Feasibility, technical performance, and acceptability of a wearable Maternal Stress Tracker (MaST) in monitoring the daily stress experienced during the postpartum period - Modified Project Summary Section PROJECT SUMMARY Women experience significant postpartum stress due to the physical, psychological, and social adjustments associated with the postpartum period. The current postpartum follow-up schedule does not adequately monitor daily stress, and prolonged untreated stress increases the risks of maternal morbidity and mortality. Therefore, this pilot study aims to test the feasibility, technical performance, and acceptability of a wearable Maternal Stress Tracker (MaST) in monitoring the daily stress experienced during the postpartum. To accomplish this goal, we propose three aims:1) Investigate the feasibility and technical performance of the MaST wearable device (Garmin Viviosmart 4’ wristwatch) to accurately monitor postpartum sleep and daily stress calculated as a proprietary composite of the real-time measurements of heart rate (HR), and Heart Rate Variability (HRV). We will also assess concordance of wristwatch-sensed stress with a chronic stress biomarker (hair cortisol), in addition to blood pressure (BP) monitoring and social needs assessments using the PhenX toolkit44, including: a) housing instability b) money to pay bills, c) shut off utilities, d) food insecurity, e) transportation, f) childcare, g) job insecurity, and h) safety. 2) Examine the ability of the MaST wearable device to transmit the HR and HRV data used to determine stress, and sleep data via Bluetooth to the mEMA app on the user's phone, trigger surveys to measure stress and depressive symptoms, and generate alerts in real-time based on the woman’s stress levels to both the user and study staff to deliver the immediate personalized intervention. 3) To assess the usefulness, acceptability, and satisfaction with the MaST wearable device, the process of survey triggers and responses to survey questions about their stress and mood. We will recruit 64 women, provide them with the MaST in the postpartum period during their birth hospitalization, and follow them for six weeks. MaST biosensor-measured outcome variables are sleep quality measures, and maternal stress levels calculated as a proprietary composite of the HR and HRV measures. Patient-reported outcomes include Perceived Stress Scale scores and Edinburg Postpartum Depression Scale scores, BP readings, and process measures for the frequency of triggers, ED visits, or hospital admissions in the first six weeks after birth. Additionally, we will obtain hair samples and social needs surveys at the beginning and end of the intervention to measure the change in the level of chronic stress and social needs over 6-weeks postpartum, and a survey and in-depth interview to explore their experience of using the wearable device, participant acceptability, satisfaction, and perceived usefulness of MaST. This pilot study will generate data to support a larger randomized trial and align well with the current NIH priorities by advancing maternal health, leveraging digital technologies, and enabling earlier identification of risk in populations with higher rates of adverse outcomes.
