Project Summary/Abstract
Perinatal Mood and Anxiety Disorders (PMADs) encompass a range of mental health disorders that occur during
pregnancy and up to one year postpartum. Approximately 13% of women experience PMADs. This rate doubles
for those with adverse perinatal outcomes (APO) and triples in Black women. Recent research points to racism
as one significant source of these health disparities. Cultural adaptations to improve communication with
providers decrease rates of depression in minority patients as well as improve adherence to treatment, insight
and alliance. Discrimination stress and worries about experiencing medical consequences are thought to
increase systemic inflammation, a mechanism known to drive mental and physical symptoms. Inflammation has
been implicated in both PMADs and APO, suggesting a shared underlying etiology. Evidence from our work
suggests that inflammation contributes to the pathophysiology of PMADs. The proposed pilot randomized control
trial will allow us to build on promising preliminary results and identify whether our culturally relevant mobile
Health (mHealth) intervention is effective in improving outcomes among Black pregnant women randomized to
the intervention compared to a control group. The culturally relevant modules include building communication
and self-advocacy skills and provide a support network. The primary objective of this research is to provide
guidance for clinical care of Black women during the perinatal period, with the goal to improve mental
health and physical health outcomes. A secondary goal is to examine novel inflammatory signatures
that change as a function of the intervention to reduce PMADs in this population. As inflammation may be
diagnostic of PMADs, identification of its role may shed light of potential intervention targets and provide critical
knowledge to improve women’s long-term health. PMAD symptoms will be assessed prospectively in 150 Black
pregnant women, half of whom will be randomized to receive the culturally relevant mHealth intervention. We
hypothesize that women in the intervention group will have reduced rates of PMADs and APOs, an increase in
adherence to mental health treatment and will report increased self-advocacy skills, increased communication
with providers, and reduced levels of discrimination related stress. They will also have improved biological risk
indicators including lower circulating C-reactive protein and a transcription profile of differentially expressed
inflammatory genes, marked by a decreased activity of inflammatory transcription factors from blood spots. Given
the high burden of both PMADs and APOs among Black mothers and the numerous consequences on maternal
and child outcomes, it is imperative that we develop and implement effective interventions, and test the biological
mechanisms that might drive these effects. This work is interdisciplinary, building on a network of community
advocates to implement a novel mHealth intervention informed by real world experiences designed to enhance
self-advocacy, reduce stress and prevent adverse outcomes.
