Cardiovascular Disease-Related Pregnancy Complications Are Associated with Increased Maternal Levels and Trajectories of Cardiovascular Disease Biomarkers During and After Pregnancy.

Background: Having a pregnancy complicated by hypertensive disorders of pregnancy (HDP) and/or having a small or preterm baby put a woman at risk for later cardiovascular disease (CVD). It is uncertain if higher maternal CVD risk factors (reflected by increased peripartum CVD biomarker levels) account for this risk, or if experiencing a complicated pregnancy itself increases a woman's CVD risk (reflected by an increase in biomarker trajectories from early pregnancy to postpartum). Methods: We conducted a secondary analysis of an 8-week mindful eating and stress reduction intervention in 110 pregnant women. We used mixed linear regression analysis to compare CVD biomarker levels and trajectories, between women with and without a CVD-related pregnancy complication (including HDP [gestational hypertension or preeclampsia] or having a small for gestational age [<10th percentile] or preterm [<37 weeks] baby), at three times: (1) 12-20 weeks of gestation, (2) 3 months postpartum, and (3) 9 months postpartum. CVD biomarkers studied included serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI), blood pressure (BP), interleukin-6 (IL-6), tumor necrosis factor, and lipids. We adjusted for age, maternal smoking, prepregnancy BMI, BP, age × time, and BMI × time. Results: Women had a mean age of 28 years (standard deviation [SD] 6), mean prior pregnancies of 0.8 (SD 1.0), and 22 women had one or more CVD-related pregnancy complications. HOMA-IR, diastolic BP, triglyceride, high-density lipoprotein cholesterol, and IL-6 average levels, but not trajectories, differed among women with complicated versus normal pregnancy (all p values were ≤0.04). Peripartum glucose and systolic BP trajectories were statistically greater in complicated versus normal pregnancies (p values were 0.008 and 0.01, respectively). Conclusion: We conclude that the experience of a complicated pregnancy in addition to elevated CVD risk factor levels may both increase a woman's risk of future CVD. ClinicalTrials.gov Identifier: NCT01307683.

The mindful moms training: development of a mindfulness-based intervention to reduce stress and overeating during pregnancy.

BACKGROUND: Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress and non-homeostatic eating behaviors - or eating for reasons other than hunger or caloric need. We developed a mindfulness-based intervention for high-risk, low-income overweight pregnant women over a series of iterative waves using the Obesity-Related Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its effects on stress and eating behaviors. METHODS: Overweight pregnant women (n = 110) in their second trimester were enrolled in an 8-week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as well as stress, depression and eating behaviors before and after the intervention. We also examined whether pre-to-post intervention changes in outcomes of well-being and eating behaviors were associated with changes in proposed mechanisms of mindfulness, acceptance, and emotion regulation. RESULTS: Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and facilitator fidelity was very good. Of the women who completed class evaluations, at least half reported that each of the three class components (mindful breathing, mindful eating, and mindful movement) were "very useful," and that they used them on most days at least once a day or more. Women improved in reported levels of mindfulness, acceptance, and emotion regulation, and these increases were correlated with reductions in stress, depression, and overeating. CONCLUSIONS: These findings suggest that in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov NCT01307683 , March 8, 2011.

Distant healing of surgical wounds: an exploratory study.

BACKGROUND: Distant healing intention (DHI) is one of the most common complementary and alternative medicine (CAM) healing modalities, but clinical trials to date have provided ambivalent support for its efficacy. One possible reason is that DHI effects may involve variables that are sensitive to unknown, uncontrolled, or uncontrollable factors. OBJECTIVE: To examine 2 of those potential variables-expectation and belief-we explored the effects of DHI on objective and psychosocial measures associated with surgical wounds in 72 women undergoing plastic surgery. DESIGN: Participants were randomly assigned to 1 of 3 groups: blinded and receiving DHI (DH), blinded and not receiving DHI (control), and knowing that they were receiving DHI (expectancy). Outcome measures included collagen deposition in a surrogate wound and several self-report measures. DHI was provided by experienced distant healers. No differences in the main measures were observed across the three groups. RESULTS: Participants' previous belief in the efficacy of DHI was negatively correlated with the status of their mental health at the end of the study (P = .04, 2-tailed), and healers' perceptions of the quality of their subjective "contact" with the participants were negatively correlated both with change in mood (P = .001) and with collagen deposition (P = .04). A post-hoc analysis found that among participants assigned to receive DHI under blinded conditions, those undergoing reconstructive surgery after breast cancer treatment reported significantly better change in mood than those who were undergoing purely elective cosmetic surgery (P = .004). CONCLUSION: If future DHI experiments confirm the post-hoc observations, then some of the ambiguity observed in earlier DHI studies may be attributable to interactions among participants' and healers' beliefs, their expectations, and their motivations.

Negative affect, emotional acceptance, and smoking cessation.

This article describes recent theoretical developments and empirical findings regarding the role of negative affect (NA) and emotion regulation in nicotine dependence and smoking cessation. It begins with a review of affect-based models of addiction that address conditioning, affect motivational, and neurobiological mechanisms and then describes the role of NA and emotion regulation in the initiation and maintenance of cigarette smoking. Next, the role of emotion regulation, coping skill deficits, depression, and anxiety sensitivity in explaining the relationship between NA and smoking relapse are discussed. We then review recent models of affect regulation, including emotional intelligence, reappraisal and suppression, and emotional acceptance, and describe implications for substance abuse and smoking cessation interventions. Finally, we point out the need for further investigations of the moderating role of individual differences in response to NA in the maintenance of nicotine dependence, and controlled randomized trials testing the efficacy of acceptance-based interventions in facilitating smoking cessation and relapse prevention.