Neurobiological changes during the peripartum period: implications for health and behavior

Changes in estrogen receptor α positive cells in the amygdala and bed nucleus of the stria terminalis during pregnancy and the postpartum period in rats

Estrogen affects a variety of brain functions, including higher functions. The estrogen level is persistently high during pregnancy and then declines rapidly with delivery, which causes the brain to be subjected to marked effects during this period. Thus, pregnant and parturient women are prone to altered mental activity and have a higher probability of anxiety and depressive disorders, which may be caused by marked changes in estrogen levels. The central nucleus (CeA) and basolateral nucleus (BLA) of the amygdala and the anterior division (BNSTa) and principal nucleus (BNSTp) of the bed nucleus of the stria terminalis are regions involved in emotional processing, including anxiety, and also target brain areas of estrogenic action. However, the expression of estrogen receptors during this period is not clear. In this study, we analyzed the distribution of estrogen receptor α (ERα)-immunoreactive cells at gestational days 7 (G7) (early gestation), 14 (G14) (mid-gestation), 21 (G21) (late gestation), and 4 days after delivery (P4) (early postpartum) in rats. In the CeA, the number of nuclear ERα-positive cells decreased significantly at G7, G14, and G21. In the BLA, distribution of ERα was detected in the cell body (indicating membrane-associated ERα) with a trend toward decreased immunoreactivity during pregnancy. The BNSTp showed no changes, but in the BNSTa, nuclear ERα-positive cells were significantly reduced at G14, G21, and P4. These regional differences in changes of ERα-positive cells may be involved in the symptoms of anxiety and depression during pregnancy and the postpartum period.

Suffering in silence: Accessing mental health care and repetitive transcranial magnetic stimulation (rTMS) for peripartum depression - A qualitative study

Peripartum depression (PPD) is a prevalent and serious mental health disorder that is often underdiagnosed and undertreated due to limited effective and safe treatment options. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive treatment for PPD, yet awareness among patients is low. This study aims to identify barriers and facilitators to accessing mental health treatment, particularly rTMS, for PPD. We conducted 36 interviews with individuals who experienced depressive symptoms during the peripartum period and health providers, followed by a descriptive interpretive thematic analysis. Key risk factors identified include personal (i.e., age), clinical (i.e., traumatic birth), situational (i.e., COVID-19, homelessness), and social (i.e., discrimination, domestic abuse). Five themes emerged regarding barriers and facilitators: 1) the need for mom-centered care, 2) systemic challenges, 3) the importance of mental health education, 4) stigma and custody concerns, and 5) challenges in accessing care. Eighty-three percent of participants were unaware of rTMS, but following a brief description, 75% were willing to receive or refer to rTMS if it was available to them. Addressing systemic and access-related concerns is crucial to ensuring patients with PPD have access to safe, effective, and accessible treatments.

The Perinatal Microbiota-Gut-Brain Axis: Implications for Postpartum Depression

BACKGROUND

Pregnancy and childbirth are accompanied by widespread maternal physiological adaptations and hormonal shifts that have been suggested to result in a period of vulnerability for the development of mood disorders such as postpartum depression (PPD). There is also evidence of peripartum changes in the composition of the gut microbiota, but the potential contribution of intestinal microbes to the adaptations, or subsequent vulnerabilities, during this period are unknown.

SUMMARY

Here, we outline key pathways involved in peripartum adaptations including GABAergic signaling, oxytocin, and immunomodulation that are also associated with susceptibility to mood disorders and present evidence that these pathways are modulated by gut microbes. We also discuss the therapeutic potential of the microbiota-gut-brain axis in PPD and identify future directions for research to help realize this potential.

KEY MESSAGES

Peripartum adaptations are associated with shifts in gut microbial composition. Disruption of GABAergic, oxytocin, and immunomodulatory pathways may contribute to vulnerability of mood disorders including PPD. These key adaptive pathways are modulated by intestinal microbes suggesting a role for the gut microbiota in determining susceptibility to PPD. More research is needed to confirm relationship between gut microbes and PPD and to gain the mechanistic understanding required to realize the therapeutic potential of microbiota-gut-brain axis in this mood disorder.

Longitudinal investigation of neurobiological changes across pregnancy

Pregnancy is a period of profound biological transformation. However, we know remarkably little about pregnancy-related brain changes. To address this gap, we chart longitudinal changes in brain structure during pregnancy and explore potential mechanisms driving these changes. Ten participants (Mean age = 28.97 years) are assessed 1-6 times (median = 3) during their pregnancy. Each visit includes anatomical and diffusion-weighted MRI, and assessments of waking salivary hormones, hair hormones, and inflammatory cytokines. Here we observe a reduction in gray matter volume and an increase in neurite density index (NDI), a proxy of axon density, in white matter tracts across pregnancy. Progesterone levels are associated with reductions in brain volumetric measurements, and both progesterone and estradiol levels are linked to increases in NDI in white matter tracts. This study highlights the profound neurobiological changes experienced by pregnant individuals and provides insights into neuroplasticity in adulthood.

A systematic review of associations between hormone levels in hair and peripartum depression

Peripartum depression is a global health concern, characterized by mood disturbances inclusive of pregnancy through up to 12-months postpartum. Hormones play a vital role in pregnancy maintenance, fetal development, and labor and delivery and change significantly as a function of pregnancy and childbirth. However, such life sustaining changes may have consequences related to risk for peripartum depression. To date, most studies that have examined hormones in relation to peripartum depression have focused on blood or saliva sampling approaches, though hair analysis offers unique information on trajectories of hormone concentrations over more sustained periods of time (i.e., over months). The aim of this systematic review was to provide a comprehensive review of the association between hair measures of hormones (i.e., cortisol, progesterone, estrogen, and testosterone) and depression during the peripartum period. Forty-one studies were identified for inclusion. A majority of studies reported statistically null associations. Between-person studies varied widely in reported direction and magnitude of hair hormone-depression associations, most likely attributable to a wide range of methodological approaches including timing of assessments and sample size. Studies using within-person approaches observed positive coupling of cortisol concentration and symptoms across time. Most studies focused exclusively on cortisol. We recommend future research consider both stress and reproductive hormones, prioritize within-person change in hormone levels given this is a period of dramatic change, and include contextual (e.g., social support, adverse and benevolent childhood experiences, physical and psychiatric conditions) features that may modify both changes in hormones and the association between hormone levels and depression in the peripartum period.

Longitudinal Investigation of Neurobiological Changes Across Pregnancy

Pregnancy is a period of profound biological transformation. However, we know remarkably little about pregnancy-related brain changes. To address this gap, we chart longitudinal changes in brain structure during pregnancy and explore potential mechanisms driving these changes. Ten participants (Mean age = 28.97 years) are assessed 1-6 times (median = 3) during their pregnancy. Each visit includes anatomical and diffusion-weighted MRI, and assessments of waking salivary hormones, hair hormones, and inflammatory cytokines. Here we observe a reduction in gray matter volume gestational week, while neurite density index (NDI), a proxy of axon density, in white matter tracts increase across pregnancy. Progesterone levels are associated with reductions in brain volumetric measurements, and both progesterone and estradiol levels are linked to increases in NDI in white matter tracts. This study highlights the profound neurobiological changes experienced by pregnant individuals and provides insights into neuroplasticity in adulthood.

The future of intergenerational transmission research: A prospective, three-generation approach

Dr. Dante Cicchetti's pioneering theory and research on developmental psychopathology have been fundamental to the proliferation of research on intergenerational transmission over the last 40 years. In part due to this foundation, much has been learned about continuities and discontinuities in child maltreatment, attachment, parenting, and psychopathology across generations. Looking towards the future, we propose that this field stands to benefit from a prospective, three-generation approach. Specifically, following established prospective, longitudinal cohorts of children over their transition to parenting the next generation will afford the opportunity to investigate the developmental origins of intergenerational transmission. This approach also can address key outstanding questions and methodological limitations in the extant literature related to the confounding of retrospective and prospective measures; examination of mediators and moderators; and investigation of the roles of biology, environment, and their interplay. After considering these advantages, we offer several considerations and recommendations for future research, many of which are broadly applicable to the study of two or more generations. We hope that this discussion will inspire the leveraging of existing prospective cohorts to carry forward Dr. Cicchetti's remarkable contributions, with the ultimate aim to inform the development of preventions and interventions that disrupt deleterious intergenerational cycles.

Prenatal Stress and Maternal Role in Neurodevelopment

This review summarizes recent findings on stress-related programming of brain development in utero, with an emphasis on situating findings within the mothers' broader psychosocial experiences. Meta-analyses of observational studies on prenatal stress exposure indicate the direction and size of effects on child neurodevelopment are heterogeneous across studies. Inspired by lifespan and topological frameworks of adversity, we conceptualize individual variation in mothers' lived experience during and prior to pregnancy as a key determinant of these heterogeneous effects across populations. We structure our review to discuss experiential categories that may uniquely shape the psychological and biological influence of stress on pregnant mothers and their developing children, including current socioeconomic resources, exposure to chronic and traumatic stressors, culture and historical trauma, and the contours of prenatal stress itself. We conclude by identifying next steps that hold potential to meaningfully advance the field of fetal programming.

Call For Action: The Obstetrician's Role In Peripartum Mental Health

Peripartum mental health is an underdiagnosed and undertreated entity; obstetricians are in a dilemma when patients present with signs of any mental disturbance. The peripartum period is fraught with triggers that can cause, or exacerbate, mental illness, and obstetricians need to be aware of diagnoses and treatment of blues, depression, psychosis and other problems. Key strategies that can be adopted are discussed in this review, along with the scenario in India.

A common neural response to perceiving but not implicitly regulating infant and adult affect in postpartum mothers

The transition to parenthood requires parents develop caregiving behaviors, such as the ability to identify their infant's emotions and regulate their own emotional response. Research has identified patterns of neural activation in parenting contexts that are interpreted as socioemotional processing. However, no prior research has directly tested whether mothers' neural responses to their infant's affect are the same as those involved in emotion perception/experience and regulation in other contexts. We employed conjunction analyses to clarify which components of mothers' neural response to viewing their infant's affect are shared with passively viewing and labeling adult affective faces (emotion perception/experience and implicit emotion regulation, respectively) in 24 mothers three months postpartum. Our results support a common neural response to viewing infant and adult affect in regions associated with emotion perception/experience (bilateral hippocampi, amygdalae, thalami, orbitofrontal cortex, and ventrolateral prefrontal cortex), but no areas of common response to viewing negative infant affect and implicitly regulating negative adult affect outside of the occipital lobe and cerebellum. This study provides corroborating evidence for shared neural patterns being involved in perceiving/experiencing infant and adult affect but not implicit regulation of infant and adult negative affect.

Women's neuroplasticity during gestation, childbirth and postpartum

Pregnancy is a unique neuroplastic period in adult life. This longitudinal study tracked brain cortical changes during the peripartum period and explored how the type of childbirth affects these changes. We collected neuroanatomic, obstetric and neuropsychological data from 110 first-time mothers during late pregnancy and early postpartum, as well as from 34 nulliparous women evaluated at similar time points. During late pregnancy, mothers showed lower cortical volume than controls across all functional networks. These cortical differences attenuated in the early postpartum session. Default mode and frontoparietal networks showed below-expected volume increases during peripartum, suggesting that their reductions may persist longer. Results also pointed to different cortical trajectories in mothers who delivered by scheduled C-section. The main findings were replicated in an independent sample of 29 mothers and 24 nulliparous women. These data suggest a dynamic trajectory of cortical decreases during pregnancy that attenuates in the postpartum period, at a different rate depending on the brain network and childbirth type.

Effects of reproductive experience on cost-benefit decision making in female rats

Many individuals undergo mating and/or other aspects of reproductive experience at some point in their lives, and pregnancy and childbirth in particular are associated with alterations in the prevalence of several psychiatric disorders. Research in rodents shows that maternal experience affects spatial learning and other aspects of hippocampal function. In contrast, there has been little work in animal models concerning how reproductive experience affects cost-benefit decision making, despite the relevance of this aspect of cognition for psychiatric disorders. To begin to address this issue, reproductively experienced (RE) and reproductively naïve (RN) female Long-Evans rats were tested across multiple tasks that assess different forms of cost-benefit decision making. In a risky decision-making task, in which rats chose between a small, safe food reward and a large food reward accompanied by variable probabilities of punishment, RE females chose the large risky reward significantly more frequently than RN females (greater risk taking). In an intertemporal choice task, in which rats chose between a small, immediate food reward and a large food reward delivered after a variable delay period, RE females chose the large reward less frequently than RN females. Together, these results show distinct effects of reproductive experience on different forms of cost-benefit decision making in female rats, and highlight reproductive status as a variable that could influence aspects of cognition relevant for psychiatric disorders.

Host-gut microbiota interactions during pregnancy

Mammalian pregnancy is characterized by a well-known suite of physiological changes that support fetal growth and development, thereby positively affecting both maternal and offspring fitness. However, mothers also experience trade-offs between current and future maternal reproductive success, and maternal responses to these trade-offs can result in mother-offspring fitness conflicts. Knowledge of the mechanisms through which these trade-offs operate, as well as the contexts in which they operate, is critical for understanding the evolution of reproduction. Historically, hormonal changes during pregnancy have been thought to play a pivotal role in these conflicts since they directly and indirectly influence maternal metabolism, immunity, fetal growth and other aspects of offspring development. However, recent research suggests that gut microbiota may also play an important role. Here, we create a foundation for exploring this role by constructing a mechanistic model linking changes in maternal hormones, immunity and metabolism during pregnancy to changes in the gut microbiota. We posit that marked changes in hormones alter maternal gut microbiome composition and function both directly and indirectly via impacts on the immune system. The gut microbiota then feeds back to influence maternal immunity and metabolism. We posit that these dynamics are likely to be involved in mediating maternal and offspring fitness as well as trade-offs in different aspects of maternal and offspring health and fitness during pregnancy. We also predict that the interactions we describe are likely to vary across populations in response to maternal environments. Moving forward, empirical studies that combine microbial functional data and maternal physiological data with health and fitness outcomes for both mothers and infants will allow us to test the evolutionary and fitness implications of the gestational microbiota, enriching our understanding of the ecology and evolution of reproductive physiology.

Mitochondrial might: powering the peripartum for risk and resilience

The peripartum period, characterized by dynamic hormonal shifts and physiological adaptations, has been recognized as a potentially vulnerable period for the development of mood disorders such as postpartum depression (PPD). Stress is a well-established risk factor for developing PPD and is known to modulate mitochondrial function. While primarily known for their role in energy production, mitochondria also influence processes such as stress regulation, steroid hormone synthesis, glucocorticoid response, GABA metabolism, and immune modulation - all of which are crucial for healthy pregnancy and relevant to PPD pathology. While mitochondrial function has been implicated in other psychiatric illnesses, its role in peripartum stress and mental health remains largely unexplored, especially in relation to the brain. In this review, we first provide an overview of mitochondrial involvement in processes implicated in peripartum mood disorders, underscoring their potential role in mediating pathology. We then discuss clinical and preclinical studies of mitochondria in the context of peripartum stress and mental health, emphasizing the need for better understanding of this relationship. Finally, we propose mitochondria as biological mediators of resilience to peripartum mood disorders.

Neural reactivity to infant emotion cues during pregnancy: Associations with peripartum anxiety and depressive symptoms

BACKGROUND

Pregnancy is marked by physiological and psychosocial changes for women, and event-related potentials (ERP) are comfortable and safe for examining brain function across pregnancy. The late positive potential (LPP) ERP, a measure of allocated attention to emotional stimuli, may provide insight into associations between internalizing symptoms and neural processing of infant emotion cues, which may be particularly salient in this life stage.

METHODS

We developed a task to examine neural and behavioral responses to infant faces in pregnant women (N = 120, Mage=31.09, SD=4.81), the impact of auditory infant cries on the LPP to faces, and associations between the LPP and anxiety and depressive symptoms. Participants matched distressed, happy, and neutral infant faces and shapes as a comparison condition with interspersed auditory conditions (infant cry sounds vs. white noise) while electroencephalogram data were collected. Participants also completed self-report measures of anxiety and depressive symptoms.

RESULTS

Reaction time (RT) was faster for the infant cry vs. white noise condition and when matching shapes vs. infant faces. Depressive symptoms were associated with slower RTs to neutral infant faces. The LPP was enhanced overall to faces vs. shapes, but there was no main effect of auditory condition. Anxiety symptoms were associated with an enhanced LPP to infant distressed faces in the infant cry condition.

CONCLUSIONS

Results support these methods for measuring neural and behavioral responses to infant emotional cues in pregnancy and provide evidence that combinations of auditory and visual stimuli may be particularly useful for capturing emotional processes relevant to anxiety.

Longitudinal study of energy, neurosensory and eating responses durinG pregnancY (ENERGY cohort): A study protocol

BACKGROUND AND AIMS

Physiological changes that occur during pregnancy can have long-term impacts on metabolism and neurosensory responses to food, which can impact nutrition and health outcomes. The ENERGY cohort is a longitudinal study that aims to capitalizes on pregnancy as a natural model of metabolic reprogramming in order to understand the neurosensory mechanisms underpinning links between metabolism and dietary behaviour. The study objectives are to test for multi-sensory shifts during pregnancy, and the effect of sensory changes on dietary choices and bodyweights, and to identify neurosensory mechanisms that determine macronutrient selection before and after pregnancy.

METHODS

A longitudinal cohort study involving 130 pregravid women planning to conceive with the next 12-months and 65 pregravid women with no short-term plans to conceive. Participants will be recruited from Dunedin and Auckland, New Zealand. The study will test for changes in diet, neurosensory outcomes, and metabolism across the reproductive cycle, from pre-pregnancy to 1-year post-pregnancy. Data will be collected at six timepoint throughout the pregnancy which will occur approximately every 3 months. The primary response variables will be changes in supra-threshold sensitivity across modalities, dietary intake, and metabolism between pre-pregnancy and post-pregnancy. Longitudinal data analysis will use linear mixed models to assess changes in the response outcomes over time adjusted for age, ethnicity, and socioeconomic status.

DISCUSSION

Understanding the relationship between metabolism, sensory processing, and macronutrient preferences will provide crucial insights into diet-related health issues, including obesity. This study will lead to the formation of a prospective research cohort that is unique to Aotearoa New Zealand, and will develop multidisciplinary skills that are increasingly necessary to addressing the obesity epidemic.

The maternal brain is more flexible and responsive at rest: effective connectivity of the parental caregiving network in postpartum mothers

The field of neuroscience has largely overlooked the impact of motherhood on brain function outside the context of responses to infant stimuli. Here, we apply spectral dynamic causal modelling (spDCM) to resting-state fMRI data to investigate differences in brain function between a group of 40 first-time mothers at 1-year postpartum and 39 age- and education-matched women who have never been pregnant. Using spDCM, we investigate the directionality (top-down vs. bottom-up) and valence (inhibition vs excitation) of functional connections between six key left hemisphere brain regions implicated in motherhood: the dorsomedial prefrontal cortex, ventromedial prefrontal cortex, posterior cingulate cortex, parahippocampal gyrus, amygdala, and nucleus accumbens. We show a selective modulation of inhibitory pathways related to differences between (1) mothers and non-mothers, (2) the interactions between group and cognitive performance and (3) group and social cognition, and (4) differences related to maternal caregiving behaviour. Across analyses, we show consistent disinhibition between cognitive and affective regions suggesting more efficient, flexible, and responsive behaviour, subserving cognitive performance, social cognition, and maternal caregiving. Together our results support the interpretation of these key regions as constituting a parental caregiving network. The nucleus accumbens and the parahippocampal gyrus emerging as 'hub' regions of this network, highlighting the global importance of the affective limbic network for maternal caregiving, social cognition, and cognitive performance in the postpartum period.

Cortical and subcortical morphological alterations in postpartum depression

Postpartum depression (PPD) is the most common postpartum psychiatric disorder, which can negatively affect both mothers and their offspring. Although the functional changes of PPD have been extensively studied, little is known about its structural abnormalities. This study aimed to examine the cortical and subcortical morphological abnormalities in PPD. High resolution T1 structural MRI data of 29 PPD women and 23 matched healthy postpartum women (HPW) were included in this study. Using surface-based morphometry, we examined the differences between the PPD and HPW group in the cortical thickness, local gyrification index and shape changes of deep gray matter nuclei. Compared with the HPW group, women with PPD showed significantly increased cortical thickness in the left superior frontal gyrus, cuneus and right lingual gyrus and fusiform gyrus, which correlated marginally with the EPDS scores of these subjects. In addition, women with PPD showed significant regional inflation in the right pallidum compared with the HPW group. These findings provided further evidence for the structural brain abnormalities in PPD.

Matrescence: lifetime impact of motherhood on cognition and the brain

Profound environmental, hormonal, and neurobiological changes mark the transition to motherhood as a major biosocial life event. Despite the ubiquity of motherhood, the enduring impact of caregiving on cognition and the brain across the lifespan is not well characterized and represents a unique window of opportunity to investigate human neural and cognitive development. By integrating insights from the human and animal maternal brain literatures with theories of cognitive ageing, we outline a framework for understanding maternal neural and cognitive changes across the lifespan. We suggest that the increased cognitive load of motherhood provides an initial challenge during the peripartum period, requiring continuous adaptation; yet when these demands are sustained across the lifespan, they result in increased late-life cognitive reserve.

Pregnant women's experiences of well-being in high-risk pregnancy: A qualitative study

BACKGROUND

Physical changes in high-risk pregnancy (HRP) can lead to changes in mood and social relationships and negative effects on women's well-being. Individuals in different sociocultural contexts have different perceptions of well-being. Yet, there is limited information about perceptions of well-being in HRP. This study aimed to explore the Iranian women's experiences of well-being in HRP.

MATERIALS AND METHODS

This qualitative study was conducted in 2019-2020 through directed content analysis based on the conceptual framework of well-being in HRP. Participants were 26 women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran. Face-to-face semistructured interviews were held for data collection until data saturation. Data were analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed using the MAXQDA (v. 10) program.

RESULTS

Well-being in HRP had seven attributes in the five main dimensions of physical, mental-emotional, social, marital, and spiritual well-being. The seven attributes of well-being in HRP were controlled physical conditions, controlled mood, emotions, and affections, perceived threat, self-efficacy, and competence for multiple role performance, maintained social relationships, meaning seeking and relationship with the Creator, and positive marital relationships.

CONCLUSION

The present study provide an in-depth understanding about well-being in the Iranian women with HRP. It is a complex and multidimensional concept with physical, mental-emotional, social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to promote well-being among women with HRP and designed the guidelines to provide woman-centered care.

Potential mechanisms and modulators of food intake during pregnancy

Dietary choice during pregnancy is crucial not only for fetal development, but also for long-term health outcomes of both mother and child. During pregnancy, dramatic changes in endocrine, cognitive, and reward systems have been shown to take place. Interestingly, in different contexts, many of these mechanisms play a key role in guiding food intake. Here, we review how food intake may be impacted as a function of pregnancy-induced changes across species. We first summarize changes in endocrine and metabolic signaling in the course of pregnancy. Then, we show how these may be related to cognitive function and reward processing in humans. Finally, we link these to potential drivers of change in eating behavior throughout the course of pregnancy.

Pregnancy during the pandemic: the impact of COVID-19-related stress on risk for prenatal depression

BACKGROUND

Pregnant women may be especially susceptible to negative events (i.e. adversity) related to the coronavirus disease 2019 (COVID-19) pandemic and negative affective responses to these events (i.e. stress). We examined the latent structure of stress and adversity related to the COVID-19 pandemic among pregnant women, potential antecedents of COVID-19-related stress and adversity in this population, and associations with prenatal depressive symptoms.

METHOD

We surveyed 725 pregnant women residing in the San Francisco Bay Area in March-May 2020, 343 of whom provided addresses that were geocoded and matched by census tract to measures of community-level risk. We compared their self-reported depressive symptoms to women matched on demographic factors and history of mental health difficulties who were pregnant prior to the pandemic.

RESULTS

Women who were pregnant during the pandemic were nearly twice as likely to have possible depression than were matched women who were pregnant prior to the pandemic. Individual- and community-level factors tied to socioeconomic inequality were associated with latent factors of COVID-19-related stress and adversity. Beyond objective adversity, subjective stress responses were strongly associated with depressive symptoms during the pandemic.

CONCLUSIONS

Highlighting the role of subjective responses in vulnerability to prenatal depression and factors that influence susceptibility to COVID-19-related stress, these findings inform the allocation of resources to support recovery from this pandemic and future disease outbreaks. In addition to policies that mitigate disruptions to the environment due to the pandemic, treatments that focus on cognitions about the self and the environment may help to alleviate depressive symptoms in pregnant women.

Childbirth Experience Questionnaire: Cross-cultural validation and psychometric evaluation for European Portuguese

BACKGROUND

Self-reported measures are relevant both for the clinic and for health evaluation because they provide an interpretation of quality parameters. Women who experience labour can express themselves through these measures, identifying indicators that need improvement.

OBJECTIVE

The objective of this study is to adapt the Childbirth Experience Questionnaire to the Portuguese context and to determine its psychometric properties.

METHOD

A methodological study carried out with a convenience sample where the participants were 161 female users of a hospital in southern Portugal. They were aged between 20 and 43 years (M = 31.05, SD = 4.87) and answered a questionnaire approximately 48 h postpartum, preserving the ethical principles. The original instrument, with 22 items, underwent the linguistic and cultural adequacy process.

RESULTS

Factor analysis with Varimax rotation was performed, revealing a set of 19 items with factor weights above .400. The set of items remained four-dimensional as the original, explaining 62.517% of the variance. In the retest, the reliability results showed that similar characteristics to the original study are maintained in the two subscales that express 'Participation' (three items) and 'Professional Support' (four items), with internal consistency values of .807 and .782. The 'Own Performance' and 'Own Threshold' subscales were elaborated from the results of the Varimax rotation, presenting Cronbach's alpha coefficients of .840 and 714, respectively. The total scale showed alpha values of .873 and .823 in the test and retest, respectively. Time stability showed a positive association, with r = .659 (p < .001). Accuracy through the split-half method reached an alpha value of .880 with Spearman-Brown correction. The floor effect was high in the 'Participation' subscale, both in the test and in the retest. Convergent validity between the instrument and the 'Index of Strategies for Pain Relief in Labour' discrete variable showed a Spearman's rho value of .209 (p = .011) in the total scale. In discriminating validity, the Mann-Whitney test reveals that the women who recognize interactions with the midwife have more favourable scores in Childbirth Experience Questionnaire (U = 2748.000; Z = 2.905; p = .004).

CONCLUSION

The current version in European Portuguese suggests that it is a valid and reliable measure. This study may facilitate other validation processes in Lusophony countries.

Trait coping styles and the maternal neural and behavioral sensitivity to an infant

During the postpartum period, new mothers experience drastic changes in their body, brain, and life circumstances. Stress from the emotional and physical demands of caring for an infant is associated with negative mood and parenting outcomes. The use of active coping strategies can increase mothers’ resilience during the postpartum period. However, little is known about the association between coping styles and maternal brain responses to infant cues. In the current study, we examined the associations among trait coping style, maternal brain responses, and behavioral sensitivity in a socioeconomically diverse sample of first-time mothers (N = 59). The use of more active trait coping strategies compared to passive coping strategies was associated with increased brain responses to infant cry sounds in brain regions that are critically involved in motivation and emotion regulation—substantia nigra, anterior cingulate gyrus, and inferior frontal gyrus. Increased brain activations in the midbrain and anterior cingulate gyrus were further associated with higher levels of maternal sensitivity observed during interactions with the infant. Thus, the findings provide support for mothers’ use of more active coping styles to promote neural and behavioral resilience for a positive transition to parenthood.

Sex differences in the human brain: a roadmap for more careful analysis and interpretation of a biological reality

The presence, magnitude, and significance of sex differences in the human brain are hotly debated topics in the scientific community and popular media. This debate is largely fueled by studies containing strong, opposing conclusions: either little to no evidence exists for sex differences in human neuroanatomy, or there are small-to-moderate differences in the size of certain brain regions that are highly reproducible across cohorts (even after controlling for sex differences in average brain size). Our Commentary uses the specific comparison between two recent large-scale studies that adopt these opposing views-namely the review by Eliot and colleagues (2021) and the direct analysis of ~ 40k brains by Williams and colleagues (2021)-in an effort to clarify this controversy and provide a framework for conducting this research. First, we review observations that motivate research on sex differences in human neuroanatomy, including potential causes (evolutionary, genetic, and environmental) and effects (epidemiological and clinical evidence for sex-biased brain disorders). We also summarize methodological and empirical support for using structural MRI to investigate such patterns. Next, we outline how researchers focused on sex differences can better specify their study design (e.g., how sex was defined, if and how brain size was adjusted for) and results (by e.g., distinguishing sexual dimorphisms from sex differences). We then compare the different approaches available for studying sex differences across a large number of individuals: direct analysis, meta-analysis, and review. We stress that reviews do not account for methodological differences across studies, and that this variation explains many of the apparent inconsistencies reported throughout recent reviews (including the work by Eliot and colleagues). For instance, we show that amygdala volume is consistently reported as male-biased in studies with sufficient sample sizes and appropriate methods for brain size correction. In fact, comparing the results from multiple large direct analyses highlights small, highly reproducible sex differences in the volume of many brain regions (controlling for brain size). Finally, we describe best practices for the presentation and interpretation of these findings. Care in interpretation is important for all domains of science, but especially so for research on sex differences in the human brain, given the existence of broad societal gender-biases and a history of biological data being used justify sexist ideas. As such, we urge researchers to discuss their results from simultaneously scientific and anti-sexist viewpoints.

Benevolent Childhood Experiences and Childhood Maltreatment History: Examining their Roles in Depressive Symptoms Across the Peripartum Period

Peripartum depressive symptoms are associated with a range of adverse outcomes for offspring and mothers. Childhood experiences, both negative and positive, may impact peripartum depression risk. Longitudinal studies are needed to examine trajectories of change in depression across the peripartum and predictors of symptoms across time. We examined the associations between women's reports of specific childhood experiences and trajectories of depressive symptoms across the peripartum period. Participants were 208 pregnant women (Mage=30.31, SD=5.45, range=20-45 years) at the prenatal session. Participants completed follow up sessions approximately 1 month and 6 months postpartum. At baseline, participants completed questionnaire measures of benevolent childhood experiences, childhood maltreatment, and depressive symptoms. Greater benevolent childhood experiences were associated with lower depressive symptoms across the peripartum period. The association with postpartum symptoms remained significant even when covarying antepartum depressive symptoms, indicating that benevolent childhood experiences may protect against postpartum depressive symptoms even after accounting for earlier symptoms. We did not find significant associations between childhood maltreatment and depressive symptoms. These findings extend previous research on benevolent childhood experiences by offering insight into unique associations with symptoms across the peripartum period.

Associations between reproductive history, hormone use, APOE ε4 genotype and cognition in middle- to older-aged women from the UK Biobank

Introduction

Relative to men, women are at a higher risk of developing age-related neurocognitive disorders including Alzheimer's disease. While women's health has historically been understudied, emerging evidence suggests that reproductive life events such as pregnancy and hormone use may influence women's cognition later in life.

Methods

We investigated the associations between reproductive history, exogenous hormone use, apolipoprotein (APOE) ε4 genotype and cognition in 221,124 middle- to older-aged (mean age 56.2 ± 8.0 years) women from the UK Biobank. Performance on six cognitive tasks was assessed, covering four cognitive domains: episodic visual memory, numeric working memory, processing speed, and executive function.

Results

A longer reproductive span, older age at menopause, older age at first and last birth, and use of hormonal contraceptives were positively associated with cognitive performance later in life. Number of live births, hysterectomy without oophorectomy and use of hormone therapy showed mixed findings, with task-specific positive and negative associations. Effect sizes were generally small (Cohen's d < 0.1). While APOE ε4 genotype was associated with reduced processing speed and executive functioning, in a dose-dependent manner, it did not influence the observed associations between female-specific factors and cognition.

Discussion

Our findings support previous evidence of associations between a broad range of female-specific factors and cognition. The positive association between a history of hormonal contraceptive use and cognition later in life showed the largest effect sizes (max. d = 0.1). More research targeting the long-term effects of female-specific factors on cognition and age-related neurocognitive disorders including Alzheimer's disease is crucial for a better understanding of women's brain health and to support women's health care.

Migraine as a risk factor for mixed symptoms of peripartum depression and anxiety in late pregnancy: A prospective cohort study

BACKGROUND

Migraine has been identified as a risk factor for peripartum depression. However, little is known about the contribution of anxiety to this association or potential changes throughout the peripartum period.

METHODS

In a sample of 4,831 women from the Biology, Affect, Stress, Imaging and Cognition cohort in Sweden, participants were asked about history of migraine prior to pregnancy. The participants completed the Edinburgh Postnatal Depression Scale (EPDS) at gestational weeks 17 and 32 and postpartum week 6. Multinomial logistic regression analyses were used to assess associations between migraine and symptoms of depression, anxiety or mixed depression and anxiety, while adjusting for potential confounders.

RESULTS

In crude estimates, migraine was associated with separate and mixed symptoms of depression and anxiety at most time points. After adjustments, migraine was associated with anxiety at week 17 (adjusted odds ratio: 1.69; 95% confidence interval: 1.11-2.54) and with mixed depression and anxiety at week 32 (adjusted odds ratio: 1.45; 95% confidence interval: 1.06-1.99). None of the other associations remained statistically significant after adjustments.

LIMITATIONS

Migraine history was self-reported. Symptoms of depression and anxiety were based on the screening tool EPDS and not on clinical diagnoses.

CONCLUSIONS

The results demonstrate that migraine may be a risk factor for anxiety in mid- pregnancy and mixed symptoms of peripartum depression and anxiety in late pregnancy. Inflammatory and hormonal factors may underlie the association between migraine, depression and anxiety across the peripartum period.

Fathers' Involvement in Early Childcare is Associated with Amygdala Resting-State Connectivity

Becoming a parent requires new skills and frequent task switching during daily childcare. Little is known about the paternal brain during the transition to fatherhood. The present study examined intrinsic neuronal network connectivity in a group of first-time expectant and new fathers (total N = 131) using amygdala seed-based resting-state functional connectivity analysis. Furthermore, we examined the association between paternal involvement (i.e. hours spent in childcare and real-time push notifications on smartphone) and connectivity within the parental brain network in new fathers. There were no significant differences in functional connectivity between expectant and new fathers. However, results show that in new fathers, time spent in childcare was positively related to amygdala connectivity with the supramarginal gyrus, postcentral gyrus and the superior parietal lobule—all regions within the cognition/mentalizing network that have been associated with empathy and social cognition. Our results suggest that fathers’ time investment in childcare is related to connectivity networks in the parental brain.

Maternal perinatal anxiety and neural responding to infant affective signals: Insights, challenges, and a road map for neuroimaging research

Anxiety symptoms are common among women during pregnancy and the postpartum period, potentially having detrimental effects on both mother and child's well-being. Perinatal maternal anxiety interferes with a core facet of adaptive caregiving: mothers' sensitive responsiveness to infant affective communicative 'cues.' This review summarizes the current research on the neural correlates of maternal processing of infant cues in the presence of perinatal anxiety, outlines its limitations, and offers next steps to advance future research. Functional neuroimaging studies examining the neural circuitry involved in, and electrophysiological studies examining the temporal dynamics of, processing infant cues during pregnancy and postpartum are reviewed. Studies have generally indicated mixed findings, although emerging themes suggest that anxiety may be implicated in several stages of processing infant cues- detection, interpretation, and reaction- contingent upon cue valence. Limitations include inconsistent designs, lack of differentiation between anxiety and depression symptoms, and limited consideration of parenting-specific (versus domain-general) anxiety. Future studies should incorporate longitudinal investigation of multiple levels of analysis spanning neural, cognitive, and observed aspects of sensitive caregiving.

The birthing brain: A lacuna in neuroscience

During pregnancy, maternal brain neuroplasticity indicates vast neurofunctional and neuroanatomical changes. Recent findings documented a similarly massive readjustment after pregnancy. Currently, these brain changes are interpreted as preparation for and adjustment of the maternal brain to motherhood. Yet, this perspective leaves many questions unsolved. Neuroscientific studies have not yet been conducted to determine the brain areas that function during natural childbirth even though physiological birth is the natural process of women who have reproduced successfully throughout two million years of evolution of the genus Homo. It is rational to believe that the female brain is an active and crucial actor during birth and that birth, itself, is a process that requires brain neuroplasticity. Lack of studies of the birthing brain and brain preparation for birth is a significant lacuna in neuroscience research. I demonstrate theoretically that a new hypothesis for complementary interpretation of maternal brain neuroplasticity is reasonable: Certain maternal brain changes during pregnancy can be interpreted asbrain preparation for birth and certain maternal brain changes after birth can be interpreted asbrain recovery after the tremendous event of birth. This essay can be a starting point for new directions in neuroscience studies.

Theory of mind processing in expectant fathers: Associations with prenatal oxytocin and parental attunement

Social cognition may facilitate fathers' sensitive caregiving behavior. We administered the Why-How Task, an fMRI task that elicits theory of mind processing, to expectant fathers (n = 39) who also visited the laboratory during their partner's pregnancy and provided a plasma sample for oxytocin assay. Three months postpartum, fathers reported their beliefs about parenting. When rating "Why" an action was being performed versus "How" the action was being performed (Why > How contrast), participants showed activation in regions theorized to support theory of mind, including the dorsomedial prefrontal cortex and superior temporal sulcus. Fathers' prenatal oxytocin levels predicted greater signal change during the Why > How contrast in the inferior parietal lobule. Both prenatal oxytocin and attunement parenting beliefs were associated with Why > How activation in the dorsolateral prefrontal cortex, a theory of mind region implicated in emotion regulation. Posterior parahippocampal gyrus and dorsolateral prefrontal cortex activation during the Why > How contrast predicted fathers' attunement parenting beliefs. In conclusion, fathers' neural activation when engaging in a theory of mind task was associated with their prenatal oxytocin levels and their postpartum attunement parenting beliefs. Results suggest biological and cognitive components of fathering may track with the theory of mind processing.

Do Pregnancy-Induced Brain Changes Reverse? The Brain of a Mother Six Years after Parturition

Neuroimaging researchers commonly assume that the brain of a mother is comparable to that of a nulliparous woman. However, pregnancy leads to pronounced gray matter volume reductions in the mother's brain, which have been associated with maternal attachment towards the baby. Beyond two years postpartum, no study has explored whether these brain changes are maintained or instead return to pre-pregnancy levels. The present study tested whether gray matter volume reductions detected in primiparous women are still present six years after parturition. Using data from a unique, prospective neuroimaging study, we compared the gray matter volume of 25 primiparous and 22 nulliparous women across three sessions: before conception (n = 25/22), during the first months of postpartum (n = 25/21), and at six years after parturition (n = 7/5). We found that most of the pregnancy-induced gray matter volume reductions persist six years after parturition (classifying women as having been pregnant or not with 91.67% of total accuracy). We also found that brain changes at six years postpartum are associated with measures of mother-to-infant attachment. These findings open the possibility that pregnancy-induced brain changes are permanent and encourage neuroimaging studies to routinely include pregnancy-related information as a relevant demographic variable.

Neuroprotective Effects of Motherhood on Brain Function in Late Life: A Resting-State fMRI Study

The maternal brain undergoes structural and functional plasticity during pregnancy and the postpartum period. Little is known about functional plasticity outside caregiving-specific contexts and whether changes persist across the lifespan. Structural neuroimaging studies suggest that parenthood may confer a protective effect against the aging process; however, it is unknown whether parenthood is associated with functional brain differences in late life. We examined the relationship between resting-state functional connectivity and number of children parented in 220 healthy older females (73.82 ± 3.53 years) and 252 healthy older males (73.95 ± 3.50 years). We compared the patterns of resting-state functional connectivity with 3 different models of age-related functional change to assess whether these effects may be functionally neuroprotective for the aging human parental brain. No relationship between functional connectivity and number of children was obtained for males. For females, we found widespread decreasing functional connectivity with increasing number of children parented, with increased segregation between networks, decreased connectivity between hemispheres, and decreased connectivity between anterior and posterior regions. The patterns of functional connectivity related to the number of children an older woman has parented were in the opposite direction to those usually associated with age-related cognitive decline, suggesting that motherhood may be beneficial for brain function in late life.

A new molecular risk pathway for postpartum mood disorders: clues from steroid sulfatase-deficient individuals

Postpartum mood disorders develop shortly after childbirth in a significant proportion of women. These conditions are associated with a range of symptoms including abnormally high or low mood, irritability, cognitive disorganisation, disrupted sleep, hallucinations/delusions, and occasionally suicidal or infanticidal ideation; if not treated promptly, they can substantially impact upon the mother's health, mother-infant bonding, and family dynamics. The biological precipitants of such disorders remain unclear, although large changes in maternal immune and hormonal physiology following childbirth are likely to play a role. Pharmacological therapies for postpartum mood disorders can be effective, but may be associated with side effects, concerns relating to breastfeeding, and teratogenicity risks when used prophylactically. Furthermore, most of the drugs that are used to treat postpartum mood disorders are the same ones that are used to treat mood episodes during non-postpartum periods. A better understanding of the biological factors predisposing to postpartum mood disorders would allow for rational drug development, and the identification of predictive biomarkers to ensure that 'at risk' mothers receive earlier and more effective clinical management. We describe new findings relating to the role of the enzyme steroid sulfatase in maternal postpartum behavioural processes, and discuss how these point to a novel molecular risk pathway underlying postpartum mood disorders. Specifically, we suggest that aberrant steroid hormone-dependent regulation of neuronal calcium influx via extracellular matrix proteins and membrane receptors involved in responding to the cell's microenvironment might be important. Testing of this hypothesis might identify novel therapeutic targets and predictive biomarkers.

Neurobiology of maternal mental illness

This chapter provides an overview of current research discoveries beginning to uncover the neurobiology of maternal mental illness. Results are described according to standard diagnostic categories (specifically, perinatal depression, perinatal anxiety and OCD, postpartum psychosis and bipolar disorder, and trauma and posttraumatic stress disorder), yet we aim to put this approach in context with the introduction of a classification model for psychiatric research, the research domain criteria, gaining traction in basic and clinical translational fields. We first review a new area of study, the neuroplasticity of the pregnant and postpartum brain, as work here has relevance for understanding the pathophysiology of mental disorders and may provide clues to changes in brain functioning that are related to compromised parenting in the context of postpartum depression. We next provide background information on neuroendocrine and immune changes during pregnancy and, to a lesser extent, the postpartum period, as alterations in these systems are significantly implicated in underlying neurobiology of mental illness for peripartum women. Our discussion of the major mental illnesses for pregnant and postpartum women includes neuroendocrine changes, neuroinflammation, and neurotransmitter alterations, as well as circuit dysfunction. Overall, remarkable progress has been made in identifying variations in neurobiology (and related systems) involved in maternal mental illness; yet, it is clear that, as classified with standard diagnostic systems, these are heterogeneous disorders and there is individual variability in the alterations in neurobiology for the same illness.