In Search of Neural Endophenotypes of Postpartum Psychopathology and Disrupted Maternal Caregiving

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.

Temperament disturbances measured in infancy progress to substance use disorder 20years later

“…single parenting, abusive partner, limited emotional resources, etc. ; Moses-Kolko, Horner, Phillips, Hipwell, & Swain, 2014; Pokorni & Stanga, 1996). These factors impede consolidating positive affective synchrony between parent and child.…”

Hippocampal Plasticity during the Peripartum Period: Influence of Sex Steroids, Stress and Ageing

“…During the peripartum period, women are at great risk to develop several psychiatric disorders such as postpartum depression (in this issue see (6, 7)), which affects 15–20 % of mothers (3). Further, the greatest incidence for depression in women is during the reproductive years (62).…”

“…Gestation and lactation are physiologically demanding and thus it perhaps should not be so surprising that there are changes in disease risk after pregnancy. For example, there is not only a decreased risk for many reproductive cancers after giving birth but an increased risk to develop depression, anxiety, psychosis and obsessive compulsive disorder (2–5); in this issue see (6, 7). In addition, the peripartum period is accompanied by changes to the brain (in this issue see (7)) and in cognition.…”

Maternal alterations in the proteome of the medial prefrontal cortex in rat

“…In addition, the mPFC is part of the limbic system and is associated with emotional changes, including anxiety, stress responses, and depression, as well as aggression [9][10][11][12][13][14][15]. Impaired maternal responsiveness in human mothers suffering from postpartum depression (PPD) has been shown to be associated with reduced activity in brain areas corresponding to the mPFC [16][17][18]. Approximately 13% of women experience PPD within 14 weeks after giving birth [19], and 19% of women experience a depressive episode during pregnancy or during the first 3 months postpartum [20].…”