制定了文化定制的正念干预措施。本行政 补充，我们建议调查1）参与产前正念的障碍和促进因素 训练干预，以及2）正念训练对种族相关压力的压力缓冲作用， 黑人和拉丁裔孕妇高血压疾病风险的心血管标志物我们将 在一项正在进行的电话正念训练与常规护理的随机对照试验中研究这些问题， 妊娠期高血压疾病风险的不同种族妊娠患者样本 （R01HL157288）。定量调查将探讨歧视和种族相关警惕的经历 怀孕前和怀孕期间。定性访谈将确定参与的障碍和促进因素， 在不同种族和民族的参与者中进行产前正念训练。我们的调查小组 由于我们在文化方面的互补专长，我们非常适合执行这一行政补充 量身定制的身心干预，妇女的心血管行为健康，和定性研究方法。 这项研究的结果将导致产前电话传递正念干预的完善， 减少正念参与的文化障碍，促进正念的压力缓冲效果 在将来传播干预措施之前进行培训。

PROJECT SUMMARY/ABSTRACT Hypertensive disorders of pregnancy are the most common medical condition affecting pregnancy and a leading cause of maternal morbidity and mortality in the Unites States. Hypertensive disorders of pregnancy increase lifetime cardiac disease risk in women and infants exposed during pregnancy and are considered an independent, gender-specific cardiovascular risk factor by the American Heart Association. Importantly, hypertensive disorders of pregnancy contribute to maternal health disparities; Black and Latina women have higher rates of hypertensive disorders, present with more severe disease, experience more critical complications (stroke, fetal demise, heart failure), and have higher mortality rates compared to non-Hispanic white women. Thus, interventions to prevent hypertensive disorders are urgently needed that are feasible, acceptable, and effective across minoritized populations. Mindfulness-based interventions hold significant promise as a non-pharmacological intervention to prevent hypertensive disorders of pregnancy; mindfulness- based interventions significantly reduce blood pressure in adults with hypertension and prehypertension. However, Black and Latinx adults in the United States are less likely to engage in mindfulness training than white adults, and there has been low racial and ethnic diversity in prior RCTs of mindfulness-based interventions. Barriers to mindfulness participation including cultural factors, stigma, religious beliefs, time constraints, and caregiving responsibilities. Barriers are likely magnified in the perinatal period, yet no studies have developed culturally tailored mindfulness interventions for the prenatal period. In this administrative supplement, we propose to investigate 1) barriers and facilitators to participation in prenatal mindfulness training interventions, and 2) the stress buffering effects of mindfulness training on race-related stress and cardiovascular markers of risk for hypertensive disorders among Black and Latina pregnant women. We will examine these questions within an ongoing RCT of phone-delivered mindfulness training vs usual care among a racially diverse sample of pregnant patients who are at risk to develop hypertensive disorders of pregnancy (R01HL157288). Quantitative surveys will probe for experiences of discrimination and race-related vigilance prior to and during pregnancy. Qualitative interviews will identify barriers and facilitators of participation in prenatal mindfulness training among participants across racial and ethnic categories. Our investigative team is perfectly suited to execute this administrative supplement given our complementary expertise in culturally tailored mind-body interventions, women’s cardiovascular behavioral health, and qualitative study methods. Results from this study will lead to refinement of the prenatal phone-delivered mindfulness intervention to reduce cultural barriers to mindfulness participation and promote stress-buffering effects of mindfulness training prior to future dissemination of the intervention.