PTSD and Pregnancy: Psychophysiology, Response to Treatment & Pregnancy Outcome

创伤后应激障碍（PTSD）和怀孕：心理生理学、治疗反应

• 批准号: 8813630
• 负责人: Sara L. Kornfield
• 金额: $ 1.56万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8813630
• 关键词: Acoustics; Address; African American; Aftercare; Arousal; Biological Markers; Brief Psychotherapy; Clinic; Clinical Research; Data; Development; Diagnostic; Diagnostic and Statistical Manual of Mental Disorders; Discipline of obstetrics; Disease; Distress; Drops; Electromyography; Evidence based treatment; Female; Foundations; Generations; Gestational Age; Goals; Growth; Health; Health behavior; Healthcare; Heart Rate; Hispanics; Hormonal; Hormones; Hydrocortisone; Intervention; K-Series Research Career Programs; Knowledge; Lead; Literature; Low Birth Weight Infant; Low income; Measures; Mental Health; Mental Health Services; Mentors; Minority; Minority Groups; Mood Disorders; National Institute of Mental Health; Outcome; Ovarian; Participant; Patients; Perinatal; Physiological; Plasma; Population; Population Heterogeneity; Positioning Attribute; Post-Traumatic Stress Disorders; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prenatal care; Primary Health Care; Procedures; Psychophysiology; Public Health; Quality of life; Randomized; Recruitment Activity; Regulation; Research; Risk; Role; Salivary; Sampling; Stimulus; Strategic Planning; Stress; Symptoms; Testing; Translating; Trauma; Treatment outcome; United States National Institutes of Health; Veterans; Woman; base; biological adaptation to stress; brief intervention; care delivery; clinically relevant; comparison group; experience; fetal; functional disability; hypothalamic-pituitary-adrenal axis; improved; inner city; innovation; male; meetings; novel; offspring; pregnancy hypertension; pregnant; prenatal; programs; racial and ethnic; response; stem; therapy design

DESCRIPTION (provided by applicant): Partial Posttraumatic Stress Disorder (pPTSD) describes trauma-related symptoms which cause distress and functional impairment yet do not meet full diagnostic criteria for disorder according to DSM. PTSD symptoms are more likely to occur in young, low-income, females than any other group, with partial symptoms especially prevalent among pregnant women (up to 28.6%). Experiencing these symptoms during pregnancy is likely to lead to poor prenatal care, adverse pregnancy outcomes, and lasting effects in the offspring. Hormonal shifts in pregnancy can influence the expression of the stress response in women with PTSD, especially as it relates to arousal, which is a cardinal symptom of PTSD. It is not yet known how normal pregnancy changes in ovarian, placental, and hypothalamic pituitary adrenal (HPA) axis hormones modulate arousal. This project aims to measure baseline autonomic response, as assessed by the acoustic startle response (ASR), in pregnant women with PTSD symptoms, pregnant women with trauma exposure and no PTSD symptoms, and non-traumatized controls. For women with partial and full symptoms of PTSD, a novel brief psychotherapy will be tested for the potential to reduce PTSD symptoms, and we will evaluate whether the treatment has an effect on the arousal rates as measured by the acoustic startle paradigm. Participants will be recruited from a prenatal clinic that primarily serves low-income, inner city, minority women. This is a population known to have high rates of trauma exposure in their lifetimes, who are unlikely to seek out mental health care, and who frequently drop out of mental health care during pregnancy. All study procedures, including the administration of the acoustic startle paradigm and the delivery of the brief psychotherapy, will take place in the prenatal clinic. We hypothesize that compared to women in the two comparison groups, pregnant women (gestational age 12-16 weeks) with partial or full symptoms of PTSD will demonstrate greater magnitude of ASR, higher levels of placental CRF, and lower salivary cortisol awakening response. We also expect that significantly more pregnant women receiving 4 sessions of the brief treatment will show decreases in PTSD symptoms than women randomized to a contact control. Lastly, we predict that the magnitude of the ASR will decrease from pre to post treatment in pregnant women who participate in all 4 treatment sessions compared to women in the contact control and that the magnitude of the decrease in ASR will be correlated with the decrease in PTSD symptoms as measured by the PTSD Checklist. We will also explore whether PTSD symptoms during pregnancy and HPA axis and arousal dysregulation increase a woman's risk for an adverse pregnancy outcome as defined by either preterm birth, low birth weight, or pregnancy induced hypertension.

描述（由申请人提供）：部分创伤后应激障碍（pPTSD）描述了导致痛苦和功能障碍的创伤相关症状，但不符合 DSM 的完整疾病诊断标准。与其他群体相比，年轻、低收入女性更容易出现 PTSD 症状，其中部分症状在孕妇中尤其普遍（高达 28.6%）。怀孕期间出现这些症状可能会导致不良的产前护理、不良的妊娠结局以及对后代的持久影响。怀孕期间的荷尔蒙变化会影响患有 PTSD 的女性应激反应的表达，尤其是与唤醒有关，而唤醒是 PTSD 的主要症状。目前尚不清楚正常妊娠时卵巢、胎盘和下丘脑垂体肾上腺 (HPA) 轴激素的变化如何调节觉醒。该项目旨在测量有 PTSD 症状的孕妇、有创伤暴露但无 PTSD 症状的孕妇以及未受创伤的对照组的基线自主反应，通过声惊吓反应 (ASR) 进行评估。对于具有部分和全部 PTSD 症状的女性，将测试一种新颖的简短心理治疗是否有可能减轻 PTSD 症状，并且我们将评估该治疗是否对通过声学惊吓范式测量的唤醒率有影响。参与者将从主要为低收入、内城区、少数族裔妇女服务的产前诊所招募。众所周知，这一人群一生中遭受创伤的几率很高，他们不太可能寻求心理保健，并且在怀孕期间经常放弃心理保健。所有研究程序，包括声学惊吓范式的管理和简短心理治疗的实施，都将在产前诊所进行。我们假设，与两个比较组中的女性相比，具有部分或全部 PTSD 症状的孕妇（胎龄 12-16 周）将表现出更严重的 ASR、更高水平的胎盘 CRF 和更低的唾液皮质醇觉醒反应。我们还预计，与随机接受接触对照的女性相比，接受 4 次简短治疗的孕妇的 PTSD 症状会明显减轻。最后，我们预测，与接触对照中的女性相比，参与所有 4 个治疗疗程的孕妇从治疗前到治疗后，ASR 的幅度将会下降，并且 ASR 下降的幅度将与 ASR 下降的幅度相关。通过 PTSD 检查表衡量的 PTSD 症状。我们还将探讨妊娠期间的 PTSD 症状以及 HPA 轴和唤醒失调是否会增加女性不良妊娠结局的风险，不良妊娠结局的定义是早产、低出生体重或妊娠高血压。