Disasters have negative effects in the short term (physical trauma, adverse environmentalexposures, and unstable housing) and the long term (relocation, changes in familyfunctioning, and negative economic effects), which interact with social determinants toworsen health among the most vulnerable women, infants, and communities. Trauma andsevere stress are directly linked to pregnancy complications, and raise blood pressureduring pregnancy, alter stress hormones, and increase vulnerability to infection, all ofwhich predispose to reduced fetal growth and preterm birth. Disasters also worsen mentalhealth, and depression during pregnancy and postpartum, for instance, is associated withworse physical health during pregnancy, maternal impairment, poorer quality parenting,negative child behavior, and poorer infant cognitive development.The goal of thisintervention is to improve mental health in pregnant women living in a disaster-affectedregion.The main questions this intervention aims to answer are: - Assess the implementation outcomes (acceptability, adaptation, adoption, feasibility, fidelity, and sustainability) of a pilot intervention in a disaster recovery environment. - Assess the effectiveness of the M-O-M-S pilot intervention in a disaster recovery environment.The study will recruit pregnant women in areas that have experienced a natural disaster.Women will be recruited in early pregnancy and attend a series of classes on thecognitive and relationship changes of pregnancy and motherhood, and mental preparationfor labor, led by a "mentor," a mother who has experienced pregnancy, labor, andmotherhood.
The M-O-M-S™ (Mentors Offering Maternal Support) intervention is based in a theoretical
framework addressing the major transitions that occur with pregnancy and close
relationship processes. Weis et al. found that community esteem-building support, focused
in first and second trimester, decreased anxiety associated with pregnancy and maternal
adaptation. The M-O-M-S™ intervention was specifically designed to address
pregnancy-specific anxiety (inclusive of depressive symptoms), concerns related to
family/partner relationships, and provide esteem-building peer support, with each session
directly aligned to specific aspects of anxiety and depression pertinent to the point in
pregnancy for the women. Women are recruited in early pregnancy and attend a series of
classes on the cognitive and relationship changes of pregnancy and motherhood, and mental
preparation for labor, led by a "mentor", a mother who has experienced pregnancy, labor,
and motherhood.
Up to 400 subjects will be recruited, with a goal of 240 completing the study. Each group
will consist of 15-20 recruits, assuming a degree of attrition that will lead to group
sizes of 10-12. The outcome measures will be compared between the intervention and
control data and linear regression (with adjustment for partial clustering) used to
adjust for differences in participant characteristics. Given an estimated effect size and
variance (both pre-post and intervention-control) from previous trials, 240 participants
gives good power for reasonable effect sizes for both the pre-post analysis and
intervention-control analyses incorporating a design (cluster) effect.
Recruitment will take place at ob/gyn practices, WIC clinics, health units, and at
community sites. Clinicians will be informed of the intervention and asked to encourage
their patients to participate. They will also refer potential participants and provide
flyers to interested women. Study staff will also attend the clinics on days when a large
number of prenatal visits are scheduled, and clinic staff will inform them who can be
approached as a potential participant. Flyers and posters will also be provided to
participating clinics, and participants can self-refer. Participants will be contacted
via the method they indicate they prefer.
Participants will attend 6 group meetings lasting 1 hr. every other week. These sessions
are aimed at decreasing pregnancy concerns and building coping skills through supportive
relationships with experienced local mothers and the other participants in the group. The
meetings are closed group sessions.
Participants also receive a "Birth of a Mother" manual designed to guide open discussion
during the course of the sessions.
In addition, participants will complete questionnaires at baseline and at the end of the
intervention about their mental health, experience of the intervention, and disaster
experience.
Behavioral: M-O-M-S on the Bayou
Peer and mentor support and meetings across pregnancy
Inclusion Criteria:
- Pregnant
- Below 20 weeks' gestation
- Enrolled in prenatal care
Exclusion Criteria:
- Not pregnant
- Under age 18
- Does not speak English or Spanish
- Does not plan to carry to term
- Does not plan to remain in the study area through pregnancy
- Fetal defects likely to lead to death or extensive hospitalization postpartum
Tulane University
New Orleans, Louisiana, United States
Investigator: Emily Harville
Contact: 504-988-7327
Emily Harville, PhD
504-988-7327
eharvill@tulane.edu
Not Provided