Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Idiopathic Intracranial Hypertension.

Hypertensive disorders of pregnancy (HDP), a group of disorders including gestational hypertension, chronic hypertension, preeclampsia, and eclampsia, are a leading cause of maternal morbidity and mortality and impact 1 in 7 pregnancies in the United States []. Maternal and infant morbidity from HDP include placental abruption, severe neurological complications, cardiovascular disease, acute liver and kidney failure, fetal growth restriction, and sequelae of prematurity [, ]. Pharmacological interventions to prevent HDP are used conservatively in pregnancy due to some perinatal risks [-], and non-pharmacological interventions to prevent HDP, including exercise, vitamin intake, fish oil, and salt restriction, have not shown significant benefits on HPD risk [, ]. Given potential fetal safety concerns and the fact that patients may be reluctant to take prescription medications in pregnancy [], we examined prenatal mindfulness training as a non-pharmacological intervention to reduce risk for HDP. Mindfulness training teaches participants to "pay attention in a particular way, on purpose, in the present moment and non-judgmentally, to the unfolding of experience moment by moment [].” According to ‘Mindfulness Stress Buffering Theory’ [], mindfulness training leads to improved health by reducing emotional reactivity to everyday stressors. As well, recent meta-analyses report that mindfulness training (MT) significantly reduces blood pressure in non-pregnant adults [, ]. In pregnant participants at low risk for obstetric complications, higher trait mindfulness was associated with lower blood pressure [] and improvements in parasympathetic function []. Our previous published findings from this pilot clinical trial showed that prenatal MT was associated with significant reductions in clinic-obtained systolic and diastolic blood pressure []. Now, we aimed to examine if improvements in psychological symptoms serve as a possible mechanism explaining blood pressure reduction. The American Heart Association and European guidelines identify poor mental health as a risk factor for cardiovascular disease []. However, the risk factors included in the American College of Obstetricians and Gynecologists guidelines to assess clinical risk for preeclampsia [] do not include maternal mental health. In a systematic review and meta-analysis of RCTs in patients with vascular disease, mindfulness-based interventions significantly reduced symptoms of stress, depression and anxiety [], and simultaneously reduced blood pressure [-], however psychological changes were not examined as mechanisms leading to blood pressure improvements. Ecological momentary assessment studies in non-pregnant adults demonstrated that MT was associated with lower momentary stress [, ], negative affect variability [], and depression and anxiety symptoms [], however these studies did not examine effects on blood pressure or other cardiovascular parameters. In a large clinical trial of an adapted mindfulness program (MT/BP) for adults with elevated BP, participants experienced reductions in BP, sedentary behavior, and dietary changes, along with increased mindfulness []. However, these outcomes—along with other psychological factors—were not evaluated as potential mechanisms of BP reduction. []. Qualitative evidence from the same study showed that MT resulted in greater self-awareness, attention control, and emotion regulation, which participants believed was beneficial to their cardiovascular health []. No studies to date, to our knowledge, have examined psychological mechanisms of MT on blood pressure or hypertension risk in pregnancy.