Emotion Reactivity Is Increased 4-6 Weeks Postpartum in Healthy Women: A Longitudinal fMRI Study

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.

A tumultuous transition to motherhood: Altered brain and hormonal responses in mothers with postpartum depression

“…Although this may appear contradictory to prior reports, it is suggested that, in this non‐clinical sample of mothers in the early postpartum period, subclinical levels of depression may capture an emotional experience that is qualitatively distinct from PPD and may in fact reflect normal or even healthy response to adjusting to the stress of new motherhood. Similar results were documented by Gingnell et al with regard to the insula, a region involved in integrating affective cues and producing emotions . In their sample of non‐depressed mothers 4‐6 weeks postpartum compared to non‐pregnant control women, increased reactivity of the insula to negative emotional adult faces (vs sensorimotor control) was positively correlated with the mothers’ subclinical depressive symptoms.…”

“…Furthermore, insular reactivity significantly increased from 48 hours postpartum to 4‐6 weeks postpartum. Although, the increased insular reactivity observed in this non‐clinical sample of mothers is similarly interpreted as reflecting normal postpartum adaptation, Gingnell et al also raise the possibility that these normal adaptive changes in the postpartum period may place women at an increased risk of PPD, as reflected in the positive correlations observed between these changes and depressive symptoms. We tentatively draw from the conclusions of both Swain and Gingnell et al that normative early postpartum adaptation may involve an increase in, at least part of, salience network reactivity.…”

“…Although, the increased insular reactivity observed in this non‐clinical sample of mothers is similarly interpreted as reflecting normal postpartum adaptation, Gingnell et al also raise the possibility that these normal adaptive changes in the postpartum period may place women at an increased risk of PPD, as reflected in the positive correlations observed between these changes and depressive symptoms. We tentatively draw from the conclusions of both Swain and Gingnell et al that normative early postpartum adaptation may involve an increase in, at least part of, salience network reactivity. Although these changes may be conducive to a woman's adjustment in taking on the role of a new mother during the early weeks of motherhood, it is possible that these changes may also put some women at risk emotionally for depressive symptoms.…”

“…Although these changes may be conducive to a woman's adjustment in taking on the role of a new mother during the early weeks of motherhood, it is possible that these changes may also put some women at risk emotionally for depressive symptoms. Alternatively, it is important to consider the possibility that the discrepant findings obtained by Swain and Gingnell et al may stem from discrepancies in study design, such as timing of assessment (ie, up to 6 weeks postpartum in Swain and Gingnell et al vs several months postpartum in other studies reviewed here).…”

Understanding Peripartum Depression Through Neuroimaging: a Review of Structural and Functional Connectivity and Molecular Imaging Research

“…within 48 hours and 4–6 weeks) in 13 healthy postpartum women and 15 naturally cycling non-pregnant controls (54). Early postpartum women had lower reactivity in right insula, left middle frontal gyrus, and bilateral inferior frontal gyrus when compared to late postpartum women.…”