The purpose of the proposed Mentored Research Scientist Career Development Award is to promote the candidate's development as an independent clinical trial researcher in mind-body medicine with a focus on reducing disparities in maternal-child health. Rates of preterm birth and low birth weight are increasing and are persistently higher among vulnerable U.S. populations. Animal and human models consistently implicate maternal stress as a significant risk factor in the etiology of adverse birth outcomes. Maladaptive patterns in hormonal and cardiovascular aspects of the stress response appear to be linked with preterm birth and low birth weight. In addition, psychological stress and poor coping may drive physiological stress responses that lead to adverse birth outcomes. Dr. Duncan's research, using the framework of revised Stress and Coping Theory (Folkman, 1997), has shown that pregnant women who learn mind-body practices during pregnancy report healthy improvements in levels of perceived stress, pregnancy anxiety, mindfulness, positive and negative affect, and depression in the perinatal period. The candidate seeks additional training in the design and conduct of randomized clinical trials (RCTs) of mind-body interventions and understanding of physiological and psychological mechanisms underlying the stress response during pregnancy. The University of California, San Francisco is an ideal environment for the proposed training because it provides access to experts in RCT methodology, integrative medicine, and the basic sciences of psychological and physiological aspects of the stress response, including the physiology of human pregnancy. The training plan includes formal coursework, informal tutorials with experts in their respective fields, and supervision of Dr. Duncan's leadership as PI on an RCT assessing the efficacy of a mind-body enhanced version of an existing, culturally-sensitive, group-based model of prenatal healthcare delivery. Rigorous testing of hypotheses regarding the impact of the mind-body practices will occur by comparing the effects of the mindbody enhanced program with the standard program. Effects of each intervention on psychological stress and coping mechanisms, stress physiology (neuroendocrine and cardiovascular/ autonomic nervous system function), and birth outcomes (gestational age and birth weight) will be compared. The results of the study will provide initial information about whether a mind-body intervention targeted to reduce stress during the perinatal period through mindfulness may provide clinical benefit for improving birth outcomes, thus informing development of an R01 proposal and advancing the long term goal of reducing health disparities.
Maternal stress is consistently linked with preterm birth and low birth weight. The integrative stress reduction intervention being tested targets psychological stress and coping, stress hormones, and cardiovascular stress reactivity through mindfulness practices. If the enhanced intervention is effective, it will help to address a key public health problem and may help reduce health disparities in maternal-child health.
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