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Mindfulness in Pregnancy: A Brief Intervention for Women at Risk

Abstract

Introduction

The U.S. has the highest rate of preterm birth (PTB), of all developed countries, especially among African American women. Social determinants of health and inequalities in health outcomes are understudied areas. The intersectionality of race and socioeconomic status has been shown to contribute to chronic stress, stress has been shown to be associated with PTB, yet the mechanisms that affect pregnancy outcomes have not been explicit. Mindfulness-based Interventions that address stress reduction during pregnancy may improve quality of life during pregnancy, perhaps enhancing resilience, and be on the pathway to reducing the risk of negative pregnancy outcomes such as PTB.

Methods

We over-enrolled African American women and those covered by Medicaid to reach women at higher risk for PTB and included women in substance use treatment. Participants were enrolled in a 6-week mindfulness in pregnancy (MIP) intervention at the obstetric clinic. Sociodemographic characteristics and psychosocial assessments were obtained at three time points.

Results

We enrolled 35 women who self-identified as: non-white, Medicaid recipients, aged 25–35 years, with high school or less education. We found reductions in perceived stress, pregnancy specific stress, trait anxiety and depression and increases in mindfulness that sustained post-intervention at 2 and 7 months.

Discussion

Social determinants and stress in particular have been associated with negative birth outcomes. This paper describes a brief intervention and results of MIP tailored to women who have significantly more stress due to race, poverty, homelessness, substance use treatment and other comorbid health risks including PTB.

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References

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342.

    Article  PubMed  Google Scholar 

  • Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23(1), 67–82.

    CAS  Article  PubMed  Google Scholar 

  • Burns, L., Mattick, R. P., & Cooke, M. (2006). The use of record linkage to examine illicit drug use in pregnancy. Addiction, 101(6), 873–882.

    Article  PubMed  Google Scholar 

  • Catov, J. M., Abatemarco, D. J., Markovic, N., & Roberts, J. M. (2010). Anxiety and optimism associated with gestational age at birth and fetal growth. Maternal and Child Health Journal, 14(5), 758–764.

    Article  PubMed  Google Scholar 

  • Catov, J. M., Flint, M., Lee, M., Roberts, J. M., & Abatemarco, D. J. (2015). The relationship between race, inflammation and psychosocial factors among pregnant women. Maternal and Child Health Journal, 19(2), 401–409.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, S. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of Health (pp. 31–67). Sage Publications Inc.

    Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 24, 385–396.

    CAS  Article  PubMed  Google Scholar 

  • Cohen, S., Kessler, R. C., & Gordon, L. U. (Eds.). (1997). Measuring stress: A guide for health and social scientists. Oxford University Press on Demand.

    Google Scholar 

  • Committee on Health Care for Underserved Women. (2018). ACOG committee opinion no. 729: Importance of social determinants of health and cultural awareness in the delivery of reproductive health care. Obstetrics and Gynecology, 131(1), e43–e48.

    Article  Google Scholar 

  • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Edinburgh postnatal depression scale (EPDS). British Journal of Psychiatry, 150, 782–786.

    CAS  Article  Google Scholar 

  • Dawe, S., & Harnett, P. (2007). Reducing potential for child abuse among methadone-maintained parents: Results from a randomized controlled trial. Journal of Substance Abuse Treatment, 32(4), 381–390.

    Article  PubMed  Google Scholar 

  • Dhillon, A., Sparkes, E., & Duarte, R. V. (2017). Mindfulness-based interventions during pregnancy: A systematic review and meta-analysis. Mindfulness, 8(6), 1421–1437.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dorner, R. A., Rankin, K. M., & Collins, J. W. (2017). Early preterm birth across generations among whites and African-Americans: A population-based study. Maternal and Child Health Journal, 21(11), 2061–2067.

    Article  PubMed  Google Scholar 

  • Dumas, J. (2005). Mindfulness-based parent training: Strategies to lessen the grip of automaticity in families with disruptive children. Journal of Clinical Child and Adolescent Psychology, 34(4), 779–791.

    Article  PubMed  Google Scholar 

  • Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190–202.

    Article  PubMed  Google Scholar 

  • Dunn, C., Hanieh, E., Roberts, R., & Powrie, R. (2012). Mindful pregnancy and childbirth: Effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Archives of Women’s Mental Health, 15(2), 139–143.

    Article  PubMed  Google Scholar 

  • Feldman, J. G., Minkoff, H. L., McCalla, S., & Salwen, M. (1992). A cohort study of the impact of perinatal drug use on prematurity in an inner-city population. American Journal of Public Health, 82(5), 726–728.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Gannon, M., Mackenzie, M., Kaltenbach, K., & Abatemarco, D. (2017). Impact of mindfulness-based parenting on women in treatment for opioid use disorder. Journal of Addiction Medicine, 11(5), 368–376.

    Article  PubMed  Google Scholar 

  • Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.

    Article  PubMed  Google Scholar 

  • Guardino, C. M., & Schetter, C. D. (2014). Understanding pregnancy anxiety: Concepts, correlates, and consequences. Zero to Three, 34(4), 12–21.

    Google Scholar 

  • Hayatbakhsh, M. R., Flenady, V. J., Gibbons, K. S., Kingsbury, A. M., Hurrion, E., Mamun, A. A., & Najman, J. M. (2012). Birth outcomes associated with cannabis use before and during pregnancy. Pediatric Research, 71(2), 215–219.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.

    CAS  Article  PubMed  Google Scholar 

  • Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., Lenderking, W. R., & Santorelli, S. F. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. The American journal of psychiatry, 149(7), 936–943.

    CAS  Article  PubMed  Google Scholar 

  • Ladhani, N. N. N., Shah, P. S., Murphy, K. E., & Knowledge Synthesis Group on Determinants of Preterm/LBW Births. (2011). Prenatal amphetamine exposure and birth outcomes: A systematic review and metaanalysis. American Journal of Obstetrics and Gynecology, 205(3), 219-e1.

    Article  Google Scholar 

  • Lobel, M., & Dunkel-Schetter, C. (1990). Conceptualizing stress to study effects on health: Environmental, perceptual, and emotional components. Anxiety Research, 3(3), 213–230.

    Article  Google Scholar 

  • Marlatt, G. A., & Witkiewitz, K. (2010). Update on harm-reduction policy and intervention research. Annual Review of Clinical Psychology, 6, 591–606.

    Article  PubMed  Google Scholar 

  • Matijasevich, A., Munhoz, T. N., Tavares, B. F., Barbosa, A. P., da Silva, D. M., Abitante, M. S., Dall’Agnol, T. A., & Santos, I. S. (2014). Validation of the Edinburgh postnatal depression scale (EPDS) for screening of major depressive episode among adults from the general population. BMC Psychiatry, 14, 284. https://doi.org/10.1186/s12888-014-0284-x

    Article  PubMed  PubMed Central  Google Scholar 

  • Menon, R., Dunlop, A. L., Kramer, M. R., Fortunato, S. J., & Hogue, C. J. (2011). An overview of racial disparities in preterm birth rates: Caused by infection or inflammatory response. Acta Obstetricia Et Gynecologica Scandinavica, 90(12), 1325–1331.

    Article  PubMed  PubMed Central  Google Scholar 

  • National Vital Statistics Reports. (2018). Births: Final data for 2017. 67(8)

  • Pitiphat, W., Gillman, M. W., Joshipura, K. J., Williams, P. L., Douglass, C. W., & Rich-Edwards, J. W. (2005). Plasma C-reactive protein in early pregnancy and preterm delivery. American Journal of Epidemiology, 162(11), 1108–1113.

    Article  PubMed  Google Scholar 

  • Rising, S. S. (1998). Centering pregnancy: An interdisciplinary model of empowerment. Journal of Nurse-Midwifery, 43(1), 46–54.

    CAS  Article  PubMed  Google Scholar 

  • Romero, R., Dey, S. K., & Fisher, S. J. (2014). Preterm labor: One syndrome, many causes. Science, 345(6198), 760–765.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • SAMHSA. (2015). Complementary health approaches: Advising clients about evidence and risks fall. 14(2)

  • SAMHSA. National Registry of Evidenced Based Programs and Practices. Online registry. 2018.

  • Santorelli, S. F., Kabat-Zinn, J., Blacker, M., Meleo-Meyer, F., & Koerbel, L. (2017). Mindfulness-based stress reduction (MBSR) authorized curriculum guide. Center for Mindfulness in Medicine, Health Care, and Society (CFM), University of Massachusetts Medical School.

    Google Scholar 

  • Shavitz, D. A., Kaufman, J. S., Dole, N., Siega-Riz, A. M., Thorp, J. M., & Kaczor, D. T. (2004). Poverty, education, race, and pregnancy outcome. Ethnicity & Disease, 14(3), 322–329.

    Google Scholar 

  • Short, V. L., Gannon, M., Weingarten, W., Kaltenbach, K., LaNoue, M., & Abatemarco, D. J. (2017). Reducing stress among mothers in drug treatment: A description of a mindfulness based parenting intervention. Maternal and Child Health Journal, 21(6), 1377–1386.

    Article  PubMed  Google Scholar 

  • Smith-Nielsen, J., Matthey, S., Lange, T., & Væver, M. S. (2018). Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression. BMC Psychiatry, 18, 393. https://doi.org/10.1186/s12888-018-1965-7

    Article  PubMed  PubMed Central  Google Scholar 

  • Spielberger, C. D. (1983). State-trait anxiety inventory for adults. Mind Garden.

    Google Scholar 

  • Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Consulting Psychologists Press.

    Google Scholar 

  • Steinberg, L. D. (2004). The ten basic principles of good parenting. Simon and Schuster.

    Google Scholar 

  • Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615.

    CAS  Article  PubMed  Google Scholar 

  • Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Koehler, R., & Marlatt, A. (2009). Mindfulness meditation for substance use disorders: A systematic review. Substance Abuse, 30(4), 266–294.

    Article  PubMed  Google Scholar 

  • Zhang, M. F., Wen, Y. S., Liu, W. Y., Peng, L. F., Wu, X. D., & Liu, Q. W. (2015). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: A meta-analysis. Medicine, 94(45), e0897.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding was provided by March of Dimes Foundation (Grant No. CGP001-PA).

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Correspondence to Diane J. Abatemarco.

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Abatemarco, D.J., Gannon, M., Short, V.L. et al. Mindfulness in Pregnancy: A Brief Intervention for Women at Risk. Matern Child Health J 25, 1875–1883 (2021). https://doi.org/10.1007/s10995-021-03243-y

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Keywords

  • Mindfulness
  • Pregnancy
  • Stress
  • Anxiety
  • Depression