Longitudinal endocrinological correlates of white matter integrity loss during the postpartum period
Poster No:
1743
Submission Type:
Abstract Submission
Authors:
Susanne Meinert1, Susanne Nehls2, Natalya Chechko3
Institutions:
1Institute for Translational Psychiatry, University of Münster, Münster, North Rhine-Westphalia, 2RWTH University Hospital, Aachen, Germany, Germany, 3RWTH University Hospital, Aachen, Germany
First Author:
Susanne Meinert
Institute for Translational Psychiatry, University of Münster
Münster, North Rhine-Westphalia
Institute for Translational Psychiatry, University of Münster
Münster, North Rhine-Westphalia
Co-Author(s):
Introduction:
The postpartum period, which includes the early stages of motherhood, brings profound biological, psychological, and social changes for mothers. It can be divided into three distinct phases (Figure 1) (Romano et al., 2010). The first 6-12 hours up until the first 10 days after birth - the acute postpartum phase - are characterized by the sudden withdrawal of previously stored hormones (e.g., progesterone, estradiol). This time window is accompanied by depressive symptoms termed 'baby blues' (Kennerley & Gath, 1989), affecting up to 55-60% of all new mothers (Chechko et al., 2024). The following subacute postpartum phase lasts 2-6 weeks. During this phase, hemodynamic recovery processes related to the urogenital system, metabolism and emotional status take place (Romano et al., 2010). At the same time, estradiol levels gradually return to normal, while progesterone levels rise only slowly (Bloch et al., 2003). This is also the period when mental diagnoses with postpartum onset such as PPD or adjustment disorder (AD) can be diagnosed. AD represents a subthreshold form of depressive or anxious mood, affecting up to 18-20% of all new mothers (Hahn et al., 2021; Tsoneva et al., 2023). In contrast to AD, PPD is rarely self-remitting and, therefore requires a timely and intensive treatment to reduce its negative consequences on the quality of life. Finally, the delayed postpartum period can last up to 6 months. Ovarian function and therefore progesterone levels recover (Campbell & Gray, 1993), muscle tone and connective tissue return to pre-pregnancy levels and the woman's body returns to pre-pregnancy physiology (Romano et al., 2010). Understanding the neurobiological changes during this critical window could help to understand mood disorders, from baby blues to AD and PPD.
·Figure 1. The three phases of the postpartum period.
Methods:
Longitudinal diffusion tensor imaging (DTI) data were collected from N=25 healthy postpartum mothers with five follow-up measurements (starting at <10 days postpartum with repeated measures every 3 weeks up until week 12 postpartum and again at 24 weeks postpartum) and analyzed using tract-based spatial statistics (TBSS). The effect of time on fractional anisotropy (FA) was estimated with linear mixed-effect models with random intercepts. To correct for multiple comparisons, threshold free cluster enhancement (TFCE) was used to correct α-values at the family-wise error rate (FWE; ptfce-FWE).
Results:
We found a significant decline in FA over time (ptfce-FWE<.001, ktotal=11.433 in 59 cluster, largest cluster: k=4.926, x=-36, y=-29, z=0) in the postpartum period in the corpus callosum, corona radiata, and superior longitudinal fasciculus. Post-hoc t-contrasts showed that this effect was driven by a sharp drop in FA values between the first and second measurement (>10 days to 3-4 weeks, ptfce-FWE=.003) with the onset of the subacute postpartum phase and again between the second and third measurement (3-4 to 6-7 weeks, ptfce-FWE=.004) up until the start of the delayed postpartum phase. The initial drop in FA values was associated with the decrease in estradiol (ptfce-FWE=.048) and progesterone (ptfce-FWE=.003) levels that occurs after delivery, from the heightened values during pregnancy (Figure 2).
·Figure 2. White matter reorganization of postpartum brains.
Conclusions:
These findings highlight that the subacute postpartum phase (3-6 weeks post-delivery) is a crucial transitional period marked by significant hormonal fluctuations that align with neurobiological changes. The sensitivity to these hormonal shifts is considered pivotal in the development of postpartum depression. Given that the neurobiological alterations in the corpus callosum, corona radiata, and superior longitudinal fasciculus mirror those seen in Major Depressive Disorders, this period warrants further investigation to enhance our understanding of mood disorders.
Modeling and Analysis Methods:
Diffusion MRI Modeling and Analysis
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
Normal Development 1
White Matter Anatomy, Fiber Pathways and Connectivity
Novel Imaging Acquisition Methods:
Diffusion MRI 2
Physiology, Metabolism and Neurotransmission:
Physiology, Metabolism and Neurotransmission Other
Keywords:
MRI
White Matter
Other - pregnancy and postpartum
1|2Indicates the priority used for review
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Campbell, O. M. R., & Gray, R. H. (1993). Characteristics and determinants of postpartum ovarian function in women in the United States. American Journal of Obstetrics and Gynecology, 169(1), 55–60. https://doi.org/10.1016/0002-9378(93)90131-2
Chechko, N., Losse, E., Frodl, T., & Nehls, S. (2024). Baby blues, premenstrual syndrome and postpartum affective disorders: Intersection of risk factors and reciprocal influences. BJPsych Open, 10(1), e3. https://doi.org/10.1192/bjo.2023.612
Hahn, L., Eickhoff, S. B., Habel, U., Stickeler, E., Schnakenberg, P., Goecke, T. W., Stickel, S., Franz, M., Dukart, J., & Chechko, N. (2021). Early identification of postpartum depression using demographic, clinical, and digital phenotyping. Translational Psychiatry, 11(1), 121. https://doi.org/10.1038/s41398-021-01245-6
Kennerley, H., & Gath, D. (1989). Maternity blues. I. Detection and measurement by questionnaire. The British Journal of Psychiatry: The Journal of Mental Science, 155, 356–362.
Romano, M., Cacciatore, A., Giordano, R., & La Rosa, B. (2010). Postpartum period: Three distinct but continuous phases. Journal of Prenatal Medicine, 4(2), 22–25.
Tsoneva, K., Chechko, N., Losse, E., Nehls, S., Habel, U., & Shymanskaya, A. (2023). Pandemic-induced increase in adjustment disorders among postpartum women in Germany. BMC Women’s Health, 23(1), 486. https://doi.org/10.1186/s12905-023-02638-z