Neural underpinnings of postpartum adaptation following traumatic delivery and implications for infant development

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PROJECT SUMMARY. Maternal bonding is the basis for secure attachment in the child, stimulating protection and nurturing crucial for the child’s socioemotional development. Failure to achieve bonding in the early postpartum period can result in adverse developmental problems in the child with heavy societal costs. Many women suffering from postpartum psychopathology exhibit poor maternal bonding, which, at its extreme, may lead to child abuse and neglect, the prevention of which is a stated NICHD mission. Understanding the underlying neural mechanism mediating postpartum maternal bonding impairment is crucial to achieve prevention. We propose to use quantitative neuroimaging approaches to determine the neural basis of maternal response to a child related stressor and how this is altered in the context of postpartum psychopathology. Recent and limited neuroimaging studies focused largely on postpartum maternal bonding in the context of postpartum depression with other conditions largely overlooked. One such disorder is childbirth-related posttraumatic stress disorder (CB-PTSD). CB-PTSD symptoms have been reported in up to 25% of mothers with the acute symptoms induced by birth related traumatic events including near-death experience. To date, there is very limited understanding of the biological and neural basis of CB-PTSD. In this study we will implement a valid protocol to determine the altered neural activity in mothers with CB-PTSD using functional neuroimaging. Commencing in the hours following parturition, we will identify 60 women at risk for CB-PTSD who will be assessed in the early postpartum for CB-PTSD symptoms and neural activation as visualized by fMRI evoked by infant cry and distressed facial expression. Neural activations will be correlated with maternal bonding measurements and collected child developmental scores. Maternal CB-PTSD will be measured with psycho-diagnostics and psychometrics; maternal bonding will be quantified by psychometrics and observational assessment of the bonding behavior; and child development via standardized observational methods. We expect our findings will advance scientific knowledge of the neural correlates mediating impairments in maternal bonding in women suffering from postpartum psychopathology. Identification of novel neural markers of maternal impairments in CB-PTSD in the very early postpartum could help distinguish CB-PTSD from other postpartum pathologies and encourage specialized psychological interventions. This study will promote improved implementations of psychopharmacological and neurofeedback treatments, which are currently lacking. In conclusion, this study furthers the Agency’s mission for children to achieve healthy and productive lives. It may serve as a platform for future investigations of the complex interplay between maternal mental illness in the postpartum period, mother– infant bonding, and the underlying neurobiological mechanisms.