Self-perception of cognitive changes during pregnancy and the early postpartum: salience and attentional effects

Memory and mood changes in pregnancy: a qualitative content analysis of women's first-hand accounts

OBJECTIVE

This qualitative study aimed to explore how pregnant women and new mothers self-report changes to their mood and memory during pregnancy.

BACKGROUND

Researchers have investigated the various changes that women report throughout their pregnancy. Despite this evidence base, there is a notable lack of studies that take a qualitative approach to understanding how pregnant women and women in the postpartum period experience memory and mood changes through their pregnancy.

METHOD

The present study involved a qualitative content analysis of women's first-hand accounts. Of the 423 participants who responded, 118 participants provided textual responses to questions about their memory and 288 participants provided textual responses to questions about their mood. Data were collected online via a free-text survey and analysed using both deductive inductive open coding.

RESULTS

A qualitative content analysis generated four overall categories: two typologies of self-reported memory changes in pregnancy ('short-term memory lapses' and 'chronic memory fog') and two typologies of self-reported mood changes ('mood instability and constant change' and 'low mood and parenting anxiety').

CONCLUSION

These typologies represent unique profiles of the memory and mood changes that women experience during pregnancy and serve to accompany and expand the quantitative literature, which documents the changes women experience during pregnancy.

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.

Evidence of Subjective, But Not Objective, Cognitive Deficit in New Mothers at 1-Year Postpartum

Background: The experience and even existence of cognitive deficits in the postpartum period is uncertain, with only a few scientific studies, reporting inconsistent results. Methods: In this study, we investigate cognition in 86 women (43 first-time mothers 1 year postpartum and 43 non-mothers). Results: Mothers and non-mothers showed no significant differences on measures of objective cognition (verbal memory, working memory, and processing speed or theory of mind). Despite the absence of objective differences, mothers self-reported significantly worse subjective memory than non-mothers. To interpret the difference between objective and subjective measures of memory, we investigated relationships between subjective memory, objective memory, and wellbeing. Mothers, but not non-mothers, showed a positive correlation between subjective and objective measures of memory, indicating mothers are "in-tune" with their memory performance. Mothers also demonstrated a positive relationship between subjective memory and wellbeing (sleep, anxiety, and depression), where better wellbeing correlated with higher subjective memory. This relationship was not apparent in non-mothers. The results suggest that poorer sleep, higher anxiety, and higher depression are related to reports of poorer self-reported memory in mothers. Conclusion: Our results add to our growing understanding of maternal cognition at 1 year postpartum, with no evidence of cognitive differences between mothers and non-mothers.

Differences in cognition, short-chain fatty acids and related metabolites in pregnant versus non-pregnant women: a cross-sectional study

Background

Pregnancy induces cognitive reorganization which can lead to mental disorders. The aim of this study is to determine differences in cognitive scores, short-chain fatty acids (SCFAs) and related metabolites between pregnant and non-pregnant participants.

Methods

This cross-sectional study included 67 full-term pregnant women and 31 non-pregnant women. We compared scores of mental state and cognitive assessment tests, as well as serum concentrations of SCFAs, hormones, inflammatory factors, and neurotransmitters between these groups.

Results

Scores for information processing speed, immediate visual memory, motor response speed and accuracy, execution ability and verbal use ability in the pregnant group were lower than those in the non-pregnant group (p < 0.05 for all tests). Total serum SCFAs in the pregnant group were significantly lower than those in the non-pregnant group (P = 0.031). Among them, acetate and propionate were significantly decreased (P = 0.013 and 0.037, respectively) whereas butyrate was significantly increased (P = 0.035). Serum peptide YY, glucagon-like peptide-1, γ-aminobutyric acid, and dopamine showed no differences between the two groups. However, cortisol, adrenocorticotropic hormone, and acetylcholine were significantly increased in the pregnant group as compared with the non-pregnant group (P = 0.039, 0.016, and 0.012, respectively). Tumor necrosis factor-α was increased and interleukin-10 significantly decreased in the pregnant group (P = 0.045 and 0.019, respectively).

Conclusion

According to our study findings, cognitive reorganization in the third trimester of pregnancy showed that both the passive storage capacity of working memory and the executive function of online information processing were decreased to varying degrees. At the same time, the changes in total SCFAs, the proportions of SCFAs and related metabolites were also detected. These changes in the internal environment may be increasing the risk of perinatal mental illness.

Acupuncture in Obstetrics and Gynecology

Importance

Acupuncture is a key component of therapy in traditional Chinese medicine. Only in the last few decades has acupuncture become popular in the United States. The mechanism behind acupuncture's effects on the body and brain has not been completely elucidated, but there is evidence that acupuncture has effects on the endocrine, immune, and sympathetic and parasympathetic nervous systems. It may also act through electrical and mechanical signaling through the connective tissue and fascia. Despite this uncertainty, the positive effects of acupuncture have been well established.

Objective

In this review, we discuss the basic concepts of traditional Chinese medicine and acupuncture and examine the evidence regarding the use of acupuncture in obstetrics and gynecology.

Evidence Acquisition

We conducted a literature review of acupuncture in obstetrics and gynecology using PubMed.

Results

The available data demonstrate that acupuncture is beneficial in the treatment of labor pain, back pain in pregnancy, and dysmenorrhea. It is unclear if acupuncture is effective for hyperemesis, chemotherapy-induced nausea and vomiting, and menopausal hot flushes, or if moxibustion is effective in correcting breech presentation. There are limited but positive data regarding menopause-related sleep disturbances, depression in pregnancy, and overactive bladder. Acupuncture is not beneficial for improving outcomes in in vitro fertilization.

Conclusions and Relevance

Acupuncture is an increasingly popular therapy with many potential applications in obstetrics and gynecology. A general understanding of the basic principles of acupuncture and the safety and efficacy of its practice is necessary for the general obstetrician and gynecologist to make informed recommendations to patients.

Cognitive costs of reproduction: life-history trade-offs explain cognitive decline during pregnancy in women

Life-history theory predicts that access to limited resources leads to trade-offs between competing body functions. Women, who face higher costs of reproduction when compared to men, should be especially vulnerable to these trade-offs. We propose the 'cognitive costs of reproduction hypothesis', which states that energy trade-offs imposed by reproduction may lead to a decline in maternal cognitive function during gestation. In particular, we hypothesize that the decline in cognitive function frequently observed during pregnancy is associated with the allocation of resources between the competing energetic requirements of the mother's brain and the developing foetus. Several distinctive anatomical and physiological features including a high metabolic rate of the brain, large infant size, specific anatomical features of the placenta and trophoblast, and the lack of maternal control over glucose flow through the placenta make the occurrence of these trade-offs likely. Herein, we review several lines of evidence for trade-offs between gestation and cognition that are related to: (i) energy metabolism during reproduction; (ii) energy metabolism of the human brain; (iii) links between energy metabolism and cognitive function; and (iv) links between gestation and cognitive function. We also review evidence for the important roles of cortisol, corticotropin-releasing hormone and sex hormones in mediating the effects of gestation on cognition, and we discuss possible neurophysiological mechanisms underlying the observed effects. The evidence supports the view that energy trade-offs between foetal growth and maternal endocrine and brain function lead to changes in maternal cognition, and that this phenomenon is mediated by neuroendocrine mechanisms involving the hypothalamic-pituitary-adrenal axis, brainstem nucleus locus coeruleus and hippocampus.

Emotional memory in pregnant women at risk for postpartum depression

Postpartum depression (PPD) is associated with debilitating effects on mothers and their infants. A previous history of depression is considered the strongest risk factor for PPD. Depressed individuals recall more negative than positive content and higher levels of stress hormones released during encoding are associated with enhanced recall of emotional stimuli. This study examined the impact of a previous history of major depressive disorder (MDD) and pregnancy on emotional memory. Seventy-seven participants completed the study [44 pregnant women in the second trimester of pregnancy with and without a lifetime history of MDD and 33 non-pregnant women with and without a lifetime history of MDD]. All completed an encoding task and provided salivary cortisol (sCORT) and alpha-amylase (sAA) samples. Participants returned one week later for a surprise incidental recognition memory task. Women with a history of MDD had worse recognition than women without a history of MDD for negative, but not positive images; this effect was independent of sCORT and sAA levels. Pregnancy did not affect emotional memory. Considering that several previous studies found enhanced memory bias for negative content during depressive states, our results suggest that clinical remission may be associated with an opposite cognitive processing of negative emotional content.

Sleep fragmentation and false memories during pregnancy and motherhood

Pregnant women, both before and after childbirth, frequently experience memory deficits and disrupted sleep. In the present study we assessed the relationship between false memory generation and fragmented sleep during pregnancy and motherhood. We tested 178 pregnant women and 58 female non-pregnant childless controls, during pregnancy (15-35th week of gestation) and again after childbirth (8-13th month). False memories were defined as memories of gist words that were semantically related to studied word lists but were not presented during learning of these lists in the Deese-Roediger-McDermott (DRM) paradigm. Sleep was monitored by actigraphy in the home environment for seven consecutive nights. Compared to the controls, the group of pregnant women produced more false memories and displayed more fragmented sleep both during pregnancy and after childbirth. However, false memory generation was not correlated to measures of sleep fragmentation. These results show that pregnant women suffer from sleep fragmentation and a higher susceptibility to false memories, but leave open the question as to whether both phenomena are related.

Recognition of Novel Faces after Single Exposure is Enhanced during Pregnancy

Protective mechanisms in pregnancy include Nausea and Vomiting in Pregnancy (NVP) ( Fessler, 2002 ; Flaxman and Sherman, 2000 ), increased sensitivity to health cues ( Jones et al., 2005 ), and increased vigilance to out-group members (Navarette, Fessler, and Eng, 2007). While common perception suggests that pregnancy results in decreased cognitive function, an adaptationist perspective might predict that some aspects of cognition would be enhanced during pregnancy if they help to protect the reproductive investment. We propose that a reallocation of cognitive resources from nonessential to critical areas engenders the cognitive decline observed in some studies. Here, we used a recognition task disguised as a health rating to determine whether pregnancy facilitates face recognition. We found that pregnant women were significantly better at recognizing faces and that this effect was particularly pronounced for own-race male faces. In human evolutionary history, and today, males present a significant threat to females. Thus, enhanced recognition of faces, and especially male faces, during pregnancy may serve a protective function.

Prospective-memory functioning is affected during pregnancy and postpartum

Although there is considerable anecdotal and empirical evidence showing that retrospective memory may be adversely affected during pregnancy and postpartum, it remains unclear whether capacity for prospective memory is also impaired. In Phase 1 of the present study 20 participants in their third trimester of pregnancy were compared with 20 nonpregnant matched controls on a laboratory measure of prospective memory that closely represents the types of prospective-memory tasks that actually occur in everyday life, in addition to a naturalistic time-logging prospective-memory task that was conducted over a period of 7 days as part of their day-to-day lives. In Phase 2, 15 of the pregnant women were retested on the time-logging task approximately 13 months after giving birth. The results indicated that although pregnancy was not associated with deficits on the laboratory measure of prospective memory, significant impairment was observed on the naturalistic measure. These preliminary data therefore provide the first empirical evidence showing that pregnancy may be associated with increased difficulty in implementing delayed intentions in everyday life.

A review of the impact of pregnancy on memory function

Although until recently much of the evidence for pregnancy-related deficits in memory was anecdotal or based on self-report, a number of studies have now been conducted that have tested whether these subjective appraisals of memory difficulties reflect objective impairment. However, these studies have failed to yield consistent results. A meta-analysis of the 14 studies that have been conducted over the past 17 years comparing pregnant and/or postpartum women with healthy matched controls on behavioral measures of memory was conducted. The results indicate that pregnant women are significantly impaired on some, but not all, measures of memory, and, specifically, memory measures that place relatively high demands on executive cognitive control may be selectively disrupted. The same specific deficits associated with pregnancy are also observed postpartum. These findings highlight the need for exploration of the etiologies and functional consequences of pregnancy-related memory difficulties and may help to guide the interpretation of neuropsychological data for the purpose of determining cognitive status in individuals who are pregnant or postpartum.