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）描述了与创伤相关的症状，这些症状会导致困扰和功能障碍，但不符合DSM的全部诊断标准。与其他任何群体相比，年轻，低收入，女性的PTSD症状更可能发生，孕妇的部分症状尤其普遍（高达28.6％）。怀孕期间经历这些症状可能会导致产前护理不良，不良怀孕结果和后代的持久影响。怀孕中的激素转移会影响PTSD女性的压力反应的表达，尤其是与唤醒有关，这是PTSD的基本症状。尚不清楚卵巢，胎盘和下丘脑垂体肾上腺（HPA）轴激素的正常妊娠变化如何调节唤醒。该项目的目的是通过声音惊吓反应（ASR），具有PTSD症状的孕妇，受创伤的孕妇和无PTSD症状以及非创伤对照的孕妇评估，旨在衡量基线自主反应。对于有PTSD的部分和全部症状的女性，将测试一种新型的简短心理治疗，以减少PTSD症状，我们将评估该治疗是否会影响由声学惊悚范式测量的唤醒率。参与者将是从主要为低收入，内城，少数民族妇女服务的产前诊所招募的。这是一个已知的人群，其一生中的创伤率很高，他们不太可能寻求精神卫生保健，并且在怀孕期间经常退出精神卫生保健。所有研究程序，包括施用声学惊吓范式和短暂心理治疗的递送，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，孕妇（妊娠12-16周）具有PTSD的部分或全部症状，将表现出更大的ASR，更高水平的胎盘CRF和较低的唾液皮质醇觉醒反应。我们还期望，与随机分配接触对照的女性相比，接受4次短暂治疗的孕妇明显更多的孕妇会显示PTSD症状的减少。最后，我们预测，与接触对照中的妇女相比，参加所有4个治疗课程的孕妇的ASR幅度将减少，而在接触对照中，ASR降低的幅度将与PTSD清单衡量的PTSD症状的降低相关。我们还将探讨怀孕期间的PTSD症状和HPA轴和唤醒失调是否会增加女性患不良怀孕结局的风险，这是早产，低出生体重或怀孕诱发的高血压所定义的。