Prenatal Mindfulness Training and Interoceptive Awareness in Pregnant People at Risk for Hypertensive Disorders.

Aim: In this secondary analysis of a pilot randomized controlled trial (RCT), we sought to examine whether mindfulness training (MT) is associated with change in interoceptive awareness in pregnant people at risk for hypertension using quantitative and qualitative methods. Interoceptive awareness is the perception, regulation, and integration of bodily sensations. Interoceptive awareness increases following MT and has been proposed as a psychosomatic process underlying hypertension outside of pregnancy. Methods: Twenty-nine participants (mean age 32 ± 4 years; 67% White) with a history of hypertensive disorders of pregnancy (HDP) were enrolled at 16 weeks' gestation (SD = 3) for a RCT assessing the feasibility and acceptability of an 8-week phone-delivered MT intervention. Fifteen participants were randomized to MT, whereas 14 were randomized to usual prenatal care. Before and after the intervention, all participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA) measure and participated an individual interview, which queried for mind-body changes noticed across the study period. Results: Adjusting for baseline interoceptive awareness and gestational age, participants randomized to MT reported less worry about physical sensations on the MAIA after the intervention compared to those randomized to usual care. Qualitative data corroborated these results; MT participants described improved awareness of body and breath sensations, ability to notice blood pressure changes, non-judgmental observation of thoughts, and improved responses to interpersonal challenges. Conclusions: MT may improve the ability to notice body sensations that arise in pregnancy in a way that promotes healthy responding rather than worry. Results provide support for interoceptive awareness as a potential mechanism through which mindfulness may modulate blood pressure and potentially reduce the prevalence of HDP. Clinical Trial Registration: ClinicalTrials.gov (NCT03679117).

Sleep Quality in High-Risk Pregnancies: Mixed Methods Results from a Randomized Controlled Trial of a Mindfulness Training Intervention.

Objectives: Sleep difficulties in pregnancy are common and increase the risk for obstetric complications. Past research shows that mindfulness training (MT) is helpful for improving sleep in non-pregnant adults and may improve sleep during pregnancy. However, it is unknown if MT improves sleep among pregnant people at risk for obstetric complications. We examined the effects of MT on sleep quality in individuals at risk of developing hypertensive disorders of pregnancy. Methods: Twenty-nine participants (mean age, 32 ± 4 years; mean gestational age, 16 ± 3weeks) at risk for hypertensive disorders in pregnancy (HDP) were randomized to an 8-week phone-delivered MT intervention (n = 15) or treatment as usual (TAU; n = 14), designed to test MT feasibility and acceptability. As part of the study, participants completed the Pittsburgh Sleep Quality Index and participated in a semi-structured individual qualitative interview which queried for sleep changes over pregnancy. Results: Participants randomized to MT reported less daytime sleep dysfunction compared to TAU (F = 5.79, p = 0.03, ηp2 = 0.28). Qualitative data illustrated the common experiences of sleep disturbance across both study groups; however, MT participants reported an improved ability to initiate sleep and return to sleep using mindfulness skills. About half of the participants in the MT condition reported an improvement in overall sleep quality due to less interference related to anxiety and restlessness, while other MT participants reported no change in sleep quality. Conclusions: Results from this study confirm that pregnant individuals frequently encounter sleep challenges. Findings also suggest that MT may be a helpful tool in improving sleep quality among pregnant people at risk for obstetric complications.

Internalized Weight Bias, Weight-Related Experiences, And Peripartum Weight.

INTRODUCTION: The purpose of this study was to investigate internalized weight bias (IWB) and its relationship with pregnancy-related weight changes and postpartum depression. IWB is defined as the internalization of negative attitudes and beliefs about people due to their weight. Although IWB has been linked with weight change and depression in other samples, it has never been investigated in the postpartum period. METHODS: We used a cross-sectional survey design. Participants were 251 women recruited via social media who were living in the United States and 6 to 12 months postpartum. We calculated percentage of body weight gained during pregnancy and percentage of that weight that was retained postpartum from self-reported weights. Participants completed self-report measures of IWB (modified version of the Weight Bias Internalization Scale) and postpartum depression (Edinburgh Postnatal Depression Scale). RESULTS: Gestational weight gain was not significantly associated with IWB or depression. Postpartum retention of gestational weight was significantly positively associated with both IWB and depressive symptoms. Furthermore, IWB mediated the relationship between postpartum weight retention and depressive symptoms. DISCUSSION: Postpartum retention of weight gained during pregnancy, but not weight gain itself, was related to both IWB and depressive symptoms. The relationship between pregnancy-related weight changes and psychological distress is complex. Sociocultural pressures to return to a prepregnancy physical state swiftly after giving birth may increase risk for IWB during a time in life when stress is already likely to be high, posing additional psychological risk. IWB existing prepregnancy may also worsen postpartum self-concept, contributing to depression. This is the first study, to our knowledge, to directly assess associations among gestational weight change, IWB, and postpartum depression. In addition to discussing weight in pregnancy, perinatal care providers could improve postpartum health by helping women set realistic, body-positive goals postpartum.

Dispositional Optimism, Mode of Delivery, and Perceived Labor Control among Recently Delivered Parturients.

OBJECTIVE: Dispositional optimism (DO) is an understudied transdiagnostic resilience factor among peripartum individuals. Low DO is associated with increased fear and pain in labor and increased rates of emergent cesarean delivery, but it is unknown whether DO is associated with perceived control over the labor process. STUDY DESIGN: This a planned secondary analysis of a prospective observational cohort of term parturients (n = 164) who were recruited in July and August 2021 during their delivery hospitalization at a single, tertiary medical center. Participants completed a baseline demographic survey prior to delivery and then completed evaluations of DO (Revised Life-Orientation Test [LOT-R]) and control over the labor process (Labor Agentry Scale [LAS]) during their postpartum hospitalization. DO was dichotomized into low and high by score of ≤14 or >14 on LOT-R, respectively, and labor agentry scores were compared between groups. Maternal demographics, pregnancy, and delivery characteristics were compared by DO status. Multivariable regression was performed, adjusting for known confounders (induction, labor analgesia, and mode of delivery). RESULTS: Demographic, pregnancy, and neonatal characteristics were similar between those with low compared with high DO. People with low DO had significantly higher rates of cesarean section (44 vs. 24%, p = 0.02) and overall had lower LAS scores (139.4 vs. 159.4, p < 0.001), indicating that they felt less control over their labor process than those with high DO. In the multivariable regression, those with low DO had higher odds of a low LAS score after controlling for induction, labor analgesia, and mode of delivery (adjusted odds ratio = 1.29, 95% confidence interval: 1.20-1.39). CONCLUSION: People with low DO had significantly lower perceived control over their labor, even after controlling for differences in mode of delivery. Interventions to alter DO may be an innovative way to improve birth experience and its associated perinatal mental health morbidities. KEY POINTS: · It is unknown if there is an association between DO and perceived labor control.. · People with low DO had higher rates of cesarean delivery and lower perceived labor control.. · Altering DO may be a novel mechanism for improving birth experience..

Childhood adversity, prenatal depression, and maternal inflammation across pregnancy.

Background: To examine whether change in neutrophil-lymphocyte ratio, a marker of systemic inflammation, differs by childhood adversity and prenatal depression. Methods: Prenatal complete blood count data were used to calculate neutrophil-lymphocyte ratio in first and third trimesters. The Adverse Childhood Experiences scale measured childhood adversity, and the Patient Health Questionnaire-9 measured depression. This is a secondary analysis of a study of predictors of risk for sleep-disordered breathing. Results: Participants were 98 pregnant women, mean age 30 years (SD = 5), mean body mass index of 35 kg/m2 (SD = 7), 61% identified as white, and 28% identified as Hispanic. Women who reported childhood sexual abuse history displayed greater increase in neutrophil-lymphocyte ratio over pregnancy relative to women without childhood sexual abuse. Change in neutrophil-lymphocyte ratio across pregnancy did not differ by prenatal depression. Conclusion: Experiences of sexual abuse in childhood may impact markers of systemic inflammation in pregnancy.

Sleep Disordered Breathing Measures in Early Pregnancy Are Associated with Depressive Symptoms in Late Pregnancy.

Sleep disordered breathing (SDB) and depression are both common complications of pregnancy and increase risk for adverse maternal and neonatal outcomes. SDB precedes onset of depression in non-pregnant adults; however, the longitudinal relationship has not been studied in pregnancy. The present research examined temporal associations between SDB and depressive symptoms in 175 pregnant women at risk for SDB (based on frequent snoring and obesity), but without an apnea hypopnea index of ≥5 events per hour at enrollment. Women completed a self-report assessments of depressive symptoms using PHQ-9 and in-home level III sleep apnea monitoring at approximately 12- and 32-weeks' gestation. We also assessed the risk for SDB using the Berlin Questionnaire in early pregnancy. Results revealed that measures of SDB in early pregnancy as assessed by in-home sleep study, but not by self-reported SDB, predicted elevated depressive symptoms in late pregnancy. SDB in late pregnancy was not associated with depressive symptoms. To conclude, these findings suggest that SDB may increase the risk for elevated depressive symptoms as pregnancy progresses.

NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress.

This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.

Counterbalanced Comparison of the BSID-II and Bayley-III at Eighteen to Twenty-two Months Corrected Age.

OBJECTIVE: To evaluate differences in developmental assessments using the current version of the Bayley Scales of Infant Development (Bayley-III) as compared to the older BSID-II. Previous studies suggest that average scores on the Bayley-III may be significantly higher than scores on the previous version, but the magnitude and potential impact of differences between these 2 assessments are uncertain. METHODS: We enrolled 77 former preterm infants (born <32 wk gestation and ≤2000 g) at 18 to 22 months corrected age in this randomized crossover study. The Bayley-III was administered in follow-up clinic per standard of care. The BSID-II was administered during a separate study visit. The order of testing was randomly assigned. The assessments were performed 4 to 8 weeks apart by masked personnel. The main outcomes were mean difference between BSID-II Mental Development Index (MDI) and Bayley-III Cognitive Composite score, mean difference between BSID-II Psychomotor Development Index (PDI) and Bayley-III Motor Composite score, and difference in the proportion of infants classified as having "developmental delay." RESULTS: Bayley-III scores were significantly higher across the range of scores and in all domains. Mean Cognitive Composite scores were almost 1 SD higher than MDI scores (14.1 ± 12.9 points, p < .001). Mean Motor Composite scores were 9.0 ± 11.9 points higher than PDI scores (p < .001). When severity of delay was classified using standardized cut-points for moderate and severe developmental delay (1 and 2 SDs below reference norm), 40% of children (n = 31/77) were classified as less severely delayed with the Bayley-III Cognitive Composite score than with the BSID-II MDI, whereas only 1 (<2%) was classified as more severely delayed with the Bayley-III (p < .001). CONCLUSION: These findings have critical implications for both the interpretation of clinical research studies and determination of eligibility for services in high-risk children.

Crystal structure of Escherichia coli sigmaE with the cytoplasmic domain of its anti-sigma RseA.

The sigma factors are the key regulators of bacterial transcription. ECF (extracytoplasmic function) sigma's are the largest and most divergent group of sigma(70) family members. ECF sigma's are normally sequestered in an inactive complex by their specific anti-sigma factor, which often spans the inner membrane. Here, we determined the 2 A resolution crystal structure of the Escherichia coli ECF sigma factor sigma(E) in an inhibitory complex with the cytoplasmic domain of its anti-sigma, RseA. Despite extensive sequence variability, the two major domains of sigma(E) are virtually identical in structure to the corresponding domains of other sigma(70) family members. In combination with a model of the sigma(E) holoenzyme and biochemical data, the structure reveals that RseA functions by sterically occluding the two primary binding determinants on sigma(E) for core RNA polymerase.