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.
Highlights
A normal pregnancy and postpartum period are associated with major endocrine alterations which are adaptive changes in preparation for childbirth and nursing [1]
The hormonal changes across pregnancy and the puerperium have repeatedly been proposed as important risk factors for postpartum depression [9,10], indicating that emotion processing is affected by these adaptive changes
Previous studies have reported a relatively rapid increase in ovarian steroid levels to be accompanied by decreased insular reactivity to emotional stimuli [35]; the results of the present study show the opposite pattern, wherein the shift from high to low estradiol and progesterone levels was followed by an increase in insular reactivity
Summary
A normal pregnancy and postpartum period are associated with major endocrine alterations which are adaptive changes in preparation for childbirth and nursing [1]. The competing interests of Dr Sundström-Poromaa do not alter the authors’ adherence to PLOS ONE policies on sharing data and materials and these conflicts of interest have been clearly stated upon submission. These adaptations would be considered pathological if present in non-pregnant women. The hormonal changes across pregnancy and the puerperium have repeatedly been proposed as important risk factors for postpartum depression [9,10], indicating that emotion processing is affected by these adaptive changes
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