Developments Towards Personalized Care for Pregnancy-Related Depression

This article will summarize and debrief the research paper titled, “Toward personalized clinical interventions for perinatal depression: Leveraging precision functional mapping” by Laura Pritschet, Emily Beydler, and Sheila Shanmugan. Here, at OvaCare, we know health research papers can be hard to understand, but we believe you have the right to know about your health and to learn about it at your level. The following information aims to teach you about a new development in the field of maternal mental health with clarity and conciseness.

The Problem

One in five women is affected by pregnancy-related depression. While this a problem in and of itself, there are also concerning health consequences that extend beyond what we might expect. If pregnancy-related depression is left untreated, it can lead to high blood pressure, premature birth, impaired mother-child bonding, and increased depressive symptoms in the child. The specific type of depression we are looking at in this article is called perinatal depression, or PND. It is a form of depression that occurs during pregnancy or shortly after delivery, and like most other forms of depression, its symptoms include low mood, inability to feel pleasure, feelings of worthlessness, and suicidal ideation.

Art by Shea Davis

While prescribing antidepressants to a mother at risk for PND seems like an easy solution, there's a problem: many psychiatric medications also pose health risks during pregnancy. This forces care providers to weigh the consequences of taking antidepressants against those of developing PND. Currently, this evaluation is based on a woman’s history with mental illness and current individual circumstances. While this has generally been a successful strategy, there is potential for a much more accurate assessment.

The Solution Depression is a mental illness; it originates from the brain. So why don’t we scan the brain to determine a woman’s risk for PND? This is exactly what researchers are currently exploring, but the connection between the brain, depression, and pregnancy is a little more complicated than a simple brain scan. Every woman is unique, and so is her brain! This means neuroanatomical¹ markers for depression will look a little different in every woman, and new techniques must be developed to account for these differences.

Fortunately, these techniques are already available and being tested for determining PND risk. Precision functional mapping (PFM) is a method of brain analysis that allows for person-specific features of the brain's pathways to be seen. While the exact science behind PFM is beyond the scope of this article, this technology is revolutionary in its ability to detect and predict mental health conditions-- including PND. With biological information about a woman’s risk of PND, care providers will be able to make better informed decisions when weighing the health risk of PND against that of psychiatric medication.

Pregnancy and The Brain

While we have already discussed the things of greatest importance, let’s dive into how the brain changes during pregnancy while we’re here. We all know a woman’s body physically changes during pregnancy, but what’s fascinating is that her brain does as well. During pregnancy, structural changes in the brain occur, which correspondingly create changes in brain function.

Art by Shea Davis

The brain has various networks wired into it that are responsible for how we act, feel, and think. One of these networks is called the default mode network (DMN); it is responsible for our cognitive and emotional processing. It makes sense, then, that this area, along with others, is heavily involved in depression circuitry. When the DMN is functionally altered as it is in pregnancy, we commonly see increased depressive symptoms. In fact, the DMN is the part of the brain that experiences the greatest changes during pregnancy, which helps explain why PND is so common.

Using This Information for Intervention Improvement

Precision functional mapping has the potential to improve medical decision-making for pregnant patients with depressive symptoms. If features of personalized default mode networks are found to reliably reflect future risk for PND, patients could undergo PFM as part of prenatal or preconception counseling evaluations, and this information could be used to inform the odds of developing depression during pregnancy and postpartum. From there, medical providers can use these odds in the risk-benefit analysis of continuing psychiatric medications during pregnancy. However, it is essential to note that brain function and anatomy are not the only factors that determine PND risk. Personal history, current circumstances, immune response, epigenetic markers, health histories, and psychosocial factors will still be important to take into account when determining a woman's risk for PND.

The ultimate goal of the research is to use standardized PFM techniques to gather a large data sample from diverse populations, which can be used to program machine-learning models. This model would use the vast data gathered and compare it to one individual’s PFM results in order to generate a probability that the individual will develop PND. This probability would then be used by a care provider in discussing treatment options with the patient.

If a woman is at high risk for PND, there are also ways that PFM can help provide a treatment with fewer health risks. Transcranial magnetic stimulation (TMS) is a treatment currently being used to stimulate the outermost layer of the brain. However, by mapping a person’s brain with PFM, there becomes the potential to safely stimulate deeper parts of the brain that are involved in depression circuitry (like the DMN). By doing this, scientists hope to alleviate depressive symptoms. We are a long way from being able to integrate this treatment as a standard option, but the possibilities are certainly exciting.

Conclusion

Pregnancy-related depression is a pressing issue in the field of women’s mental health. All of our lives are impacted by the mental health of the mothers around us, making it essential for society to prioritize effective treatment for maternal psychiatric problems, especially during pregnancy. It is currently difficult to quantify the risk a person has for developing depression during pregnancy, which in turn makes it difficult to weigh the risks versus benefits of taking an antidepressant. Precision function mapping would solve this issue by allowing us to examine the neurobiological networks involved in depressive symptoms in each mother individually. When we examine these networks, we now have a biological and quantifiable way of determining risk for PNF. This information can be used to help both the medical provider and the patient make a critical judgment regarding the use of psychiatric medication during pregnancy.

To end this article, I would like to pull a quote for the research paper itself. “Mental health conditions are among the most common and most underdiagnosed complications of the perinatal period and present lasting effects on the mother, child, and family. As such, optimizing clinical interventions for PND should be considered a high-priority research area across the neurosciences. Applying precision neuroimaging techniques to the study of the maternal brain may lead to necessary breakthroughs in women’s mental health research.” The researchers clearly exemplify the urgency for a better system, and I personally cannot wait to see where these developments lead us.

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¹Neuroanatomy refers to the anatomy or structure of the brain