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可能会导致母亲和她们的婴儿出现重大的长期健康问题。已确定的一种生物学机制是应激激素皮质醇，它可以增加女性在怀孕期间和产后出现与压力相关的健康并发症的风险。然而，调节皮质醇的最佳方法，以优化母婴健康结果，几乎没有受到关注。这项拟议的研究的目的是进行一项双臂随机对照研究，以测试产前认知行为压力管理(CBSM)干预在调节低收入孕妇皮质醇和压力水平方面的有效性。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培训)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干预的妇女是否会比随机接受标准护理对照组的妇女皮质醇产量和压力水平显著降低。这项研究还将研究皮质醇和压力水平的下降是否通过行为变化过程(例如，提高自我效能以及认知应对和放松技能的使用)来调节。这一假设是基于主要研究人员和研究合作者收集的初步数据而提出的。通过形成性研究，这项试点工作将开发并经验性地测试在低收入孕妇中使用的产前CBSM压力管理干预措施，供当地产前中心使用。这项拟议工作的结果具有重大的公共卫生影响，预计将促进我们对孕妇如何有效地利用这些认知、应对和放松技能来采取健康行为并产生积极影响她们和她们的婴儿健康的变化的理解。此外，拟议的研究将产生一种CBSM干预措施，该干预措施可以在社区环境中随时提供，可扩展，并且成本相对较低。最后，这些结果将有助于确定哪些孕妇在这些创新的压力管理方法上表现得特别好(或很差)。这对于根据个人需求和偏好定制CBSM项目具有重要意义。 与公共健康相关：越来越多的研究表明，怀孕期间经历高水平的压力，包括压力荷尔蒙皮质醇水平升高，可能会导致母亲及其婴儿出现重大的长期健康问题。这项拟议的研究的目的是测试在怀孕期间提供的创新压力管理干预是否在降低低收入孕妇的压力和皮质醇水平方面有效。拟议工作的结果在帮助预防母亲及其婴儿出现与压力有关的健康并发症方面具有重大的公共卫生影响。

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.