Mechanisms of mindfulness training to reduce maternal and infant cardiovascular disease risk

ABSTRACT Hypertensive disorders of pregnancy are the most common medical condition affecting pregnancy and a leading cause of maternal morbidity and mortality in the Unites States. Fifty percent of women with prenatal hypertensive disorders will continue to experience hypertension in the postpartum period. More than half of all pregnancy-related deaths occur in the postpartum period, and over 30% of maternal deaths are complicated by hypertensive disorders. Consequences of hypertensive disorders extend well past the perinatal period; women with prenatal hypertensive disorders are twice as likely to develop heart disease in their lifetime, and offspring exposed to hypertensive disorders in utero face significant lifetime cardiovascular disease risk. Therefore, prevention of prenatal hypertensive disorders is critical to reducing risk for postpartum obstetric complications and lifelong cardiovascular disease. Mindfulness-based interventions hold significant promise as a non- pharmacological intervention to prevent these disorders as mindfulness-based interventions reduce blood pressure in adults with hypertension and prehypertension, and results from our pilot RCT indicating that prenatal mindfulness training was associated with reduced blood pressure and risk for hypertensive disorders in at-risk women. Now, our team is conducting a 5-year RCT investigating the daily mechanisms of prenatal mindfulness training on prenatal markers of cardiovascular risk (R01HL157288). To date, we have recruited a racially and ethnically diverse sample of women at risk for hypertensive disorders of pregnancy, with >90% participant retention, and 89% of participants who completed the parent study reported interest in participating in the proposed ancillary study. However, the most severe and fatal cardiovascular complications occur in the postpartum period, and it is not yet known whether the cardiovascular benefits of prenatal mindfulness training extend into the postpartum period. Thus, in response to the Notice of Special Interest (NOSI): “Heart, Lung, Blood and Sleep Focused Ancillary Studies to Ongoing Clinical Studies,” we propose to test the long-term effects of prenatal mindfulness training on postpartum mechanisms of risk for maternal and infant cardiovascular disease. The proposed ancillary study will follow N=130 participants and infants that are enrolled in the parent RCT across the first postpartum year. At 4-, 6-, and 12-months postpartum, we will measure effects of prenatal mindfulness training on: 1) postpartum maternal cardiovascular disease biomarkers, 2) postpartum physiological and psychological responses to ecologically valid daily experiences, and 3) infant growth trajectories that confer risk for lifetime CVD. Results will have a significant impact on the field by identifying modifiable mechanisms in the pre and postnatal periods to reduce rates of hypertensive disorders and decrease lifelong burden of CVD in women and their offspring. Consistent with NHLBI’s objectives, results from this study will help to develop and optimize novel therapeutic strategies to prevent heart, lung, and blood diseases in women and infants.