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

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          Abstract

          Pregnancy and the postpartum period involve numerous physiological adaptations that enable the development and survival of the offspring. A distinct neural plasticity characterizes the female brain during this 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. While many animal studies detail these modifications, an emerging body of research reveals the existence of reproduction-related brain plasticity in human mothers too. Additionally, associations with aspects of maternal caregiving point to adaptive changes that benefit a woman’s transition to motherhood. 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. Here, we review the changes in brain structure and function that a woman undergoes during the peripartum period, outlining associations between these neural alterations and different aspects of maternal care. We additionally discuss peripartum mood disorders and postpartum psychosis, and review the neuroimaging studies that investigate the neural bases of these conditions.

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          Most cited references81

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          The neural correlates of maternal and romantic love.

          Romantic and maternal love are highly rewarding experiences. Both are linked to the perpetuation of the species and therefore have a closely linked biological function of crucial evolutionary importance. Yet almost nothing is known about their neural correlates in the human. We therefore used fMRI to measure brain activity in mothers while they viewed pictures of their own and of acquainted children, and of their best friend and of acquainted adults as additional controls. The activity specific to maternal attachment was compared to that associated to romantic love described in our earlier study and to the distribution of attachment-mediating neurohormones established by other studies. Both types of attachment activated regions specific to each, as well as overlapping regions in the brain's reward system that coincide with areas rich in oxytocin and vasopressin receptors. Both deactivated a common set of regions associated with negative emotions, social judgment and 'mentalizing', that is, the assessment of other people's intentions and emotions. We conclude that human attachment employs a push-pull mechanism that overcomes social distance by deactivating networks used for critical social assessment and negative emotions, while it bonds individuals through the involvement of the reward circuitry, explaining the power of love to motivate and exhilarate.
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            On the relationship between the “default mode network” and the “social brain”

            The default mode network (DMN) of the brain consists of areas that are typically more active during rest than during active task performance. Recently however, this network has been shown to be activated by certain types of tasks. Social cognition, particularly higher-order tasks such as attributing mental states to others, has been suggested to activate a network of areas at least partly overlapping with the DMN. Here, we explore this claim, drawing on evidence from meta-analyses of functional MRI data and recent studies investigating the structural and functional connectivity of the social brain. In addition, we discuss recent evidence for the existence of a DMN in non-human primates. We conclude by discussing some of the implications of these observations.
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              Psychiatric disorders in pregnant and postpartum women in the United States.

              Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of these conditions in this population is lacking. To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking among past-year pregnant and postpartum women in the United States. National survey. Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. A total of 43 093 respondents were interviewed, of whom 14 549 were women 18 to 50 years old with known past-year pregnancy status. Prevalence of 12-month DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking. Past-year pregnant and postpartum women had significantly lower rates of alcohol use disorders and any substance use, except illicit drug use, than nonpregnant women. In addition, currently pregnant women had a lower risk of having any mood disorder than nonpregnant women. The only exception was the significantly higher prevalence of major depressive disorder in postpartum than in nonpregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and postpartum women. Lifetime and past-year treatment-seeking rates for any psychiatric disorder were significantly lower among past-year pregnant than nonpregnant women with psychiatric disorders. Most women with a current psychiatric disorder did not receive any mental health care in the 12 months prior to the survey regardless of pregnancy status. Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period. Groups of pregnant women with particularly high prevalence of psychiatric disorders were identified. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period.
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                Author and article information

                Contributors
                e.a.hoekzema@fsw.leidenuniv.nl
                Journal
                Arch Womens Ment Health
                Arch Womens Ment Health
                Archives of Women's Mental Health
                Springer Vienna (Vienna )
                1434-1816
                1435-1102
                14 July 2018
                14 July 2018
                2019
                : 22
                : 2
                : 289-299
                Affiliations
                [1 ]ISNI 0000 0001 2312 1970, GRID grid.5132.5, Brain and Development Research Center, , Leiden University, ; Leiden, the Netherlands
                [2 ]Leiden Institute for Brain and Cognition, Leiden, the Netherlands
                [3 ]ISNI 0000 0001 2174 6723, GRID grid.6162.3, University Institute of Mental Health Vidal i Barraquer, Ramon Llull University, ; Barcelona, Spain
                [4 ]GRID grid.469673.9, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ; Madrid, Spain
                [5 ]ISNI 0000 0001 0277 7938, GRID grid.410526.4, Unidad de Medicina y Cirugía Experimental, , Instituto de Investigación Sanitaria Gregorio Marañón, ; Madrid, Spain
                [6 ]ISNI 0000 0001 2171 6620, GRID grid.36083.3e, Faculty of Health Sciences, , Universitat Oberta de Catalunya, ; Barcelona, Spain
                Author notes

                This article is part of the Topical Collection on Neurobiology of Maternal Mental Illness

                Guest Editor: Jodi Pawluski

                Article
                889
                10.1007/s00737-018-0889-z
                6440938
                30008085
                0c603903-fc82-4532-a7c0-fba911b78ff8
                © The Author(s) 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 26 March 2018
                : 2 July 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003246, Nederlandse Organisatie voor Wetenschappelijk Onderzoek;
                Award ID: 451-14-036
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000874, Brain and Behavior Research Foundation;
                Award ID: NARSAD young investigator grant
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;
                Award ID: CP16/00096
                Award Recipient :
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Austria, part of Springer Nature 2019

                Clinical Psychology & Psychiatry
                neuroplasticity,perinatal mental health,maternal behavior,postpartum depression,maternal attachment

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