PROJECT SUMMARY/ABSTRACT It is critical to understand risk and protective factors for health to optimize developmental outcomes and inform prevention of poor health behaviors across the lifespan. Research using longitudinal designs, multiple levels of analysis, and experimental clinical trials are needed. Cardiovascular disease (CVD) is the leading cause of death worldwide. The origins of adult CVD begin prenatally: High prenatal maternal depressive symptoms robustly predict offspring CVD risk. However, knowledge on risk and protective factors for CVD for offspring of mothers with high depressive symptoms has been correlational. There is a lack of experimental work using a randomized controlled trial (RCT) design to understand potential mechanisms that contribute to children's CVD risk following exposure to high maternal prenatal depressive symptoms across multiple levels (e.g., maternal and child behaviors, physiology) over time. Although efficacious interventions to diminish depressive symptoms among pregnant women exist, research has not investigated whether reducing prenatal maternal depressive symptoms can reduce offspring cardiovascular risk. The current study proposes to leverage a RCT of an effective psychosocial intervention for prenatal maternal depression to test whether reducing prenatal maternal depressive symptoms improves offspring cardiovascular health at ages 3-4 years. We hypothesize that the prenatal intervention operates by reducing both prenatal and postnatal depressive symptoms to improve child outcomes. This study will identify intervention targets for offspring of mothers with high prenatal depressive symptoms to reduce cardiovascular risk. These goals will be accomplished by building on a RCT (R01MH109662) of an established psychosocial intervention that effectively reduces maternal prenatal depressive symptoms. We propose to leverage this unique opportunity to follow up mothers and children who participated in this RCT to test whether this intervention improves offspring cardiovascular health. This project increases rigor of the existing correlational research by using an experimental RCT design. The following 3 aims will be addressed. Aim 1: To test whether reducing prenatal maternal depressive symptoms improves the quality of food the mother feeds her child, maternal feeding behaviors, and modeling of eating behaviors at 3 years. Aim 2: To test whether reducing prenatal maternal depressive symptoms improves child diet, eating behaviors, sleep, and physical activity at 3 years. Aim 3: To test whether reducing prenatal maternal depressive symptoms reduces child CVD risk at 3 and 4 years, including BMI, waist circumference, body fat, blood pressure, and arterial stiffness. This project will provide the strongest evidence to date for a mechanistic model of prenatal maternal depressive symptoms' influence on child cardiovascular health. Importantly, the project will also provide evidence for whether effective psychosocial interventions to reduce prenatal maternal depressive symptoms should be used to reduce the burden of CVD in the next generation.

PROJECT NARRATIVE Cardiovascular disease (CVD) is the leading cause of death worldwide, risk begins early in life, and as a result, policy organizations are recommending that optimal promotion of cardiovascular health begin during childhood. Prenatal maternal depressive symptoms predict offspring cardiovascular risk, though this association has not been demonstrated experimentally; as such, the proposed research will follow up a sample of offspring from pregnant mothers who participated in a randomized controlled trial to test whether reducing prenatal maternal depressive symptoms improves offspring cardiovascular health in early childhood. This research will determine whether an established, effective psychosocial intervention to reduce depression during pregnancy also reduces cardiovascular risk early in life in the next generation.