Neural correlates of peripartum depression: a systematic review, meta-analysis and comparison to major depressive disorder

Peripartum depression (PPD) is a form of major depressive disorder (MDD) that begins during the peripartum period and poses a significant mental health challenge affecting 10–29% of women. This systematic review and multimodal activation likelihood estimation (ALE) meta-analysis explored the distinct structural, functional, and metabolic features of the PPD brain as compared to female non-peripartum MDD. For this purpose, we conducted a comprehensive literature search in PubMed, Embase and PsycINFO databases to identify peer-reviewed original studies investigating the neural correlates associated with PPD or fMDD. Forty-five studies in PPD and 55 in fMDD were included in the qualitative synthesis. From these, 27 PPD and 32 fMDD studies were included in the meta-analysis. Both shared and distinct neural underpinnings of PPD and fMDD were observed. Specifically, we found alterations in the cognitive control, salience and default mode networks for both PPD and fMDD, although with reversed structural and functional activity patterns in the insula, amygdala, precentral gyrus and precuneus. These findings support the consistent pattern of dysregulation associated with emotional regulation, cognition and maternal caregiving in women with PPD, as well as possible differential sensitivity to hormonal influences, highlighting the need for targeted interventions.