Assessment of cognitive function across pregnancy using CANTAB: A longitudinal study

Do pregnancy and motherhood have an impact on cognitive functions in women

Pregnancy and motherhood are some of the most physically and mentally challenging periods in a woman's life. The aim of current study was to examine aspects of cognitive functions in pregnancy and motherhood that are controversial in the literature. The study included 30 healthy pregnant women aged between 18-40 years in their second and third trimesters, 30 healthy controls (nulliparous and non-pregnant women) and 30 healthy mothers matched with the pregnant women for age, handedness and education level. Edinburgh Postpartum Depression Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Trail Making, Stroop, Digit Span, Verbal Fluency and Rey Auditory and Verbal Learning Tests (RAVLT) were applied to all participants. The pregnant group showed significantly lower performance in trail making, digit span, verbal fluency as well as RAVLT compared to other two groups suggesting deficiencies in cognitive areas such as attention, set-shifting, planning, learning, language functions, semantic memory, working memory, encoding memory and retrieval. A trend toward increased function in response inhibition was observed in the mothers. Regression analyses revealed that pregnancy significantly decreased performance in verbal fluency, trail making, and RAVLT. Our findings from rigorously selected participants may help comprehend alterations in cognitive functioning during pregnancy and motherhood, as well as shed light on the contradictory literature.

Comprehensive assessment of memory function, inhibitory control, neural activity, and cortisol levels in late pregnancy

A considerable proportion of women subjectively perceive a detriment to their cognitive capacity during pregnancy, with decreased memory functions being the most frequently self-reported concerns. However, objective investigation of these perceived cognitive deficits has yielded inconsistent results. This study focused on memory functions during late pregnancy using multiple tasks designed to assess various memory indices, for example, working memory, learning rate, immediate recall, proactive and retroactive interference, delayed recall, retrieval efficiency, visuospatial constructional ability, recognition, and executive function. Additionally, sustained attention and inhibitory control were examined using a combined recognition stop-signal task. Electrophysiological brain activity during this task was recorded using a 128-channel electroencephalographic-event-related potential system. Salivary cortisol levels were assessed both prior to and following the experimental session. In contrast to the widely held belief, results demonstrated that women in late pregnancy did not exhibit a decline in their performance across the various memory tests. In terms of accuracy, there was not a single task in which poorer performance was found for pregnant women. The quality of memory performance was comparable, and in some cases even superior, among women in the pregnancy group. On the stop-signal task, pregnant women exhibited significantly better performance, and their electrophysiological data revealed greater centrally distributed P300 amplitude to "stop" signs, which may signify an enhanced neural efficiency in the domains of inhibitory executive control. Endocrine results revealed that pregnant women exhibited significantly lower levels of salivary cortisol, suggesting an attenuation of hypothalamic-pituitary-adrenocortical axis activity, which may contribute to the optimization of fetal development and growth.

Longitudinal Course of Sex Steroids From Pregnancy to Postpartum

CONTEXT

Sex steroids (SS) typically rise during pregnancy and decline after birth, but no consistent reference values exist for these hormonal courses. We aimed to establish an overview of SS secretion patterns during the peripartum and to better understand how SS contribute to maternal and fetal pathologies.

EVIDENCE ACQUISITION

A systematic literature search was conducted in accordance with the PRISMA guidelines using PubMed, Cochrane Library, and PsycINFO. Additionally, we conducted a supplementary manual search of references. Observational studies published in English and assessing estradiol, progesterone, and testosterone over the course of the peripartum in physically healthy female subjects were included, without restrictions on year of publication. Extracted data were analyzed descriptively and visually.

EVIDENCE SYNTHESIS

SS increase progressively during pregnancy, with an extremely wide range of reported concentrations, especially in the third trimester. In fact, reported concentrations varied up to 5000-fold at comparable measurement time points.

CONCLUSIONS

A comprehensive understanding of the influence of SS levels on associated maternal and fetal pathologies is currently hindered by 2 main factors. First, reported SS levels vary widely during the peripartum period. Second, the current state of knowledge on how SS are associated with pathologies in mothers and babies is largely based on correlational studies, and causality thus remains unclear. Consequently, we recommend the development of a systematic reference framework that follows the suggestions presented in this review. This would enable the establishment of SS reference values for a healthy population, resulting in the possibility to draw conclusions about deviations and related pathologies.

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.

Navigating intensive altered states of consciousness: How can the set and setting key parameters promote the science of human birth?

The subjective childbirth experience is crucial from a public health standpoint. There is a correlation between a negative childbirth experience and a poor mental state after birth, with effects that go far beyond the postpartum (PP) period. This paper offers a new approach as to how birthing experiences, and birth in general, can be navigated. The theory of set and setting proves that psychedelic experiences are shaped, first and foremost, by the mindset of an individual entering a psychedelic experience (set) and by the surroundings in which the experience happens (setting). In research on altered states of consciousness during psychedelic experiences, this theory explains how the same substance can lead to a positive and life-changing experience or to a traumatic and frightening experience. Because recent studies suggest that birthing women enter an altered state of consciousness during physiological birth ("birthing consciousness"), I suggest analyzing the typical modern birthing experience in terms of set and setting theory. I argue that the set and setting key parameters can help design, navigate, and explain many psychological and physiological elements of the human birth process. Thus, an operative conclusion that emerges from the theoretical analysis presented in this paper is that framing and characterizing the birth environment and birth preparations in terms of set and setting is a central tool that could be used to promote physiological births as well as subjective positive birthing experiences, which is currently a primary, yet unreached goal, in modern obstetrics and public health.

Cognitive Function Decline in the Third Trimester of Pregnancy Is Associated with Sleep Fragmentation

During late pregnancy, sleep deterioration is regularly observed. In concert with these observations, in previous studies by other researchers, a slight objective cognitive decline in pregnant women has been found. Sleep is essential for memory consolidation. The hypothesis of the study was that cognitive impairment could be related to sleep deterioration during pregnancy. The study included 19 pregnant women in their third trimester of pregnancy (28−40 weeks, median 33 weeks (IQR 32−37)) recruited at the Department of Gynecology and Obstetrics, Medical University of Warsaw, and 20 non-pregnant women as controls. The assessment was performed using the vocabulary subtest from the Wechsler Adult Intelligence Scale (WAIS), D2 Test of Attention, OSPAN task (Operational Span Task) to assess cognitive performance, actigraphy to examine sleep parameters, and a set of self-report instruments: Athens Insomnia Scale (AIS), Beck Depression Inventory (BDI), Ford Insomnia Response to Stress (FIRST), Regenstein Hyperarousal Scale (HS), and Epworth Sleepiness Scale (ESS). Although there were no differences between the groups in WAIS (p = 0.18), pregnant women had worse scores in working memory capacity (overall number of remembered letters: p = 0.012, WM span index: p = 0.004) and a significantly lower score in attention (p = 0.03). Pregnant women also had lower sleep efficiency (p = 0.001), more awakenings from sleep (p = 0.001), longer average awakenings (p < 0.0001), longer wake after sleep onset (WASO, p < 0.0001), and longer total time in bed (p < 0.0001). In psychological assessment, pregnant women had only a higher FIRST score (p = 0.02). Using mediation analysis, we found that frequent awakening might be the major factor contributing to deterioration in working memory performance, explaining almost 40% of the total effect. In conclusion, sleep fragmentation in the third trimester of pregnancy may impair working memory consolidation. Pregnant women often complain about poor daily performance as well as non-restorative sleep. In this study, we showed that there is a relationship between lower sleep quality in pregnancy and worse cognitive functioning. We can expect a cognitive decline in women with sleep disturbances in pregnancy. Therefore, we should pay more attention to the treatment of sleep disorders in pregnancy.

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.

Pregnancy and brain architecture: Associations with hormones, cognition and affect

Sex hormones such as estradiol (E2) have long-lasting influence on brain architecture. Recent studies indicate further structural changes during hormonal transition periods including pregnancy, when women experience the greatest increase in sex hormone levels across their life span. In the present study, three groups of women (n = 44) with different levels of E2 underwent structural magnetic resonance imaging: (1) first-time pregnant women (n = 13, 'extreme E2 group'); (2), nulliparous, naturally cycling women who received 12 mg of E2 valerate (n = 16, 'high E2 group'); and (3) nulliparous, naturally cycling women receiving a placebo and hence low E2 (n = 15, 'low E2 group'). Blood samples were taken to assess hormonal levels. Moreover, parameters for cognition, emotion regulation and affect were assessed. On the neuronal level, the extreme E2 compared to the high E2 group showed a reduced gray matter volume in the left putamen. However, no significant differences were found between the low vs. high E2 groups, nor between the low E2 and extreme E2 groups. Cognitive performance was reduced in the extreme E2 group, although a positive affect was increased compared to the high E2 and low E2 groups. Furthermore, regression analyses revealed several associations between cognition, subjective measures of affect, emotion regulation and gray matter volume. A volume reduction of the left putamen during pregnancy further supports the notion that the female brain is shaped by hormonal transition phases, possibly preparing women for their future roles (e.g., pregnant women for their role as mothers).

The Expectant Brain-Pregnancy Leads to Changes in Brain Morphology in the Early Postpartum Period

There is growing evidence that pregnancy may have a significant impact on the maternal brain, causing changes in its structure. To investigate the patterns of these changes, we compared nulliparous women (n = 40) with a group of primiparous women (n = 40) and multiparous mothers (n = 37) within 1–4 days postpartum, using voxel-based and surface-based morphometry (SBM). Compared with the nulliparous women, the young mothers showed decreases in gray matter volume in the bilateral hippocampus/amygdala, the orbitofrontal/subgenual prefrontal area, the right superior temporal gyrus and insula, and the cerebellum. These pregnancy-related changes in brain structure did not predict the quality of mother–infant attachment at either 3 or 12 weeks postpartum nor were they more pronounced among the multiparous women. SBM analyses showed significant cortical thinning especially in the frontal and parietal cortices, with the parietal cortical thinning likely potentiated by multiple pregnancies. We conclude that, compared with the brain of nulliparous women, the maternal brain shows widespread morphological changes shortly after childbirth. Also, the experience of pregnancy alone may not be the underlying cause of the adaptations for mothering. As regards the exact biological function of the changes in brain morphology, longitudinal research will be needed to draw any definitive conclusions.

Pregnancy-related hormones and COMT genotype: Associations with maternal working memory

Women experience different degrees of subjective cognitive changes during pregnancy. The exact mechanism underlying these changes is unknown, although endocrine alterations and genetics may be contributing factors. We investigated whether multiple pregnancy-related hormones were associated with working memory function assessed with the Digit Span Test (DST) in late pregnancy. Moreover, we examined whether the catechol-O-methyltransferase (COMT) genotype, previously related to working memory, was an effect modifier in this association. In this population-based panel study, we recorded psychiatric history, medication use, socio-demographic characteristics, and psychological well-being, gathered blood and saliva samples, and administered the DST at gestational weeks 35-39 (N = 216). We conducted multivariate linear regressions with DST as outcome, with different hormones and COMT genotype, adjusting for covariates including maternal age, BMI, education, depressive symptoms, and parity. We repeated these analyses excluding women with elevated depressive symptoms. Higher DST total scores were associated with increased free estradiol concentrations (B = 0.01, p = 0.03; B = 0.01, p = 0.02) in all participants and in participants without depressive symptoms, respectively, whereas DST forward was positively associated with free estradiol only in women without depressive symptoms (B = 0.01, p = 0.04). Lower total testosterone concentrations (B = -0.03, p = 0.01) enhanced DST backward performance in non-depressed women. Maternal higher education was significantly associated with the DST subscales in all participants. No significant differences emerged when considering the COMT genotype. Our results suggest differential associations of free estradiol and total testosterone levels with working memory function in late pregnancy.

The effect of pregnancy on maternal cognition

To determine whether there are differences in measures of cognitive function between second and third trimester pregnant women compared to non-pregnant controls. This prospective study comprised 40 pregnant and 40 non-pregnant women, 20–40 years old, native-Hebrew speakers who were recruited from the outpatient clinics during a period of nearly 2 years. The patients underwent cognitive and affective evaluation. The performance on the three following tests: difficult and total items of Verbal Paired Associates, the Digit Span—forward and the Naming Objects and Fingers test scores were significantly better among non- pregnant women. All the other test results were similar between the two groups, including the depression scores. On multivariate linear regression analysis, after adjusting for age and years of education , Verbal Paired Associates total score (p = 0.04), and Naming Objects and Fingers (p = 0.01) remained significantly associated with pregnancy, but not Digit Span (p = 0.09). Our study demonstrates an impairment in memory among pregnant women. Furthermore language skills, particularly naming, were also impaired, a finding which has not been previously described.

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.

Poor Sleep and Decision-Making Disturbance Are Associated With Suicidal Ideation in Pre-natal Depression

Although many risk factors for suicidal ideation have been identified, few studies have focused on suicidal ideation and pre-natal depression. The purpose was to investigate the relationship between decision-making (DM) dysfunction and sleep disturbance on suicidal ideation in pre-natal depression. Participants included 100 women in the third trimester of pregnancy, including pregnant women with pre-natal depression who had recent suicidal ideation (n = 30), pre-natal depression without SI (n = 35) and healthy controls (n = 35). The Iowa Gambling Task (IGT) was used to evaluate the DM function and the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep index. The Edinburgh Post-natal Depression Scale (EPDS) was used to assess suicidal ideation and the seriousness of depression. Overall, the two groups with pre-natal depression showed worse sleep quality and decreased DM function compared with healthy controls. The pre-natal depression with suicidal ideation group showed a significantly higher score in subjective sleep quality and a lower score in block 5 of IGT than the pre-natal depression without suicidal ideation group. Further correlation analysis showed that suicidal ideation positively correlated with subjective sleep quality, sleep duration, and daytime function, and negatively correlated with IGT scores. Sleep disturbance and impaired DM function may be risk factors for suicidal ideation in pre-natal depression.

Oxytocin receptor binding in the titi monkey hippocampal formation is associated with parental status and partner affiliation

Social cognition is facilitated by oxytocin receptors (OXTR) in the hippocampus, a brain region that changes dynamically with pregnancy, parturition, and parenting experience. We investigated the impact of parenthood on hippocampal OXTR in male and female titi monkeys, a pair-bonding primate species that exhibits biparental care of offspring. We hypothesized that in postmortem brain tissue, OXTR binding in the hippocampal formation would differ between parents and non-parents, and that OXTR density would correlate with frequencies of observed parenting and affiliative behaviors between partners. Subjects were 10 adult titi monkeys. OXTR binding in the hippocampus (CA1, CA2/3, CA4, dentate gyrus, subiculum) and presubiculum layers (PSB1, PSB3) was determined using receptor autoradiography. The average frequency of partner affiliation (Proximity, Contact, and Tail Twining) and infant carrying were determined from longitudinal observations (5-6 per day). Analyses showed that parents exhibited higher OXTR binding than non-parents in PSB1 (t₍₈₎ = - 2.33, p = 0.048), and that OXTR binding in the total presubiculm correlated negatively with Proximity (r = - 0.88) and Contact (r = - 0.91), but not Tail Twining or infant carrying. These results suggest that OXTR binding in the presubiculum supports pair bonding and parenting behavior, potentially by mediating changes in hippocampal plasticity.

Birthing Consciousness as a Case of Adaptive Altered State of Consciousness Associated With Transient Hypofrontality

In this article, I present the concept of “birthing consciousness,” a psychophysical altered state of women that can occur during natural and undisturbed birth. I demonstrate that this altered state of consciousness (ASC) has phenomenological and cognitive features of hypofrontality; thus, birthing consciousness probably shares a similar brain mechanism to that postulated by the transient-hypofrontality theory (THT). I argue that until recently (with the advent of modern medical intervention), in evolutionary terms, women lacking the proclivity for this specific brain mechanism had a lower chance of reproducing successfully. Hence, I suggest a general and preliminary hypothesis concerning THT: Birthing consciousness is one example of an adaptive pain-induced ASC associated with transient hypofrontality.

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, neural and endocrine functioning during late pregnancy: An Event-Related Potentials study

This study investigated cognitive, neural and endocrine function during late pregnancy. One of the first to examine brain ERPs in pregnant women, the study is unique in its focus on response inhibition function. In the study, cognitive function was evaluated by a digit-symbol coding test, an arithmetic ability test, and a visual stop-signal task which places enhanced demands on impulse control and response inhibition, considered a hallmark of executive function. Brain activity was measured by scalp-recorded Event-Related Potentials (ERPs) during the stop-signal task. HPA axis reactivity was assessed by measuring salivary cortisol levels before and after experimental sessions. Test performance, ERPs and cortisol reactivity were compared across groups of 23 women in their third trimester of pregnancy and 22 non-pregnant controls. Pregnant women scored lower than the control group on the digit-symbol coding test. On the stop-signal task, both groups had similar error rates, but pregnant women had longer response times to Go trials. On the Stop condition of the task in which a response must be inhibited, pregnant women demonstrated significantly better performance. At the electrophysiological level, in response to Go stimuli pregnant women exhibited greater amplitude of P2 than controls. In response to Stop-signals, pregnant women had lesser amplitudes of P1 and N2 and greater amplitude of P3. Cortisol reactivity to the test session was significantly more pronounced in non-pregnant women with significant correlations found between cortisol reactivity and behavioral responses. The results suggest that response patterns of women in late pregnancy are less impulsive and more cautious and controlled.

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.

SULFATION PATHWAYS: The steroid sulfate axis and its relationship to maternal behaviour and mental health

Steroid hormones can exist in functionally dissociable sulfated and non-sulfated (free) forms and can exert profound effects on numerous aspects of mammalian physiology; the ratio of free-to-sulfated steroids is governed by the antagonistic actions of steroid sulfatase (STS) and sulfotransferase (SULT) enzymes. Here, I examine evidence from human and animal model studies, which suggests that STS and its major substrate (dehydroepiandrosterone sulfate, DHEAS) and product (DHEA) can influence brain function, behaviour and mental health, before summarising how the activity of this axis varies throughout mammalian pregnancy and the postpartum period. I then consider how the steroid sulfate axis might impact upon normal maternal behaviour and how its dysfunction might contribute towards risk of postpartum psychiatric illness. Understanding the biological substrates underlying normal and abnormal maternal behaviour will be important for maximising the wellbeing of new mothers and their offspring.

Why monkeys do not get multiple sclerosis (spontaneously): An evolutionary approach

The goal of this review is to apply an evolutionary lens to understanding the origins of multiple sclerosis (MS), integrating three broad observations. First, only humans are known to develop MS spontaneously. Second, humans have evolved large brains, with characteristically large amounts of metabolically costly myelin. This myelin is generated over long periods of neurologic development—and peak MS onset coincides with the end of myelination. Third, over the past century there has been a disproportionate increase in the rate of MS in young women of childbearing age, paralleling increasing westernization and urbanization, indicating sexually specific susceptibility in response to changing exposures. From these three observations about MS, a life history approach leads us to hypothesize that MS arises in humans from disruption of the normal homeostatic mechanisms of myelin production and maintenance, during our uniquely long myelination period. This review will highlight under-explored areas of homeostasis in brain development, that are likely to shed new light on the origins of MS and to raise further questions about the interactions between our ancestral genes and modern environments.

Pregnancy-related anxiety and depressive symptoms are associated with visuospatial working memory errors during pregnancy

BACKGROUND

Cognitive deficits, especially in memory and concentration, are often reported during pregnancy. Similar cognitive dysfunctions can also occur in depression and anxiety. To date, few studies have investigated the associations between cognitive deficits and psychiatric symptoms during pregnancy. This field is of interest because maternal cognitive functioning, and particularly its higher-order aspects are related to maternal well-being and caregiving behavior, as well as later child development.

METHODS

Pregnant women (N =230), reporting low (n =87), moderate (n =97), or high (n =46) levels of depressive, general anxiety and/or pregnancy-related anxiety symptoms (assessed repeatedly with EPDS, SCL-90/anxiety subscale, PRAQ-R2, respectively) were tested in mid-pregnancy for their cognitive functions. A computerized neuropsychological test battery was used.

RESULTS

Pregnant women with high or moderate level of psychiatric symptoms had significantly more errors in visuospatial working memory/executive functioning task than mothers with low symptom level. Depressive symptoms throughout pregnancy and concurrent pregnancy-related anxiety symptoms were significant predictors of the performance in the task. General anxiety symptoms were not related to visuospatial working memory.

LIMITATIONS

Cognitive functions were evaluated only at one time-point during pregnancy precluding causal conclusions.

CONCLUSIONS

Maternal depressive symptoms and pregnancy-related anxiety symptoms were both associated with decrements in visuospatial working memory/executive functioning. Depressive symptoms seem to present more stable relationship with cognitive deficits, while pregnancy-related anxiety was associated only concurrently. Future studies could investigate, how stable these cognitive differences are, and whether they affect maternal ability to deal with demands of pregnancy and later parenting.

Fundamental study of functional changes to female brain induced by pregnancy and childbirth

In this study, we investigated variations in a women's cognitive function during a time of pregnancy and childbearing. Volunteers were composed of 114 healthy women ranging in age from 23-43 years with an average age of 31.8 years (SD=4.3). Further, 79 were pregnant and 35 were not pregnant. All the pregnant women were expecting their first child and continued with the cognitive function analysis after their childbearing was concluded. We instructed the pregnant women to carry out five kinds of tests: simple reaction, SR; choice reaction, CR; working memory, WM; one card learning, OC; and divided attention, DA using card games through a cognitive function test called "CogHealth", and compared them to a nonpregnant group. In the results of the four measurement tasks (SR, CR, WM, and DA), there were no significant differences across the three groups in the responses with the tasks. However, the response times relating to the OC learning in the postnatal women were significantly smaller, as contrasted with the times for the pregnant and the nonpregnant women (F(2,144)=4.248, P <; 0.05). Furthermore, we compared their cognitive functions between pregnant and postnatal states in corresponding volunteers in the responses with the same tasks. We also demonstrated the fact that postnatal women responded more quickly to tasks in the OC (t(32)=2.95, P <; 0.01) and the WM (t(32)=3.03, P <; 0.01) categories than responses to performing the tasks during their pregnancy. Our findings support the idea that the functions of pregnant/postnatal women are not failing, or rather postnatal women are more responsive in their reaction times with their memories by 2.7-6.2%, than the responses in both pregnant and nonpregnant women.

The search for new biomarkers for cognition in schizophrenia

The search for biomarkers in cognition has been the focus of a large part of the research on patients suffering from schizophrenia. The scientific literature is heterogeneous, and few studies establishing an integrative model of pathogenesis and therapeutic response are available in this field. In this review, we aimed to summarize three essential aspects correlated with cognitive performance: 1) the relationship between inflammation and cognition in schizophrenia, 2) the role of prolactin in cognition, and 3) the association between cognition and neurotrophic factors, particularly brain-derived neurotrophic factor (BDNF). Several studies support the association of inflammatory markers with cognitive status in schizophrenia. In recent decades, the development of effective therapies for cognitive impairment in schizophrenia has focused on the search for anti-inflammatory and immunomodulatory medications. Conversely, the implications of prolactin and its functions in cognition, the transition to psychosis and the diagnosis and prognosis of schizophrenia have been established independent of antipsychotic treatment. With regard to neurotrophic factors, a recent study has correlated BDNF levels with cognitive recovery in schizophrenic patients treated with cognitive remediation. We conclude that although there is a diversity of biomarkers focused on cognitive function in schizophrenia, BDNF is the biomarker that has accumulated the vast majority of evidence in the current literature.

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.

Is objective and accurate cognitive assessment across the menstrual cycle possible? A feasibility study

Objectives:

Variation in plasma hormone levels influences the neurobiology of brain regions involved in cognition and emotion processing. Fluctuations in hormone levels across the menstrual cycle could therefore alter cognitive performance and wellbeing; reports have provided conflicting results, however. The aim of this study was to assess whether objective assessment of cognitive performance and self-reported wellbeing during the follicular and luteal phases of the menstrual cycle is feasible and investigate the possible reasons for variation in effects previously reported.

Methods:

The Cambridge Neuropsychological Test Automated Battery and Edinburgh Postnatal Depression Scale were used to assess the cognitive performance and wellbeing of 12 women. Data were analysed by self-reported and hormone-estimated phases of the menstrual cycle.

Results:

Recruitment to the study and assessment of cognition and wellbeing was without issue. Plasma hormone and peptide estimation showed substantial individual variation and suggests inaccuracy in self-reported menstrual phase estimation.

Conclusion:

Objective assessment of cognitive performance and self-assessed wellbeing across the menstrual cycle is feasible. Grouping data by hormonal profile rather by self-reported phase estimation may influence phase-mediated results. Future studies should use plasma hormone and peptide profiles to estimate cycle phase and group data for analyses.