Low Birth Weight, Postpartum Depression, Premature Birth
Conditions
Keywords
mindfulness, stress, coping, emotion, depression, group medical visits, prenatal healthcare, preterm birth, birth weight, postpartum depression, cortisol, neuroendocrine function, blood pressure, health disparities
Brief summary
In the U.S., rates of preterm birth and low birth weight have increased over the past 30 years. Poor birth outcomes are especially high among racial/ethnic minority populations. Maternal stress is an important factor that can lead to negative birth outcomes. Thus, programs that reduce stress during pregnancy could improve birth outcomes. Initial pilot work tested a mindfulness-based approach to stress reduction during pregnancy. Women in the pilot study had lower stress and improved coping after the program. For the current study, mindfulness is added to an existing prenatal healthcare program called CenteringPregnancy (CP). CP provides prenatal care through 10 group sessions. This study compares CP with a version of CP infused with mindfulness skills training. Effects of the two versions of CP on psychological stress and coping, stress hormones, and birth outcomes will be tested. Data will be collected from participants three times: twice during pregnancy and once after birth. Medical records will provide data on birth outcomes and other health factors. The study will provide initial information about a mind-body program to reduce stress and improve birth outcomes. Data from the study will inform the development of an R01 proposal for a larger study. The study will also help advance the long term goal of reducing health disparities.
Interventions
BEHAVIORALCenteringPregnancy
CenteringPregnancy (CP) follows a standardized curriculum for group-based prenatal healthcare offered to groups of 10-12 women with similar due dates. In lieu of receiving a series of individually-delivered prenatal healthcare, participants meet 10 times over the course of pregnancy and early postpartum for 2 hour sessions, essentially pooling their minutes for each prenatal healthcare visit. The visit schedule adheres to the guidelines set forth by ACOG of monthly and then weekly visits close to birth. All sessions of CP include three core components of: (1) physical assessment (including blood pressure, weight, and fundal height assessment), (2) education and skills-building, and (3) support. Content topics for group discussion include nutrition, exercise, relaxation, understanding pregnancy problems, infant care and feeding, postpartum issues including contraception, comfort measures in pregnancy, sexuality and childbearing, abuse issues, parenting, and childbirth preparation.
BEHAVIORALCenteringPregnancy with Mindfulness Skills
CenteringPregnancy with Mindfulness Skills contains the CenteringPregnancy (CP) content combined with training in mindfulness meditation and mindful movement/yoga. The mind-body methods have been adapted from those taught in the Mindfulness-Based Childbirth and Parenting (MBCP) course, which is a tailored version of the Mindfulness-Based Stress Reduction program delivered to pregnant women during the perinatal period. These practices include mindfulness meditation of the breath, body, feelings, thoughts, and emotions; body scan meditation; yoga postures practiced with mindful awareness of the body and the physical changes associated with pregnancy; and loving-kindness meditation. In addition, MBCP includes specific exercises in coping with stress, pain, and fear associated with pregnancy, childbirth, and early parenting with a focus on shifting the way participants relate to negative thoughts and emotions and cope with stress.
Sponsors
University of California, San Francisco
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* age 18 and over * enrolled to receive group-based prenatal healthcare from the San Francisco General Hospital (SFGH) Outpatient Midwifery Clinic CenteringPregnancy program
Exclusion criteria
* ineligible for CenteringPregnancy due to the need for individualized prenatal care * Type 2 diabetes * HIV * seizure disorder * serious mental health disorder * substance abuse or medical condition that would lead to inability to adhere to intervention guidelines * not fluent in English or Spanish * previous formal training in meditation, yoga, or other mind-body practice * previous participation in CenteringPregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| preterm birth | post-birth | gestational age at birth and risk of preterm birth (\<37 weeks) |
| birth weight | post-birth | birth weight in grams, birth weight to gestational age ratio, and risk of low birth weight (\<2500 grams) |
| postpartum depression | post-birth | incidence of self-reported postpartum depression |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| change in and level of positive and negative emotion | second trimester, third trimester, post-birth | self-report of intensity and frequency of positive and negative affect |
| change in and level of pregnancy-related anxiety | second trimester, third trimester | self-report of pregnancy-related anxiety |
| change in and level of depressive mood | second trimester, third trimester | self-report of depressive mood |
| change in and level of perceived stress | second trimester, third trimester, post-birth | self-report of perceived life stress |
| change in and level of adrenocorticotropic hormone (ACTH) | second trimester, third trimester | adrenocorticotropic hormone (ACTH) assayed from blood plasma |
| change in and levels of corticotropin releasing hormone (CRH) | second trimester, third trimester | corticotropin releasing hormone (CRH) assayed from blood plasma |
| change in and levels of blood pressure | second trimester, third trimester | diastolic and systolic blood pressure |
| change in and levels of salivary cortisol | second trimester, third trimester | waking, 30-minutes post-waking, and bed-time salivary cortisol |
| change in and type(s) of coping | second trimester, third trimester, post-birth | self-report of coping with salient stressful aspects of pregnancy and parenting |
| change in and level of mindfulness | second trimester, third trimester, post-birth | self-report of mindfulness of daily experiences |
Countries
United States
Outcome results
None listed