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Oancea M, Strilciuc Ș, Borza DB, Ciortea R, Diculescu D, Mihu D. Neurobiological and Behavioral Underpinnings of Perinatal Mood and Anxiety Disorders (PMADs): A Selective Narrative Review. J Clin Med 2024; 13:2088. [PMID: 38610853 PMCID: PMC11012341 DOI: 10.3390/jcm13072088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Perinatal mood and anxiety disorders (PMADs) profoundly impact maternal and infant health, affecting women worldwide during pregnancy and postpartum. This review synthesizes current research on the neurobiological effects of PMADs, particularly their influence on brain structure, function, and corresponding cognitive, behavioral, and mental health outcomes in mothers. A literature search across PubMed, PsycINFO, and Google Scholar yielded studies utilizing neuroimaging (MRI, fMRI) and cognitive assessments to explore brain changes in PMADs. The key findings indicate significant neurobiological alterations in PMADs, such as glutamatergic dysfunction, neuronal damage, and altered neural connectivity, particularly in postpartum depression (PPD). Functional MRI studies reveal distinct patterns of brain function alteration, including amygdala non-responsivity in PPD, differing from traditional major depressive disorder (MDD). These neurobiological changes are connected with cognitive impairments and behavioral modifications, impacting maternal caregiving. Understanding these alterations is fundamental for developing effective treatments. The findings emphasize the importance of focusing on maternal mental health, advocating for early detection, and personalized treatment strategies to improve maternal and child outcomes.
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Affiliation(s)
- Mihaela Oancea
- Department of Obstetrics and Gynaecology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Ștefan Strilciuc
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, 400337 Cluj-Napoca, Romania
| | - Dan Boitor Borza
- Department of Obstetrics and Gynaecology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Răzvan Ciortea
- Department of Obstetrics and Gynaecology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Doru Diculescu
- Department of Obstetrics and Gynaecology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Dan Mihu
- Department of Obstetrics and Gynaecology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
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Long X, Zhou Y, Zhang F, Li F, Wang X, Meng Y, Roberts N, Cheng B, Jia Z. Altered MRI Diffusion Properties of the White Matter Tracts Connecting Frontal and Thalamic Brain Regions in First-Episode, Drug-Naïve Patients With Postpartum Depression. J Magn Reson Imaging 2023; 57:899-906. [PMID: 35796680 DOI: 10.1002/jmri.28346] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although progress has been made in exploring postpartum depression (PPD), the involvement of cerebral structure connectivity in PPD patients keeps unclear. PURPOSE To explore structural connectivity alternations in mothers with PPD, diffusion tensor imaging (DTI) and automated fiber quantification (AFQ) were used to calculate brain white matter microstructure properties. STUDY TYPE Cross-sectional. POPULATION A total of 51 women with first-episode, treatment-näive PPD, and 49 matched healthy postpartum women (HPW) controls. FIELD STRENGTH A 3.0 T; single-shot echo-planar imaging sequence. ASSESSMENT DTI measurements of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) were obtained for 18 specific white matter tracts. The relationship between PDD symptoms, hormone levels, and postpartum days was also investigated. STATISTICAL TESTS Two sample t test and Pearson's correlation analysis. The analysis was performed by using a permutation-based multiple-comparison correction approach, with the threshold of P < 0.05 (family wise error corrected [FWE-corrected]) separately across the four different outcome measures. RESULTS Women with PPD showed significantly increased FA and AD in right anterior thalamic radiation (ATR) tract and significantly increased FA and significantly reduced RD in the cingulum tract, compared to women without PPD. The RD values of right cingulum were significantly positively correlated with postpartum days in HPW (r = 0.39). There were no significant relationships between brain measures and hormone levels in either patients or controls. DATA CONCLUSIONS DTI measures have revealed altered integrity in the white matter of the cortical-thalamic circuits in women with PPD compared to HPW. Damage to these circuits may be a structural basis for the impaired emotional regulation and blunted mother-infant bonding in mothers with PPD and a potential target for the development of new treatments. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yushan Zhou
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Feifei Zhang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiuli Wang
- Department of Clinical Psychology, the Fourth People's Hospital of Chengdu, Chengdu, China
| | - Yajing Meng
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Neil Roberts
- School of Clinical Sciences, the Queens Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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Conelea CA, Morris S, McLaughlin N, Mamaril E, Benito K, Case B, Garcia A. Response Inhibition in Youth Undergoing Intensive Treatment for Obsessive Compulsive Disorder. J Obsessive Compuls Relat Disord 2023; 36:100764. [PMID: 36644665 PMCID: PMC9835685 DOI: 10.1016/j.jocrd.2022.100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Response Inhibition (RI) is the ability to suppress behaviors that are inappropriate for a given context. Obsessive-compulsive disorder (OCD) has been associated with impaired RI in adults as measured by the Stop Signal Task (SST). Conflicting results have been found in terms of the relationship between OCD severity and SST performance, and no studies to date have examined the relationship between SST and response to OCD treatment. Also relatively unknown is whether RI performance in OCD is associated with developmental or gender differences. This naturalistic study examined the relationship between SST performance, OCD severity, and OCD treatment response in a pediatric sample undergoing intensive treatment involving exposure and response prevention and medication management (n = 36). The SST and Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS) were administered at admission and program discharge. OCD severity was not significantly related to stop signal reaction time (SSRT) in the whole sample and among subgroups divided by age and gender. Baseline SSRT and SSRT change did not predict CYBOCS change across treatment in the whole sample, but exploratory analyses indicated both were significant predictors among female adolescents. Results suggest there may be developmental gender differences in the relationship between RI and clinical improvement in pediatric OCD.
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Affiliation(s)
- Christine A. Conelea
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, Minneapolis, MN, USA
| | - Sarah Morris
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Nicole McLaughlin
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | - Erin Mamaril
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
| | - Kristen Benito
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Brady Case
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Abbe Garcia
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
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Zhang J, Zhang T, Chen YC, Chen H, Feng Y, Tang WW, Zheng JX. Decreased brain functional connectivity associated with cognitive dysfunction in women with second pregnancy. Front Aging Neurosci 2022; 14:963943. [PMID: 36072487 PMCID: PMC9444322 DOI: 10.3389/fnagi.2022.963943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Previous research has found that women with second pregnancy may have an increased risk of cognitive dysfunction. This study aims to investigate the intrinsic functional connectivity (FC) pattern of the DMN anchored on posterior cingulate cortex (PCC) in postpartum women, especially the parous women using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Twenty parous women, 26 primiparous women, and 30 nulliparous women were included for rs-fMRI scan. They were age and education well matched. A seed based FC method was conducted to reveal FC patterns with other brain regions using a region of interest in the PCC. The relationships between FC patterns and cognitive performance were further detected. Results Relative to primiparous women, parous women had significantly decreased FC primarily between the PCC and the right middle frontal gyrus and right parahippocampal gyrus. The decreased FC to the right parahippocampal gyrus in parous women was positively associated with the reduced DST scores (rho = 0.524, p = 0.031). Moreover, parous women compared with nulliparous women showed significantly decreased FC between the PCC and the left superior frontal gyrus and left middle frontal gyrus. The reduced FC to the left superior frontal gyrus in parous women was also positively associated with the lower DST scores (rho = 0.550, p = 0.022). Conclusion Our result highlights that women with second pregnancy revealed decreased FC between the DMN regions with the parahippocampal gyrus and prefrontal cortex, which was correlated with specific impaired cognitive function. This study may provide new insights into the neuropathological mechanisms of postpartum cognitive impairment and enhance our understanding of the neurobiological aspects during postpartum period.
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Affiliation(s)
- Juan Zhang
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing, China
| | - Tao Zhang
- Department of Radiology, Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuan Feng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen-Wei Tang
- Department of Radiology, Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Wen-Wei Tang,
| | - Jin-Xia Zheng
- Department of Radiology, Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing, China
- Jin-Xia Zheng,
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Martínez-García M, Paternina-Die M, Desco M, Vilarroya O, Carmona S. Characterizing the Brain Structural Adaptations Across the Motherhood Transition. Front Glob Womens Health 2021; 2:742775. [PMID: 34816246 PMCID: PMC8593951 DOI: 10.3389/fgwh.2021.742775] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022] Open
Abstract
Women that become mothers face notable physiological adaptations during this life-period. Neuroimaging studies of the last decade have provided grounded evidence that women's brains structurally change across the transition into motherhood. The characterization of this brain remodeling is currently in its early years of research. The current article reviews this scientific field by focusing on our longitudinal (pre-to-post pregnancy) Magnetic Resonance Imaging (MRI) studies in first-time parents and other longitudinal and cross-sectional studies of parents. We present the questions that are currently being answered by the parental brain literature and point out those that have not yet been explored. We also highlight potential confounding variables that need to be considered when analyzing and interpreting brain changes observed during motherhood.
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Affiliation(s)
- Magdalena Martínez-García
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - María Paternina-Die
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Oscar Vilarroya
- Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Susanna Carmona
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Pacheco F, Guiomar R, Brunoni AR, Buhagiar R, Evagorou O, Roca-Lecumberri A, Poleszczyk A, Lambregtse-van den Berg M, Caparros-Gonzalez RA, Fonseca A, Osório A, Soliman M, Ganho-Ávila A. Efficacy of non-invasive brain stimulation in decreasing depression symptoms during the peripartum period: A systematic review. J Psychiatr Res 2021; 140:443-460. [PMID: 34147932 DOI: 10.1016/j.jpsychires.2021.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-invasive brain stimulation (NIBS) techniques have been suggested as alternative treatments to decrease depression symptoms during the perinatal period. These include brain stimulation techniques that do not require surgery and that are nonpharmacological and non-psychotherapeutic. NIBS with evidence of antidepressant effects include repetitive transcranial magnetic stimulation (rTMS), transcranial electric stimulation (TES) and electroconvulsive therapy (ECT). OBJECTIVES This systematic review aims to summarize evidence on NIBS efficacy, safety and acceptability in treating peripartum depression (PPD). METHODS We included randomized, non-randomized and case reports, that used NIBS during pregnancy and the postpartum. The reduction of depressive symptoms and neonatal safety were the primary and co-primary outcomes, respectively. RESULTS rTMS shows promising results for the treatment of PPD, with clinically significant decreases in depressive symptoms between baseline and end of treatment and overall good acceptability. Although the safety profile for rTMS is adequate in the postpartum, caution is warranted during pregnancy. In TES, evidence on efficacy derives mostly from single-arm studies, compromising the encouraging findings. Further investigation is necessary concerning ECT, as clinical practice relies on clinical experience and is only described in low-quality case-reports. LIMITATIONS The reduced number of controlled studies, the lack of complete datasets and the serious/high risk of bias of the reports warrant cautious interpretations. CONCLUSIONS AND IMPLICATIONS Existing evidence is limited across NIBS techniques; comparative studies are lacking, and standard stimulation parameters are yet to be established. Although rTMS benefits from the most robust research, future multicenter randomized clinical trials are needed to determine the position of each NIBS strategy within the pathways of care.
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Affiliation(s)
- Francisca Pacheco
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Andre R Brunoni
- Department of Internal Medicine and Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Olympia Evagorou
- University General Hospital of Alexandroupolis, Department of Psychiatry, Greece
| | - Alba Roca-Lecumberri
- Perinatal Mental Health Unit, Psychiatry and Clinical Psychology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Mijke Lambregtse-van den Berg
- Departments of Psychiatry and Child & Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Ana Fonseca
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Osório
- Graduate Program on Developmental Disorders, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Mahmoud Soliman
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
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Mao N, Che K, Xie H, Li Y, Wang Q, Liu M, Wang Z, Lin F, Ma H, Zhuo Z. Abnormal information flow in postpartum depression: A resting-state functional magnetic resonance imaging study. J Affect Disord 2020; 277:596-602. [PMID: 32898821 DOI: 10.1016/j.jad.2020.08.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/24/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is a common mental disorder among women. However, the brain information flow alteration in patients with PPD remains unclear. This study investigated the brain information flow characteristics of patients with PPD and their value for clinical evaluation by using support vector regression (SVR). METHODS Structural and resting-state functional magnetic resonance imaging data were acquired from 21 patients with PPD and 23 age-, educational level-, body mass index-, and menstruation-matched healthy controls. The preferred information flow direction between local brain regions and the preferred information flow direction index within local brain regions based on non-parametric multiplicative regression granger causality analysis were calculated to determine the global and local brain functional characteristics of the patients with PPD. Pearson's correlation analyses were performed to evaluate the relationship of the information flow characteristics with clinical scales. A predictive model for the mental state of the patients with PPD was established using SVR based on information flow characteristics. RESULTS The information flow patterns in the amygdala, cingulum gyrus, insula, hippocampus, frontal lobe, parietal lobe, and occipital lobe changed significantly in the patients with PPD. The preferred information flow direction between the amygdala and the temporal and frontal lobes significantly correlated with clinical scales. Prediction analysis shows that the information flow patterns can be used to assess depression in patients with PPD. LIMITATION This exploratory study has a small sample size with no longitudinal research. CONCLUSION The change in information flow pattern in the amygdala may play an important role in the neuropathological mechanism of PPD and may provide promising markers for clinical evaluation.
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Affiliation(s)
- Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Kaili Che
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Yuna Li
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Qinglin Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Meijie Liu
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Zhongyi Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Fan Lin
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, P. R. China.
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Beijing, 100044, P. R. China.
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Cárdenas EF, Kujawa A, Humphreys KL. Neurobiological changes during the peripartum period: implications for health and behavior. Soc Cogn Affect Neurosci 2020; 15:1097-1110. [PMID: 31820795 PMCID: PMC7657461 DOI: 10.1093/scan/nsz091] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/01/2019] [Accepted: 10/14/2019] [Indexed: 01/22/2023] Open
Abstract
Pregnancy and the transition to parenthood is an important period marked by dramatic neurobiological and psychosocial changes that may have implications for the health of women and offspring. Although human and non-human animal research suggests that the brain undergoes alterations during the peripartum period, these changes are poorly understood. Here, we review existing research, particularly human neuroimaging and psychophysiological research, to examine changes in brain structure and function during the peripartum period and discuss potential implications for the health of women and offspring. First, we discuss the potential causes of these changes across pregnancy, including physiological and psychosocial factors. Next, we discuss the evidence for structural and functional changes in the brain during pregnancy and into the postpartum period, noting the need for research conducted prospectively across human pregnancy. Finally, we propose potential models of individual differences in peripartum neurobiological changes (i.e. hypo-response, typical response, hyper-response) and emphasize the need to consider trajectories of change in addition to pre-existing factors that may predict maternal adjustment to parenthood. We suggest that the consideration of individual differences in neurobiological trajectories across pregnancy may contribute to a better understanding of risk for negative health and behavior outcomes for women and offspring.
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Affiliation(s)
- Emilia F Cárdenas
- Department of Psychology and Human Development, Vanderbilt University, 37203, Nashville, USA
| | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University, 37203, Nashville, USA
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, 37203, Nashville, USA
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Sacher J, Chechko N, Dannlowski U, Walter M, Derntl B. The peripartum human brain: Current understanding and future perspectives. Front Neuroendocrinol 2020; 59:100859. [PMID: 32771399 DOI: 10.1016/j.yfrne.2020.100859] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Abstract
The peripartum period offers a unique opportunity to improve our understanding of how dramatic fluctuations in endogenous ovarian hormones affect the human brain and behavior. This notwithstanding, peripartum depression remains an underdiagnosed and undertreated disorder. Here, we review recent neuroimaging findings with respect to the neuroplastic changes in the maternal brain during pregnancy and the postpartum period. We seek to provide an overview of multimodal neuroimaging designs of current peripartum depression models of hormone withdrawal, changes in monoaminergic signaling, and maladaptive neuroplasticity, which likely lead to the development of a condition that puts the lives of mother and infant at risk. We discuss the need to effectively integrate the available information on psychosocial and neurobiological risk factors contributing to individual vulnerability. Finally, we propose a systematic approach to neuroimaging the peripartum brain that acknowledges important co-morbidities and variation in disease onset.
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Affiliation(s)
- Julia Sacher
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Stephanstr. 1A, 04103 Leipzig, Germany; Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1A, 04103 Leipzig, Germany; Clinic of Cognitive Neurology, University of Leipzig, Liebigstr. 16, 04103 Leipzig, Germany.
| | - Natalia Chechko
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Pauwelsstr. 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428 Jülich, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert Schweitzer-Campus 1, G 9A, 48149 Muenster, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Medical School, University of Tübingen, Osianderstr. 24, 72076 Tübingen, Germany; LEAD Graduate Training & Research Network, University of Tübingen, Walter-Simon-Str. 12, 72072 Tübingen, Germany
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Zheng JX, Ge L, Chen H, Yin X, Chen YC, Tang WW. Disruption within brain default mode network in postpartum women without depression. Medicine (Baltimore) 2020; 99:e20045. [PMID: 32358387 PMCID: PMC7440189 DOI: 10.1097/md.0000000000020045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Previous studies have demonstrated that cognitive dysfunction is associated with neurophysiological changes in postpartum period. This study aimed to investigate the intrinsic functional connectivity (FC) pattern within the default mode network (DMN) and its associations with cognitive dysfunction in postpartum women without depression revealed by resting-state functional magnetic resonance imaging (fMRI).Resting-state fMRI scans were acquired from 21 postpartum women and 21 age- and education-matched nulliparous women. The posterior cingulate cortex (PCC) was selected as the seed region to detect the FC patterns and then determine whether these changes were related to specific cognitive performance.Compared with the nulliparous women, postpartum women had a significantly decreased FC between the PCC and the left medial prefrontal cortex (mPFC). After correcting for age and education, the reduced FC between the PCC and the left mPFC was positively correlated with the poorer Clock-Drawing Test (CDT) scores in postpartum women (r = 0.742, P < .001).The present study mainly demonstrated decreased resting-state FC pattern within the DMN regions that was linked with impaired cognitive function in postpartum women. These findings illustrated the potential role of the DMN in postpartum women that will provide novel insight into the underlying neuropathological mechanisms in postpartum period.
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Affiliation(s)
| | - Lili Ge
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Che K, Mao N, Li Y, Liu M, Ma H, Bai W, Xu X, Dong J, Li Y, Shi Y, Xie H. Altered Spontaneous Neural Activity in Peripartum Depression: A Resting-State Functional Magnetic Resonance Imaging Study. Front Psychol 2020; 11:656. [PMID: 32346374 PMCID: PMC7172032 DOI: 10.3389/fpsyg.2020.00656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/18/2020] [Indexed: 01/12/2023] Open
Abstract
Abnormalities related to peripartum depression (PPD) have been detected in several brain regions through tasking-state functional magnetic resonance imaging (fMRI). In this study, we used the two markers of resting-state fMRI (rs-fMRI) to investigate changes in spontaneous neural activity of PPD and their correlation with depression severity. A total of 16 individuals with PPD were compared with 16 age- and education-matched healthy controls (HCs) by using rs-fMRI. Two-sample t-test was used to compare the fractional amplitudes of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) values between groups. Pearson correlation analysis was used to determine the correlation between the fALFF and ReHo of the abnormal brain region and the Hamilton Depression Scale (HAMD) and Edinburgh Postnatal Depression Scale scores. The spontaneous neural activity of the PPD group significantly increased mainly in the left middle frontal gyrus, left precuneus, left inferior parietal lobule, and left dorsolateral prefrontal cortex (DLPFC) and decreased mainly in the bilateral precentral gyrus and right inferior occipital gyrus compared with those of the HCs. The fALFF value of the left DLPFC was negatively correlated with the HAMD score in PPD. This rs-fMRI study suggests that changes in the spontaneous neural activity of these regions are related to emotional responses. PPD cases with low fALFF values in the left DLPFC have severe depression.
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Affiliation(s)
- Kaili Che
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuna Li
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Meijie Liu
- Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Wei Bai
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xiao Xu
- Medical Imaging Department, Weifang Medical University, Weifang, China
| | - Jianjun Dong
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ying Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinghong Shi
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
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Abstract
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.
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Fiterman O, Raz S. Cognitive, neural and endocrine functioning during late pregnancy: An Event-Related Potentials study. Horm Behav 2019; 116:104575. [PMID: 31442429 DOI: 10.1016/j.yhbeh.2019.104575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 07/29/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Ora Fiterman
- Department of Behavioral Sciences, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Israel
| | - Sivan Raz
- Department of Behavioral Sciences, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Israel; Department of Psychology, Tel Hai College, Israel.
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Zhang K, Wang M, Zhang J, Xie J, Su X, Du X, Chen Z. Dynamic Alterations in Spontaneous Brain Activity in Mothers: A Resting-State Functional Magnetic Resonance Imaging Study. Neurosci Bull 2019; 35:766-770. [PMID: 31093887 DOI: 10.1007/s12264-019-00392-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/13/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kaihua Zhang
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Department of Electronic Science, Xiamen University, Xiamen, 361005, China
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, 200062, China
| | - Mengxing Wang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, 200062, China
| | - Jilei Zhang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, 200062, China
| | - Junyao Xie
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Department of Electronic Science, Xiamen University, Xiamen, 361005, China
| | - Xueyun Su
- Department of Special Education, Faculty of Education, East China Normal University, Shanghai, 200062, China
| | - Xiaoxia Du
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, 200062, China.
| | - Zhong Chen
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Department of Electronic Science, Xiamen University, Xiamen, 361005, China.
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15
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Stickel S, Eickhoff S, Goecke TW, Schneider F, Quinete NS, Lang J, Habel U, Chechko N. Cumulative cortisol exposure in the third trimester correlates with postpartum mothers' neural response to emotional interference. Biol Psychol 2019; 143:53-61. [PMID: 30797948 DOI: 10.1016/j.biopsycho.2019.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 12/23/2022]
Abstract
Prolonged stress affects the central nervous system, rendering individuals vulnerable to a wide range of mental health disorders. 76 healthy postpartum mothers were studied by means of functional magnetic resonance imaging within 6 days of childbirth. The subjects were required to perform the emotional Stroop task involving happy and anxious word-face combinations. Hair samples were collected to determine cumulative hair cortisol concentration (HCC) in the third trimester. HCC was found to be negatively correlated with the recruitment of the dorsal anterior cingulate cortex (ACC) and the midcingulate cortex (MCC). In response to the emotional interference of only anxious target faces, a negative correlation was seen between HCC and the bilateral orbitofrontal cortex, extending to the rostral ACC and the MCC. Women with lower HCC recruited brain areas relevant to emotional cognitive control, indicating that lower HCC helps preserve conflict monitoring and resolution capacities and thus benefits mental health in pregnancy.
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Affiliation(s)
- S Stickel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany.
| | - S Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - T W Goecke
- RoMed Hospital Rosenheim, Department of Obstetrics, Rosenheim, Germany
| | - F Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - N S Quinete
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany; Southeast Environmental Research Center, Florida International University, FL, USA
| | - J Lang
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany
| | - U Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - N Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
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Zheng JX, Chen YC, Chen H, Jiang L, Bo F, Feng Y, Tang WW, Yin X, Gu JP. Disrupted Spontaneous Neural Activity Related to Cognitive Impairment in Postpartum Women. Front Psychol 2018; 9:624. [PMID: 29774003 PMCID: PMC5944019 DOI: 10.3389/fpsyg.2018.00624] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/12/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose: Prior research has demonstrated that the postpartum period is associated with an increased risk of cognitive impairment. This study aims to investigate whether disrupted spontaneous neural activity exists in postpartum women without depression using resting-state functional magnetic resonance imaging (rs-fMRI) and to detect the relationship between these abnormalities and cognitive impairment. Materials and Methods: Postpartum women (n = 22) were compared with age- and education-matched nulliparous women (n = 23) using rs-fMRI. We calculated the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) values to evaluate spontaneous neural activity and detect the relationship between rs-fMRI data and cognitive performance. Results: Relative to nulliparous women, postpartum women had significantly decreased ALFF and ReHo values primarily in the left posterior cingulate cortex (PCC) and prefrontal cortex and increased ALFF values in left cerebellar posterior lobe. We found a positive correlation between the ALFF and ReHo values in the PCC and the complex figure test (CFT)-delayed scores in postpartum women (r = 0.693, p = 0.001; r = 0.569, p = 0.011, respectively). Moreover, the clock-drawing test (CDT) scores showed positive correlations with the ALFF and ReHo values in the right superior frontal gyrus (SFG; r = 0.492, p = 0.033; r = 0.517, p = 0.023, respectively). Conclusion: Our combined ALFF and ReHo analyses revealed decreased spontaneous neural activity, mainly in the PCC and prefrontal cortex, which was correlated with specific impaired cognitive functioning in postpartum women. This study may elucidate the neurophysiological mechanisms underlying postpartum cognitive impairment and enhance our understanding of the neurobiological aspects of the postpartum period.
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Affiliation(s)
- Jin-Xia Zheng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.,Department of Radiology, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fan Bo
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuan Feng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen-Wei Tang
- Department of Radiology, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian-Ping Gu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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17
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Sundström Poromaa I, Comasco E, Georgakis MK, Skalkidou A. Sex differences in depression during pregnancy and the postpartum period. J Neurosci Res 2017; 95:719-730. [PMID: 27870443 PMCID: PMC5129485 DOI: 10.1002/jnr.23859] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/01/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
Women have a lifetime risk of major depression double that of men but only during their reproductive years. This sex difference has been attributed partially to activational effects of female sex steroids and also to the burdens of pregnancy, childbirth, and parenting. Men, in contrast, have a reproductive period difficult to delineate, and research on the mental health of men has rarely considered the effects of fatherhood. However, the couple goes through a number of potentially stressing events during the reproductive period, and both mothers and fathers are at risk of developing peripartum depression. This Review discusses the literature on maternal and paternal depression and the endocrine changes that may predispose a person to depression at this stage of life, with specific focus on the hypothalamus–pituitary axis, oxytocin, and testosterone levels in men. Important findings on sex differences in the neural correlates of maternal and paternal behavior have emerged, highlighting the relevance of the emotional brain in mothers and the sociocognitive brain in fathers and pointing toward the presence of a common parents' brain. Additionally, sex differences in neurogenesis and brain plasticity are described in relation to peripartum depression. © 2016 The Authors. Journal of Neuroscience Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | - Erika Comasco
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Marios K Georgakis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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18
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Understanding Peripartum Depression Through Neuroimaging: a Review of Structural and Functional Connectivity and Molecular Imaging Research. Curr Psychiatry Rep 2017; 19:70. [PMID: 28823105 PMCID: PMC5617352 DOI: 10.1007/s11920-017-0824-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Imaging research has sought to uncover brain structure, function, and metabolism in women with postpartum depression (PPD) as little is known about its underlying pathophysiology. This review discusses the imaging modalities used to date to evaluate postpartum depression and highlights recent findings. RECENT FINDINGS Altered functional connectivity and activity changes in brain areas implicated in executive functioning and emotion and reward processing have been identified in PPD. Metabolism changes involving monoamine oxidase A, gamma-aminobutyric acid, glutamate, serotonin, and dopamine have additionally been reported. To date, no studies have evaluated gray matter morphometry, voxel-based morphometry, surface area, cortical thickness, or white matter tract integrity in PPD. Recent imaging studies report changes in functional connectivity and metabolism in women with PPD vs. healthy comparison women. Future research is needed to extend these findings as they have important implications for the prevention and treatment of postpartum mood disorders.
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Syan SK, Minuzzi L, Costescu D, Smith M, Allega OR, Coote M, Hall GBC, Frey BN. Influence of endogenous estradiol, progesterone, allopregnanolone, and dehydroepiandrosterone sulfate on brain resting state functional connectivity across the menstrual cycle. Fertil Steril 2017; 107:1246-1255.e4. [PMID: 28476183 DOI: 10.1016/j.fertnstert.2017.03.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/18/2017] [Accepted: 03/22/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To [1] study brain resting state functional connectivity (Rs-FC) in a well-characterized sample of healthy women in the mid-follicular and late luteal phases of the menstrual cycle; and [2] examine the correlation between endogenous E2, P, allopregnanolone, and DHEAS and patterns of Rs-FC across the menstrual cycle. DESIGN We studied the Rs-FC of the default mode network, salience network, meso-paralimbic network, fronto-parietal network, visual network, and sensorimotor network in the mid-follicular and late luteal phases. Serum levels of E2, P, allopregnanolone, and DHEAS were correlated to patterns of functional connectivity. SETTING University medical center. PATIENT(S) Twenty-five healthy women with regular menstrual cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Functional connectivity of key brain networks at rest and correlations of hormones to Rs-FC in the mid-follcuar and late luteal menstrual phases. RESULT(S) There were no differences in Rs-FC between the mid-follicular and late luteal menstrual phases using either independent component analysis or seed-based analysis. However, specific correlations between each hormone and patterns of functional connectivity were found in both menstrual cycle phases. CONCLUSION(S) It seems that the association between female sex hormones and brain Rs-FC is menstrual cycle phase-dependent. Future studies should examine the cognitive and behavioral correlates of this association in regularly cycling women.
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Affiliation(s)
- Sabrina K Syan
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Dustin Costescu
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Mara Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Olivia R Allega
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Marg Coote
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Geoffrey B C Hall
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Benicio N Frey
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
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20
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Emotional anticipation after delivery - a longitudinal neuroimaging study of the postpartum period. Sci Rep 2017; 7:114. [PMID: 28273912 PMCID: PMC5427895 DOI: 10.1038/s41598-017-00146-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/06/2017] [Indexed: 11/08/2022] Open
Abstract
Neuroimaging research has begun to unveil the mechanisms behind emotion processing during the postpartum period, which, in turn, may be of relevance for the development of postpartum depression. The present study sought to longitudinally investigate the neural correlates of emotion anticipation during the postpartum period in healthy women. Functional magnetic resonance imaging was employed to measure the blood oxygen level-dependent signal in the brain in response to anticipation of negative emotional stimuli and during processing of images with positive or negative valence. The participating women were scanned twice: the first scan occurred during the first 48 hours after delivery, and the second was performed 4–6 weeks after delivery. The early postpartum period was characterized by higher anterior cingulate cortex reactivity during anticipation of negative emotional stimuli than the late postpartum period. This was accompanied by a negative relationship with insular reactivity during the early postpartum period and a trend towards an increase in insular reactivity in the late postpartum period. Thus, during the first four weeks of the postpartum period, a diminished top-down regulatory feedback on emotion-related areas of the brain was noted. This finding suggests a physiologically important adaptation during the healthy postpartum period.
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Matsuo S, Matsuda KI, Takanami K, Mori T, Tanaka M, Kawata M, Kitawaki J. Decrease in neuronal spine density in the postpartum period in the amygdala and bed nucleus of the stria terminalis in rat. Neurosci Lett 2017; 641:21-25. [PMID: 28115236 DOI: 10.1016/j.neulet.2017.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/28/2016] [Accepted: 01/17/2017] [Indexed: 01/21/2023]
Abstract
In pregnancy and the postpartum period, many women have emotional instability and some suffer from depression. The ovarian steroid hormone milieu is markedly changed during these periods, and this hormonal change may be an important cause of peripartum emotional instability. The amygdala is a central region of emotion, and the bed nucleus of the stria terminalis (BNST), which is considered to be the extended amygdala, is also involved in the emotional response. The amygdala and BNST are well characterized as target brain regions for ovarian steroid hormones, and this suggests that the functional response of neurons in these regions to hormonal fluctuation is affected in the peripartum period. In this study, we investigated the neuronal morphology in the central (CeA) and basolateral (BLA) nucleus of the amygdala and BNST on gestational days 15 (G15) (mid-gestation) and 20 (G20) (late gestation) and 4days after delivery (P4) (early postpartum) in rat. Golgi staining showed that the dendritic spine density, and particularly the number of mature mushroom-type spines, in the CeA, BLA and BNST was significantly decreased at P4, compared with G15 and G20 and with virgin females in the estrous phase in the normal estrous cycle (Est). Interestingly, the presence of pups after delivery influenced the spine density in the BNST. The density was significantly decreased with pup presence compared with pup absence at P4, and compared with G15, G20 and Est. These results provide fundamental insights into the neuronal basis underlying emotional instability during pregnancy and postpartum.
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Affiliation(s)
- Seiki Matsuo
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Ichi Matsuda
- Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Keiko Takanami
- Ushimado Marine Institute, Graduate School of Natural Science and Technology, Okayama University, Ushimado, Setouchi, Okayama, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Tanaka
- Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Role of emotional processing in depressive responses to sex-hormone manipulation: a pharmacological fMRI study. Transl Psychiatry 2015; 5:e688. [PMID: 26624927 PMCID: PMC5068584 DOI: 10.1038/tp.2015.184] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/29/2015] [Accepted: 10/02/2015] [Indexed: 02/07/2023] Open
Abstract
Sex-hormone fluctuations may increase risk for developing depressive symptoms and alter emotional processing as supported by observations in menopausal and pre- to postpartum transition. In this double-blinded, placebo-controlled study, we used blood-oxygen level dependent functional magnetic resonance imaging (fMRI) to investigate if sex-steroid hormone manipulation with a gonadotropin-releasing hormone agonist (GnRHa) influences emotional processing. Fifty-six healthy women were investigated twice: at baseline (follicular phase of menstrual cycle) and 16 ± 3 days post intervention. At both sessions, fMRI-scans during exposure to faces expressing fear, anger, happiness or no emotion, depressive symptom scores and estradiol levels were acquired. The fMRI analyses focused on regions of interest for emotional processing. As expected, GnRHa initially increased and subsequently reduced estradiol to menopausal levels, which was accompanied by an increase in subclinical depressive symptoms relative to placebo. Women who displayed larger GnRHa-induced increase in depressive symptoms had a larger increase in both negative and positive emotion-elicited activity in the anterior insula. When considering the post-GnRHa scan only, depressive responses were associated with emotion-elicited activity in the anterior insula and amygdala. The effect on regional activity in anterior insula was not associated with the estradiol net decline, only by the GnRHa-induced changes in mood. Our data implicate enhanced insula recruitment during emotional processing in the emergence of depressive symptoms following sex-hormone fluctuations. This may correspond to the emotional hypersensitivity frequently experienced by women postpartum.
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Gingnell M, Bannbers E, Engman J, Frick A, Moby L, Wikström J, Sundström-Poromaa I. The effect of combined hormonal contraceptives use on brain reactivity during response inhibition. EUR J CONTRACEP REPR 2015; 21:150-7. [DOI: 10.3109/13625187.2015.1077381] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gingnell M, Bannbers E, Moes H, Engman J, Sylvén S, Skalkidou A, Kask K, Wikström J, Sundström-Poromaa I. Emotion Reactivity Is Increased 4-6 Weeks Postpartum in Healthy Women: A Longitudinal fMRI Study. PLoS One 2015; 10:e0128964. [PMID: 26061879 PMCID: PMC4465482 DOI: 10.1371/journal.pone.0128964] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 05/01/2015] [Indexed: 01/31/2023] Open
Abstract
Marked endocrine alterations occur after delivery. Most women cope well with these changes, but the postpartum period is associated with an increased risk of depressive episodes. Previous studies of emotion processing have focused on maternal–infant bonding or postpartum depression (PPD), and longitudinal studies of the neural correlates of emotion processing throughout the postpartum period in healthy women are lacking. In this study, 13 women, without signs of post partum depression, underwent fMRI with an emotional face matching task and completed the MADRS-S, STAI-S, and EPDS within 48 h (early postpartum) and 4–6 weeks after delivery (late postpartum). Also, data from a previous study including 15 naturally cycling controls assessed in the luteal and follicular phase of the menstrual cycle was used. Women had lower reactivity in insula, middle frontal gyrus (MFG), and inferior frontal gyrus (IFG) in the early as compared to the late postpartum assessment. Insular reactivity was positively correlated with anxiety in the early postpartum period and with depressive symptoms late postpartum. Reactivity in insula and IFG were greater in postpartum women than in non-pregnant control subjects. Brain reactivity was not correlated with serum estradiol or progesterone levels. Increased reactivity in the insula, IFG, and MFG may reflect normal postpartum adaptation, but correlation with self-rated symptoms of depression and anxiety in these otherwise healthy postpartum women, may also suggest that these changes place susceptible women at increased risk of PPD. These findings contribute to our understanding of the neurobiological aspects of the postpartum period, which might shed light on the mechanisms underlying affective puerperal disorders, such as PPD.
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Affiliation(s)
- Malin Gingnell
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Elin Bannbers
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Harmen Moes
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Jonas Engman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Sara Sylvén
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Kristiina Kask
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden
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Moses-Kolko EL, Horner MS, Phillips ML, Hipwell AE, Swain JE. In search of neural endophenotypes of postpartum psychopathology and disrupted maternal caregiving. J Neuroendocrinol 2014; 26:665-84. [PMID: 25059408 PMCID: PMC4353923 DOI: 10.1111/jne.12183] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 12/11/2022]
Abstract
This is a selective review that provides the context for the study of perinatal affective disorder mechanisms and outlines directions for future research. We integrate existing literature along neural networks of interest for affective disorders and maternal caregiving: (i) the salience/fear network; (ii) the executive network; (iii) the reward/social attachment network; and (iv) the default mode network. Extant salience/fear network research reveals disparate responses and corticolimbic coupling to various stimuli based upon a predominantly depressive versus anxious (post-traumatic stress disorder) clinical phenotype. Executive network and default mode connectivity abnormalities have been described in postpartum depression (PPD), although studies are very limited in these domains. Reward/social attachment studies confirm a robust ventral striatal response to infant stimuli, including cry and happy infant faces, which is diminished in depressed, insecurely attached and substance-using mothers. The adverse parenting experiences received and the attachment insecurity of current mothers are factors that are associated with a diminution in infant stimulus-related neural activity similar to that in PPD, and raise the need for additional studies that integrate mood and attachment concepts in larger study samples. Several studies examining functional connectivity in resting state and emotional activation functional magnetic resonance imaging paradigms have revealed attenuated corticolimbic connectivity, which remains an important outcome that requires dissection with increasing precision to better define neural treatment targets. Methodological progress is expected in the coming years in terms of refining clinical phenotypes of interest and experimental paradigms, as well as enlarging samples to facilitate the examination of multiple constructs. Functional imaging promises to determine neural mechanisms underlying maternal psychopathology and impaired caregiving, such that earlier and more precise detection of abnormalities will be possible. Ultimately, the discovery of such mechanisms will promote the refinement of treatment approaches toward maternal affective disturbance, parenting behaviours and the augmentation of parenting resiliency.
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Affiliation(s)
- E L Moses-Kolko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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