Examining early structural and functional brain alterations in postpartum depression through multimodal neuroimaging

Abstract

Postpartum depression (PPD) affects approximately 1 in 10 women after childbirth. A thorough understanding of a preexisting vulnerability to PPD will likely aid the early detection and treatment of PPD. Using a within-sample association, the study examined whether the brain’s structural and functional alterations predict the onset of depression. 157 euthymic postpartum women were subjected to a multimodal MRI scan within the first 6 days of childbirth and were followed up for 12 weeks. Based on a clinical interview 12 weeks postpartum, participants were classified as mentally healthy or having either PPD or adjustment disorder (AD). Voxel-based morphometry and resting-state functional connectivity comparisons were performed between the three groups. 13.4% of women in our study developed PPD (n = 21) and 12.1% (n = 19) adjustment disorder (AD). The risk factors for PPD were a psychiatric history and the experience and severity of baby blues and the history of premenstrual syndrome. Despite the different risk profiles, no differences between the PPD, AD and control group were apparent based on structural and functional neuroimaging data immediately after childbirth. At 12 weeks postpartum, a significant association was observed between Integrated Local Correlation (LCor) and the Edinburgh Postnatal Depression Score (EPDS). Our findings do not support the notion that the brain’s structural and resting-state functional alterations, if present, can be used as an early biomarker of PPD or AD. However, effects may become apparent if continuous measures of symptom severity are chosen.

Structural, functional, and metabolic signatures of postpartum depression: A systematic review

“…In contrast to the previous findings, Schnakenberg et al ( 27 ) found no difference between non-depressed and depressed postpartum women regarding rs functional connectivity. The authors controlled the time course of PPD onset to establish the prognostic value of neuroimaging data, since the women had not been depressed at the time of recruitment but might later become depressed at the time of scanning.…”

“…In contrast to the studies that found structural correlates of PPD, Schnakenberg et al ( 27 ) failed to detect any difference between depressed and healthy mothers.…”

“…This fact affects the results and impedes their generalizability. To specify this methodological discrepancy in our review, Schnakenberg et al ( 27 ) obtained the imaging data from women only 6 days after delivery, in order to explore whether fMRI correlates might represent the early PPD biomarkers. However, the early time of the testing might be the reason why they failed to find any difference between women with PPD and healthy controls ( 27 ), since the studies that included women up to 12 months after childbirth (e.g., 19 , 23 , 25 ) were more likely to find the expected differences.…”

Effect of transcranial direct current stimulation on postpartum depression: A study protocol for a randomized controlled trial

“…Functional neuroimaging (FNI) techniques, such as functional magnetic resonance imaging, electroencephalography, and magnetoencephalography, are powerful tools for studying the human brain and laying methodological foundations for cognitive neuroscience (Li et al, 2019 ). Examining structural and functional changes in the brain through FNI can assist in making accurate clinical diagnoses among individuals experiencing PDD, potentially enhancing treatment approaches for this population and improving prognosis (Schnakenberg et al, 2021 ). However, compared to the relative wealth of data available for major depressive disorders, FNI-based studies focusing on PPD are limited in number and design (Fiorelli et al, 2015 ).…”

Maternal separation: Does it hold the potential to model consequences of postpartum depression?

“…Furthermore, a recent study examining whether neuronal alterations of PPD in women are detectable right after birth found that despite risk profiles pointing toward developing PPD (and developing PPD 12 weeks postpartum), no structural and functional alterations were found immediately after childbirth in the participants (Schnakenberg et al, 2021). This might suggest that early structural or functional alterations in PPD might be too subtle to be detected with neuroimaging at first but might become more profound in the disease course (Schnakenberg et al, 2021).…”