56. Postpartum Brain Changes

[Music] Hi everyone, welcome to another episode of Mummy Brain Revisited. I'm Dr. Jody Poluski, your host, and today I have the opportunity of speaking with Dr. Natalia Tecco, who is a specialist in psychiatry and psychotherapy at the University of Akin in Germany. And we talk about some of her recent work in mothers, as well as fathers, looking at how the brain changes in the postpartum period and what this means in terms of parenting, but also mental health. Hi Natalia, it's so nice to meet you. Nice to meet you too. I'm going to jump in with my first question about why you started doing research on the brains of mothers. So it was actually a coincidence. I'm a psychiatrist and the whole story started about six, seven years ago when we decided to do some study which would help us how to predict development of postpartum depression. So the idea was to recruit women shortly after them giving a post-to-chal, like with just a couple of days after they gave a post-to-chal, in to see in healthy women how we maybe with the first MRI scan, with changes in the brain, can predict if they're going to develop depression, yes or no, within the next three months. And it was actually a very challenging project. Actually we are working in a big hospital which has a psychiatry, but the necologistry hospital and we were actually recruiting really young moms just immediately after them having a birth and asked them to participate in MRIs so it was actually sometimes very challenging. And then we collected quite a big group of women, about 200 women young mothers, they got structural brain imaging, connectivity imaging and then we started to do, can we predict how women feel later. And basically we didn't, it was quite heterogeneous so we saw that about 10% of mother developed depression, but we could not see it very clearly in the brain. And then I started hearing stories that brain after the birth is different, you know, it's like comforts publication from Barcelona and I like I don't believe it myself. I mean I have two children, I'm quite sure that my brain is pretty the same. So now what we did, we took this same cohort and compared that with women who never gave a birth to a child and was actually quite shocked seeing so much less brain shortly after the birth affecting preferential cortex and hypochalopropos. And then we did some research and then we understood that it's a quite stable pattern but you can see after a woman having a child and it doesn't have anything to do how the woman feels but it is like just like that. After the birth, shortly after the birth the brain is different and it's affects crucial areas for emotional regulation, for memory, for cognitive control and we could reproduce it later in the later cohort. That's how it started. I like this disbelief piece. But because I think that goes with the theme of you know we always think it's structurally if the brain is shrinking, it's a bad thing. But in fact they've shown and now it's been repeated, you're working others whereas just it's normal, this is what happens and it seems to be positively related to feelings of sensitivity towards the child. Yeah, yeah. Anyway, but yeah I like where you started this where you're like hold on a second, let's double check this. Yeah. So today I thought we'd focus on one of your recent papers where you were interested in looking at the resting state functional MRI across the postpartum and relation with hormones and which I thought was really important because we often are talking about hormones. We talk a lot about brain structure but not as much about function in terms of just what's normally happening at rest, right? So maybe you can tell us about why you decided to do this study in particular. Okay. So that was actually connected to the first study as well when we just interfirst looked at the first point like what happened shortly after the birth and the question really kept me busy. Will it stay like that or will it get better? Like does it recover after a certain period of time? So it was actually for me personally very important to see what happens afterward. So and then we looked at previous research and we saw that usually all the previous research has very in homogenous time points when they when they actually measure women after the birth and then sometimes they compare moms one month's postpartum with moms four months postpartum and I thought I said such a dynamic process you have to look an assorted period of times and that what we did after that we got a grant for them support from German research foundation that we recruited a new group and we looked what happens to structure in function in function over a longer period of time. So we did first MRI scan the same shortly after the birth like there would be two three days after a woman giving a birth to a child and then we repeatedly did a scan three weeks later six weeks later nine weeks later 12 weeks later and then 24 weeks later and we were like really particularly we wanted always to see the same time point. So then we actually have two publications once related to structure recovery and the second related to resting state recovery I think instructor we saw pretty much that what previous groups see as well we saw that a lot of happening particularly within the first six weeks so we saw that actually the brain recovery structure recovery happens within the first six weeks the most we have some permanent changes but actually the huge recovery is associated with the first six weeks and we decided to see what is about connectivity what happens to connectivity and we saw the same pattern basically we saw that the connectivity shortly after the boss is reduced that somehow but Basel Ganglia communicates with the rest of the brain less shortly after the boss and you can see that these changes are still there six weeks per spartum and then they slowly disappear so they go away. So we seen the first six per spartum you have lesser connectivity between Basel Ganglia, Putamen and the rest of the brain somehow Basel Ganglia is definitely connected and it is temporary associated with progesterone level so this is the time when the progesterone level suppressed and we could see as well we looked at what is their collocalization pattern what happens with like which areas are talking to each other differently or like have a less communication during this time and we saw that this actually brain areas having a gather receptor distribution so it has something to do with gather airgic regulation and we saw that this because it's longer to general studies the same moms right we could see that after six weeks the changes disappear so the brain talks to the race differently but this time windows six weeks what I say, I just we believe it's important as well it's an onset for the passpartum depression that's what we have to take a closer look if you wanted to understand what happens what triggers a passpartum depression. Oh interesting so yes because there's that really early time point and you're seeing a lot more brain changes both structurally and functionally and then it would be really interesting then to see if we could use that to predict who does well mentally and she ends up with illness. Exactly but we are not there yet to be able to predict it because like we do at the moment as well we focus mostly on healthy mothers talking about physiological changes so we see that this is a type of physiological changes going in a healthy brain you can see that we've seen six ones healthy mothers reorganize their brain in terms of structure and function but I deeply believe if the woman has vulnerability for depression that might deal with this physiological changes differently. Yes and it's but it's been really difficult to figure this out even hormonally we don't know so much about a hormone signature that might be predictive or a biomarker of postpartum depression. or even perinatal depression. - You're looking for that, a lot of people looking for that, but we didn't find it yet. - Yeah. So then in this one study with the resting state, you also looked at progesterone levels, and then you also did something, I thought was interesting, you were able to kind of map brain areas onto kind of an atlas to look at receptor distribution. - Yes. - And I thought this was, I mean, this is a great way to do this research in humans, because humans, you can't remove their brains and put them, yeah, anyway. - Yeah, yeah, yeah. - I work with rodents, but we can do many-- - Look like you can open the brain and be, yeah, right? - Yeah, so then you were able to kind of overlap, like maybe explain this to me, you could then predict potential receptors involved, take us, yeah, through that. - So basically this type of analysis suggests that you just map this receptor maps from pet studies with structural MRI or with resting state MRI, and you can see the structural and functional changes, how they color collize with receptor distribution. So is it any relationship? Is it like areas which are involved? Do they have some pattern? Do they have more, or do they have a certain pattern of receptor distribution? In resting state, we saw that there's such a pattern with GABA is that you can see that GABA transmission is involved. I don't know if I'm just talking to early now, but we just submitted a paper and structure and color collization receptor maps when we actually exactly looked the same. That's we could see that the structural changes are very strongly collocalizing with GABA receptor over the entire period of time. Because GABA is a lot in a Mucdela, in preferential cortex, right? And if you look at the treatment of pasparta depression, we are trying to target GABA air due to modulation. So we're actually looking at allopregninalone, right? This is allosteric modulation for GABA. And we saw that's not only GABA, but glutamate is involved so that could be some excitatory, inhibitory balance in pasparta depression. So like healthy women, they can deal with that. That's okay with them. But women who have the tendency, who just cannot deal very well with the lack of allopregninalone or progesterone, could maybe rank differently. But we have to look at the high vulnerability group. So what I'm planning to do, I'm planning to do a selection in the next grant, we are looking for selection, that we are looking for high risk women. And we are going to do such a longer than the normal studies at women who have a much higher possibility to develop a depression. - Yeah, because that makes sense, right? Then you can really see the differences. I think it's also really interesting, this potential like this link with GABA, the GABA reject system, as you mentioned, because that's the allopregninalone, the immune medication that's authorized in the United States right now for postparta depression. So yeah, that's really interesting. It all seems to fit, at least at this point, to some degree. - Yeah. - But tell me in this, in your work you've done in the healthy moms, was there any relationship between mood measures or moms' feelings of attachment or bonding and the brain measures? - Well, you have some associations, as psychiatrists, I do not believe so strong in this association, because it's association between a healthy group and you will have some, so you could steal, I mean, I saw that other group reports that as well, that they see this, like how mood is fluctuating, that it's related to some racing state connectivity changes. But the effects are not as strong, but we could see indeed that over the time, you can see relationship with the quality of attachment. It does, you cannot see it immediately after the birth, but over the time, over the time, you can see that, for instance, mothers having a small, amyctolus, smaller hippocampus or weaker connectivity with HIN, insula are actually more sensitive, and they're less hostile to the child. So, meaning that this time, spending with a child, contributing to this neuroplasticity, in what we are trying to say, what is the early changes? What is the changes that triggered by this hormonal withdrawal in what's coming over the time, what's coming and top to this hormonal biological changes? This is actually the time spent with the child. Yeah. And were there any differences if they were breastfeeding or not? Did you look at that? No, it was no difference. But we could see that the breastfeeding really affects the register on level, but not the brain. Yeah, yeah. I think that's an important point, is the amount of time you spend with the child, not necessarily how you feed them. That's important. Yeah, that's really interesting. So, what Barcelona group shot as well, and what we see as well, actually somehow moms with less brain, they're better moms somehow. Yes, see? This is why I've written about how less can be more. Yeah, yeah, exactly. And I think this fine tuning, sometimes I talk about also, like dynamite comes in small packages, right? Yeah, that's a great expression. Yes. So, I think this is how we should think of the maternal brain when we're thinking of the shrinkage. In fact, yeah, yeah, yeah. It's really interesting though, that this is so consistent in the literature, right? They've seen it in the Netherlands, they've seen it in Spain, now you're in Germany. You should work together. I just don't know how we can. But my focus is this psychiatrist is going more, what is it if you look at vulnerable groups and like really unwell women, yeah? Yeah, yeah, it's a different focus, but it's incredibly important. So then the next step for you now is really to understand what's going on in women that develop postpartum depression. Yes, yeah. And then what about, I mean, do you ever look at the fathers? Indeed, yeah, yeah. So, and that's, we thought as much, so that's like we thought that's such a great control group. So like man, and it's a great group to study gender effects on depression as well, because actually you have the same time window and man do not have all this hormonal fluctuations, but they still have attachment, right? Yeah, and they still get depressed. And they still get depressed. And they need to have a bigger cohort and man about 300 men, which we just investigated over six months. So all of this is still unpublished, but we are like coming soon with interesting publications. We saw that about 8% of men in deep developed depression, their depression is really linked to how mothers feel. Yeah. So somehow if mother doesn't feel good, then the next step, men develops depression. Yeah, or can it be that if the he doesn't feel good, she does, is that you know the driving? There's some, some, some inter-couple, yeah, we saw that if women, for instance, we saw frequently that women go through such things like adjustment disorder, not like really clinical depression, but like changes of mood. And they develop it very quickly. Quickly after the birth, it could be actually severe baby blues as well. And the men feel first, the first time good. But somehow when the women start recovering, they're starting feeling bad. So we saw this dynamic and a couple. But men have slightly different symptoms as well. They have more OCD symptoms than women. And they don't like if things happen, not how they expected. If for instance, they expected a paternal role, had a different expectation and their paternal role, then they feel better as well. Men who are just really over-involved, who are actually developing some metabolic symptoms during the time of women are pregnant, are affected more as well. The difference I vey subtle, right? So since women, they have this very strong, hormonal trigger, which you would not have in men, right? So the changes are more subtle, the different. - Yeah, yeah, they're not to the same degree at all. But I think this piece of looking at the relationship is really interesting. And looking at as a comparison for sex, essentially, is and brain measures is going to be an interesting piece as well. Yeah, but we did as well. We have a I'm a writer from Father as well. This cohort of men participated in the same longitudinal study. So we measured men to the same time points and we actually measured coupled as well. So like at the same time point, the same interaction with the child. And what we can see, this is preliminary unpublished data, which we are going to submit soon as well. So this is a group of 30 young fathers. I studied every three weeks up until six months, yeah. So it is the same pattern like in mothers. And we could see that at the beginning, there are no brain changes. Over the time, there's so similar pattern like associated with attachment. There's similar pattern of brain involvement when men getting attached, spend more child with the child. Yeah, and this is the function of the brain. You're looking at the whole structure. The structure in function. OK, OK. So there are structural changes based on experience. Yes. Yeah. And functional changes as well, based on experience. Yeah. And this is important for people to realize is that the parental brain essentially is built with regards to your, you have to experience or interact with the child to make your brain parental, let's say. Yeah. Men are now more involved than before in raising small children. Yeah, which is good. Yeah, that's good. It's good, right? They should continue to do that. It's good for their brains. Yeah, it's good for their brains. Yeah. Well, that might make them more vulnerable for depression, but they have to manage that. Yeah. And sometimes I think this vulnerability piece is actually because of the social pressures, not because of the biology necessarily, right? The brain is doing what it needs to do, but if you pile on all these stressors and expectations and lack of support, then of course, your brain is not going to be functioning optimally. Yeah. Oh, this is exciting research. So I'm glad we've connected and got a brief overview of what you've been working on. I think this is really, really, really important. I also love this lens of really looking at the focus in terms of mental illness and looking at these normative changes, but also what's going to happen then when someone's ill. And can we predict it somehow? I mean, this is a great question. Yes. That's we don't know. I mean, this term of prediction, we don't know. I mean, what I believe, that's the first point, like if you just scan all women shortly of them having a burst, could be not as predictive because I think there's so much happens biologically, so that's maybe not such a strong changes between groups. But I think this long term assessment and seeing, like, for instance, we have a group of healthy women shortly after the burst. And the most of them, like, go on some biological adaptations, and then you will see women who actually develop a depression and possibly that their adaptation is different. So that's we have to assess longer generally. We have to use for this trapping of hormones, peripherally, what we do. I think epigenetic is very important to assess as well. We have to see that their stress responses are the level of cortisol. And what we have to see, what happens to them in terms of attachment, in terms how do they feel, how do they stress, in which primal vulnerability to the brain, right? So which vulnerability to the brain from the beginning? Yes, yeah. And also looking at a number of different factors, right? Because I think we sometimes want to link it one to one. Like, oh, it's just this hormone, and then that predicts an outcome. But in fact, it's a number of different factors, just kind of a signature we have to look at. And they always look at the basic hormones, like estrogen, progesterone. What about all this metabolites? Of course. And then you have the neurotransmitters of course. Because the hormones don't work in isolation. Yeah. Yeah. Yeah. And this is where the human research is limited, because you can't look at receptor densities in the brain and things like this. But you can get a better picture, I think, by measuring more things over time. Yeah. Fascinating. Well, thank you. This has been great. I'm so glad we met. Yeah. [MUSIC PLAYING] Questions, comments, suggestions, get in touch at Mummy Brain Revisited on Instagram, Twitter, or Facebook. 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