Reductions in biopsychosocial risks for pregnant Latinas and their infants: the Mastery Lifestyle Intervention

降低拉丁裔孕妇及其婴儿的生物心理社会风险：掌握生活方式干预

• 批准号: 10117401
• 负责人: Roberta Jeanne Ruiz
• 金额: $ 64.34万
• 依托单位: MICROGEN, LLC
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-08 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10117401
• 关键词: Acculturation; Address; Admission activity; American; Anxiety; Behavior Therapy; Biological; Birth; Caproates; Cervical Cerclage; Child; Clinical; Cognitive Therapy; Comprehensive Health Care; Corticotropin-Releasing Hormone; Depressed mood; Diagnosis; Discipline of obstetrics; Estriol; Gestational Age; Gynecology; Health; Hispanics; Hormonal; Hydroxyprogesterone; Infant; Intervention; Latina; Long-Term Effects; Low Birth Weight Infant; Mediating; Mediator of activation protein; Medical; Mental Depression; Mexican Americans; Mission; Modeling; Mothers; National Institute of Child Health and Human Development; Neurosecretory Systems; Nurse Midwives; Nurse Practitioners; Outcome; Participant; Pharmaceutical Preparations; Pilot Projects; Population; Postpartum Depression; Pregnancy; Premature Birth; Prenatal care; Progesterone; Provider; Psychological Stress; Psychoneuroimmunology; Public Health; Randomized Controlled Trials; Reporting; Research; Risk; Risk Factors; Stress; Stress and Coping; Subgroup; Testing; Time; Underserved Population; United States; Woman; Work; adverse birth outcomes; antepartum depression; base; biopsychosocial; care providers; college; coping; depressive symptoms; design; early pregnancy; effectiveness testing; evidence base; flexibility; follow-up; group intervention; health disparity; improved; innovation; intervention participants; lifestyle intervention; longitudinal analysis; novel; perceived stress; pregnant; premature; prenatal health; prevent; problem solving therapy; programs; psychologic; psychological distress; psychosocial; response; screening; treatment as usual; treatment group

Project Summary/Abstract Pregnant Mexican-American women (the largest subgroup of Hispanic women), hereafter referred to as Latinas, are at increasing risk for psychological distress which leads to adverse birth outcomes such as preterm birth (PTB, gestational age < 37 weeks) and low birthweight (LBW, <2500 grams). Our prior research, using a psychoneuroimmunology (PNI) framework, has identified psychological risk factors (depressive symptoms, anxiety, stress, coping) and neuroendocrine risk factors (high Corticotropin Releasing Hormone [CRH], lower progesterone, higher estriol) at 22-24 weeks gestation as strong predictors of PTB in Latina women. New interventions targeting these risk factors need to be identified and rigorously tested. To address the gaps related to interventions for Latinas, we have developed and successfully pilot tested the Mastery Lifestyle Intervention (MLI): a culturally-relevant, manualized psychosocial group intervention that integrates two evidence-based behavioral therapies – Acceptance and Commitment Therapy (ACT) and Problem-Solving Therapy (PST). The MLI is a 6-week program designed to be integrated into regular prenatal care to facilitate more comprehensive care delivered by a nurse practitioner (NP) or certified nurse midwife (CNM). We propose the following aims for a randomized controlled trial: Primary Aim 1: Determine the efficacy of the MLI in pregnant Latina women to decrease depressive symptoms, anxiety, perceived and acculturative stress, and to improve coping, versus usual care (UC), from baseline (14-20 weeks gestation) to end-of-treatment (20-26 weeks gestation) and at a 6 week follow-up (26-32 weeks gestation), with acculturation and psychological flexibility as mediators. Exploratory Aim 2: Explore the effect of the MLI on neuroendocrine risk factors of PTB (CRH, progesterone, and estriol) versus UC from baseline to end-of treatment. Exploratory Aim 3: Explore the effect of the MLI on infant birth outcomes (gestational age, birthweight, NICU admission). Analyses for each hypothesis will rely on generalized linear mixed modeling (GLMM) with random effects for participant and time as necessary to account for correlated observations. Longitudinal analyses will model each outcome as a function of treatment group, time, and the interaction between treatment group and time. We will also use SEM to analyze for mediators. We expect the MLI will provide a greatly needed, novel, feasible, and effective nonpharmacological program added to the toolbox of treatments assisting providers to improve health during pregnancy. Embedded into prenatal care, it targets psychological distress among pregnant Latina women, an underserved population. It may substantially reduce the risks for poor birth outcomes, thus reducing devastating and long-term effects for both mother and infant.

项目摘要/摘要 怀孕的墨西哥裔美国妇女（西班牙裔妇女最大的亚组） 被称为拉丁裔，正在增加心理困扰的风险，导致不利 出生结果，例如早产（PTB，胎龄<37周）和低出生体重 （LBW，<2500克）。我们先前使用Psychoneuromumumumanology（PNI）框架的研究， 已经确定了心理危险因素（抑郁症状，焦虑，压力，应对）和 神经内分泌危险因素（高皮质激素释放激素[CRH]，孕酮较低，孕酮， 较高的雌二醇）在妊娠22-24周，作为拉丁裔女性PTB的强有力预测指标。新的 针对这些风险因素的干预措施需要识别并严格测试。解决 与拉丁裔干预措施有关的差距，我们已经开发并成功进行了测试 精通生活方式干预（MLI）：一个与文化相关的，手动的社会心理群体 整合两种基于证据的行为疗法的干预措施 - 接受和 承诺疗法（ACT）和解决问题的疗法（PST）。 MLI是一个为期6周的计划 旨在融入常规产前护理中，以促进更全面的护理 由护士执业者（NP）或经过认证的护士助产士（CNM）交付。我们建议 以下目的是进行随机对照试验：主要目的1：确定效率 孕妇拉丁裔女性的MLI减轻抑郁症状，动画，感知和 适应性压力，并改善应对与常规护理（UC）（UC），从基线（14-20） 妊娠周）到治疗终结（妊娠20-26周）和6周的随访（26-32 妊娠周），作为调解人的培养和心理灵活性。探索目标 2：探索MLI对PTB神经内分泌危险因素的影响（CRH，孕酮和 从基线到治疗的UC与UC相比。探索目的3：探索效果 关于婴儿出生结果的MLI（胎龄，出生体重，NICU入院）。分析 每个假设将依赖于具有随机效应的广义线性混合建模（GLMM） 参与者和必要的时间来考虑相关观察。纵向分析 将每个结果建模为治疗组，时间和相互作用的函数 治疗组和时间。我们还将使用SEM分析调解人。 我们预计MLI将提供大量需要，新颖，可行和有效的 非药理学计划添加到治疗工具箱中，以帮助提供者改进 怀孕期间的健康。嵌入产前护理中，它针对的是心理困扰 怀孕的拉丁妇女，服务不足的人口。它可能会大大降低 出生结果不佳，从而减少了母亲和婴儿的毁灭性和长期影响。