A tumultuous transition to motherhood: Altered brain and hormonal responses in mothers with postpartum depression

Abstract

Postpartum depression (PPD) is a common but complex condition that is poorly understood and multifactorial in aetiology. It is a condition that can compromise the mother's care for her infant, which may pose challenges to the formation of the mother‐infant bond and the infant's overall development. Past research has looked at abnormalities in the brain circuitry and hormonal profiles of mothers with PPD compared to non‐depressed mothers. However, abnormalities in PPD that may specifically affect the mother's care of her infant have not been clearly assessed. Thus, the present review aims to synthesise studies of altered brain and hormonal responses in mothers with PPD in relation to their care of their infant. First, we review maternal brain responses and their relation to PPD symptomatology, focusing on the salience/fear network, reward/attachment network and default mode network. Next, we discuss oxytocin and hypothalamic‐pituitary‐adrenal axis hormones in the context of maternal behaviour and PPD. Finally, we synthesise these findings and propose how future studies may benefit from the combined study of both neural and hormonal activity to better understand the underlying neurobiology of maternal care in PPD.

How stress can influence brain adaptations to motherhood

“…The neurobiological mechanisms by which stress exposure can impact the brain and neuroendocrine systems that regulate stress responsiveness provide insight into how mood dysregulation such as high depressive mood or anxiety symptoms can increase risks for suboptimal parenting quality ( Nguyen et al, 2019 , O'Hara and McCabe, 2013 , Pawluski et al, 2017 ). The perinatal period is when risks for maternal depression and anxiety disorders significantly increase ( Goyal et al, 2010 , Segre et al, 2007 ).…”

Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence

“…Women with PPD even show reduced activation in reward-related regions in response to cues of their own infant (54,55), and the extent to which this response is dampened corresponds to PPD severity (54). Given that reward responsivity to the infant is thought to be important for mother-infant attachment (56), reduced responsivity in reward-related regions may explain the mechanism for how PPD can affect the ability to bond with the infant.…”

Realigning Expectations With Reality: A Case Study on Maternal Mental Health During a Difficult Breastfeeding Journey

“…Women who have severe perineal pain often report difficulty sitting, standing, holding, breastfeeding, and providing general care to their infant (Beck, 2021). Pain inhibits oxytocin activity and milk transfer (Brown et al, 2016;Jobst et al, 2016;Pereira et al, 2017, Reece-Stremtan, 2017, and is also significantly associated with symptoms of depression during the postpartum period (Jobst et al, 2016;Nguyen et al, 2019;Swenson et al, 2018).…”