Neurobiological Changes During the Peripartum Period

Implications for Health and Behavior

Emilia F. Cárdenas; Autumn Kujawa; Kathryn L. Humphreys

Disclosures

Soc Cogn Affect Neurosci. 2020;15(10):1097-1110. 

In This Article

Abstract and Introduction

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.

Introduction

Each year, ~4 million women in USA experience pregnancy and childbirth (Martin et al., 2018). The transition to motherhood is a dynamic period in life marked by a combination of dramatic neurobiological and psychosocial changes. These changes may have significant implications for the physical and mental health of women and offspring. Depressive symptoms affect more than 25% of women in the peripartum period (Gavin et al., 2005), and the prevalence rates of anxiety and related disorders are estimated at 10–20% (Fairbrother et al., 2016). There is also evidence that maternal depression and anxiety symptoms can have profound negative effects on infant development (Anniverno et al., 2013; Pearlstein et al., 2013; Righetti-Veltema et al., 2003).

Risk for peripartum depression and anxiety may be attributed to some of the physiological changes (e.g. shifts in hormones, neurobiological changes) that women undergo during this period (Yim et al., 2015; Barba-Müller et al., 2018). This risk may also be in part to the host of new challenges (e.g. 'around the clock' child-rearing demands) that take place as women transition to motherhood (Saxbe et al., 2018). In addition, it may be that interactions between psychosocial and physiological factors shape new mothers' ability to respond sensitively to the needs of their infant (Kim et al., 2010; Ostlund et al., 2017; Young et al., 2017). Such interactions have cascading effects on child outcomes, as early maternal sensitivity has been found to predict children's social and academic functioning from childhood into adulthood (Leerkes, 2010; Raby et al., 2015).

Both human and non-human animal research suggests that the brain undergoes substantial structural and functional changes during pregnancy and the postpartum period (Oatridge et al., 2002; Brunton & Russell, 2008; Barba-Müller et al., 2018). Yet, the purpose of these changes and the ways in which they may increase—or buffer against—risk for maternal psychopathology and transition to parenthood remain unclear. Some researchers theorize that at least some of these changes may be adaptive and prepare women for the emotional and cognitive demands necessary for caring for a new child (Barba-Müller et al., 2018). However, the peripartum period is also a unique time when neurobiological changes in women have the potential to affect the health of both women and the fetus. As such, it is possible that some peripartum brain changes are a result of processes necessary for promoting healthy offspring development (e.g. hormonal changes), but may have deleterious effects on women (e.g. increased psychopathology risk, cognitive deficits) (De et al., 2006; Anderson & Rutherford, 2012; Yim et al., 2015). Given the potential impact of structural and functional change across gestation on health and well-being of women and offspring, it is critical to identify both typical and atypical changes across this period. Understanding neurobiological changes in the peripartum period, as well as how individuals differ in these trajectories, may help us identify risk factors and targets for early interventions for high-risk women in order to promote mental health and sensitive caregiving in the peripartum period.

To this end, we review current knowledge of the structural and functional brain changes across the peripartum period and implications for the health of women and offspring. We first discuss the potential causes of change in brain structure and function across pregnancy, including both physiological and psychosocial factors. Next, we review the limited evidence for structural and functional changes in the brain during pregnancy and into the postpartum period, with a focus on human research. We focus predominantly on cross-sectional and longitudinal neuroimaging and psychophysiological studies in pregnant women in order to identify changes that may be unique to the experience of pregnancy, as opposed to the experience of parenting more broadly. To complement these findings, we also integrate findings from the larger literature on postpartum women as well as non-human animals. Finally, we conclude by proposing potential models of individual differences in peripartum neurobiological changes. Specifically, we highlight three possible trajectories of neurobiological change during pregnancy (i.e. hypo-response, typical response, hyper-response) to characterize differences across individuals and potential health and behavior implications for women and offspring.

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