Some interesting summer reading.  The first two articles discuss the changes that take place in the female brain during pregnancy and the postpartum period; these functional and structural changes in the brain promote caretaking behaviors but may also increase a woman’s vulnerability to mood and anxiety disorders.  A study from Silverman and colleagues questions the widely held belief that the postpartum period is a time of increased vulnerability to depression.


Ruta Nonacs, MD PhD

Brain plasticity in pregnancy and the postpartum period: links to maternal caregiving and mental health.

Barba-Müller E, Craddock S, Carmona S, Hoekzema E.  Arch Womens Ment Health. 2018 Jul 14.

A distinct neural plasticity characterizes the female brain during pregnancy and the postpartum period, and dynamic structural and functional changes take place that accompany fundamental behavioral adaptations, stimulating the female to progress from an individual with self-directed needs to being responsible for the care of another life.  However, the dynamic changes that affect a woman’s brain are not merely adaptive, and they likely confer a vulnerability for the development of mental disorders.

Pregnancy leads to long-lasting changes in human brain structure.

Hoekzema E, Barba-Müller E, Pozzobon C, Picado M, Lucco F, García-García D, Soliva JC, Tobeña A, Desco M, Crone EA, Ballesteros A, Carmona S, Vilarroya O.  Nat Neurosci. 2017 Feb;20(2):287-296.

Using a prospective (‘pre’-‘post’ pregnancy) study involving first-time mothers and fathers and nulliparous control groups, researchers observed that pregnancy renders substantial changes in brain structure, primarily reductions in gray matter (GM) volume in regions subserving social cognition.  The GM volume changes of pregnancy predicted measures of postpartum maternal attachment, suggestive of an adaptive process serving the transition into motherhood. Another follow-up session showed that the GM reductions endured for at least 2 years post-pregnancy.

Is depression more likely following childbirth? A population-based study.

Silverman ME, Reichenberg A, Lichtenstein P, Sandin S.  Arch Womens Ment Health. 2018 Jul 14.

In a prospective cohort of all women with live singleton births in Sweden, 1997-2008, we first calculated the relative risk (RR) of PPD for mothers with a history of depression compared to mothers without such a history.  The RR of PPD was 21.0 (CI 19.7-22.4). The RR of depression in the control group was 26.2 (CI 24.7-27.9). We provide evidence that the risk for PPD is no greater following childbirth than following a random date unrelated to childbirth.

Massachusetts Child Psychiatry Access Program for Moms: Utilization and Quality Assessment.

Byatt N, Straus J, Stopa A, Biebel K, Mittal L, Moore Simas TA.  Obstet Gynecol. 2018 Jul 10.

In the first 3.5 years, MCPAP for Moms enrolled 145 obstetric practices, conducted 145 trainings for 1,174 health care providers, and served 3,699 women.

A Systematic Review of Integrated Care Interventions Addressing Perinatal Depression Care in Ambulatory Obstetric Care Settings.

Moore Simas TA, Flynn MP, Kroll-Desrosiers AR, Carvalho SM, Levin LL, Biebel K, Byatt N.  Clin Obstet Gynecol. 2018 Mar 16.

There is evidence supporting the feasibility, effectiveness, and acceptability of integrating depression care into obstetrics settings.

How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder.

Byatt N, Cox L, Moore Simas TA, Kini N, Biebel K, Sankaran P, Swartz HA, Weinreb L.  Arch Womens Ment Health. 2018 Mar 13.

Progesterone for smoking relapse prevention following delivery: A pilot, randomized, double-blind study.

Forray A, Gilstad-Hayden K, Suppies C, Bogen D, Sofuoglu M, Yonkers KA.  Psychoneuroendocrinology. 2017 Dec;86:96-103.

Women taking progesterone were 1.8 times more likely to be abstinent during week 8 and took longer to relapse (10 vs. 4 weeks) compared to the placebo group, although these differences did not reach statistical significance.

Postpartum depression and social support in a racially and ethnically diverse population of women.

Pao C, Guintivano J, Santos H, Meltzer-Brody S.  Arch Womens Ment Health. 2018 Jul 3.

Higher levels of social support had a strong protective association against PPD (MOS total score OR, 0.23; 95% CI, 0.19-0.27), and the effects of social support did not differ when accounting for race/ethnicity. Additionally, PPD symptom severity is significantly and negatively correlated with the degree of social support.

Correlations between changes in the hypothalamic-pituitary-adrenal axis and neurochemistry of the anterior cingulate gyrus in postpartum depression.

de Rezende MG, Rosa CE, Garcia-Leal C, de Figueiredo FP, Cavalli RC, Bettiol H, Salmon CEG, Barbieri MA, de Castro M, Carlos Dos Santos A, Del-Ben CM.  J Affect Disord. 2018 Jul 10;239:274-281.

In the remote postpartum period (mean 21.8?±?6.9 weeks) and in the presence of depressive episodes, the decreased responsiveness of the HPA axis after awakening and a smaller decrease in cortisol levels over the day were associated with lower levels of metabolites in the anterior cingulate gyrus.

Maternal parity and perinatal cortisol adaptation: The role of pregnancy-specific distress and implications for postpartum mood.

Gillespie SL, Mitchell AM, Kowalsky JM, Christian LM.  Psychoneuroendocrinology. 2018 Jul 5;97:86-93.

Cortisol levels and pregnancy-specific distress are higher in primiparas versus multiparas, with pregnancy-specific distress partially mediating the association between parity and cortisol levels.

Poor sleep quality increases symptoms of depression and anxiety in postpartum women.

Okun ML, Mancuso RA, Hobel CJ, Schetter CD, Coussons-Read M.  J Behav Med. 2018 Jul 20.

Poor sleep quality at six months was significantly associated with greater symptoms of depression and anxiety.

Maternal Depression Scale: Do “Drop-In” Laborist Patients Have Increased Postpartum Screening Risks Compared to Patients with Adequate Prenatal Care?

Magliarditi AT, Lua LL, Kelley MA, Jackson DN.  Matern Child Health J. 2018 Jul 17.

Depressive symptoms (EPDS > 10) were present in 21.1% of women without prenatal care versus 10.9% with adequate prenatal care (P?=?0.003).


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