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.
