[00:00:00] Dr Renee White: Knowledge is power and we are all about empowering the mamas of the world. In each episode, we will unravel and interpret the latest research and evidence based practices for pregnancy, postpartum and motherhood. As mums and researchers ourselves, we have experienced firsthand the overwhelming complexity of information, myths and those classic old wives tales.

[00:00:27] I'm Dr. Renee White and this is The Science of Motherhood. Hello and welcome to episode 156 of the Science of Motherhood. I am your host, Dr. Renee White. Thank you so much for joining me today. We have got an awesome guest today. Oh man. Ah, this is like. This topic is something that continues to fascinate me on the daily.

[00:00:52] Like anything in this area, I am all over it, like white on rice. I'll tell you what I, for all those playing at home, I wrote about this particular topic in the book "Life After Birth", which is authored by none other than Jessica Prescott and Vaughne Geary. It is about the changes in a woman's brain when she becomes pregnant and also throughout, uh, her postpartum as well.

[00:01:27] And at the end of last year, a new Nature neuroscience paper was published. Uh, it was called "Neuroanatomical Changes Observed Over the Course of a Human Pregnancy". Again, for all those playing at home, Nature is one of the best journals you can be published in. Um, it's like cream of the crop, so the science is excellent.

[00:01:58] The primary author was Laura Pritchett and the senior author was Emily Jacobs. And it was sensational. It was essentially about mapping a woman's brain pre, pre pregnancy, during pregnancy and postpartum. This type of longitudinal study has never been done before in such a, I guess, close time points. And you'll hear from the guest today, Dr. Magdalena Martínez García about why this was so significant. They were able to, elucidate certain changes in the brain that we had previously not known about. So absolutely fascinating. And I think you know, the reason why I'm so interested in this area is because I think for a lot of women, including myself, I had, I had real kind of out of body experiences as, as someone who was pregnant, but mostly, um, early postpartum days. And I know that sleep deprivation caused a lot of that, but I just, I remember having this real shift in self identity and I'm a visual person. That's how I learn. And so, you know, when you don't have that visualisation of like, what is actually happening?

[00:03:33] And I had no idea at the time, that, you know, that these changes occur in a woman's brain, you know, to have that kind of knowledge and to know that there was a physiological, a physical reason as to why I was feeling the way I did would have been amazing. Like it just would have really normalised the entire process for me.

[00:04:00] And I still talk to people these days who are, you know, newly pregnant or even just had babies. And I talked to them and say, have you had, have you heard about matrescence? And they just look at me like a deer in the headlights. And your matrescence is that, I guess the term for the transition from maiden to mother and matrescence encapsulates like so many different emotional, hormonal, physiological changes that we go through.

[00:04:28] And so in today's episode, Dr. Magdalena Martínez García talks us through this latest research. She is a postdoctoral researcher in human neuroscience. Uh, she completed her PhD. In Madrid, Spain with the very well known Dr. Susana Carmona, and as a neuroscientist, Magdalena, she specialises in the impact of hormonal transitions on the structure and functioning of women's brains.

[00:04:59] And this is what you see in this paper, because they actually mapped the brain changes alongside blood testing. So for hormone, you know, transitions, which again, absolutely fascinating. Like my nerd brain is just exploding now thinking about it. She then applies all of her research to neuroimaging techniques, biofluid analysis, longitudinal designs, and then that enables her to characterise brain remodeling and neuroplasticity in women's brains during pregnancy, childbirth, and the postpartum period.

[00:05:36] She's currently a postdoctoral fellow in the Jacobs Lab, which is in the U.S., in California. And I cannot wait for you to listen to this episode. It is so good. I absolutely loved it. Anything to do with looking at neuroplasticity and changes in the brain, I'm all in. So I hope you enjoy this episode. Here is Dr. Magdalena Martinez Garcia. Hello and welcome to the podcast, Dr. Magdalena Martínez García. How are you today?

[00:06:13] Dr. Magdalena Martínez García: Hello, uh, Renee. Um, I'm good. I'm here in California. I'm ready for the interview.

[00:06:19] Dr Renee White: Lovely, lovely. Thank you so much for joining us today. Um, as I said offline, this is an area of much discussion and lots and lots of interest in our field.

[00:06:32] Um, In women's health. I'm not sure what it's like, um on the other side of the globe, but here in Australia, it's something that we talk about a lot. In today's episode. We are going to be talking about the latest research on the neuroplasticity of a woman's brain. And I think the The Nature paper that really prompted this article was the latest one, um, that was published in September where we had previously known like certain time points in pregnancy and postpartum, but this was the first time that a group had actually done a very kind of beautiful longitudinal study where they were testing every two weeks with scans and blood tests.

[00:07:20] Now we are gonna dive into that research in just a minute, but for all the listeners, would you just like to introduce who you are, what you are doing in your current studies? And also something that I always ask our scientists on the podcast is, how did you get into this field? And why did you become a scientist?

[00:07:41] Dr. Magdalena Martínez García: Okay. So, uh, my name is Magdalena Martínez García. I'm originally from Spain, but currently I'm doing a postdoc in, uh, UC Santa Barbara, in California. Uh, I'm a neuroscientist, um, and I've specialised in what I call the neuroscience of human pregnancy. So how the brain of a woman, uh, adapts during pregnancy and postpartum and I've been doing that through longitudinal studies.

[00:08:14] I feel like that's my expertise during the past seven years, including my PhD and together with my previous supervisor, Dr. Susana Carmona, maybe you've heard of her. She was really one of the first ones to launch in this field and in her lab, we launched and conducted different longitudinal cohort studies with first time mothers and we, we scan them before pregnancy. During pregnancy and then in the postpartum, as you say, um, when we started a few years ago, we prioritised the scanning women at key points during the maternal transition, we try to capture, you know, like, critical points that we hypothesised were essential to capture the specificity of the maternal brain.

[00:09:15] Um, but we prioritised, um, getting like higher cohorts, uh, over having temporal resolution.

[00:09:25] Dr Renee White: Yeah.

[00:09:26] Dr. Magdalena Martínez García: So, um, it took us like five years, um, we ended up having two different cohorts of first time mothers. The first cohort we scanned them at late pregnancy and during the early postpartum. So it was really like assume in the prepartum period to see if we could detect changes in the structure of a woman's brain before childbirth.

[00:09:56] And we did, and then we saw that these changes partially reversed in the postpartum. So that was kind of like the first cohort that we had as a group, I must say that in 2017, the first article, the one that really launched the field was published in nature neuroscience. And I was not part of the, of Susanna's lab at that point, but it was kind of like the paper that, uh, made Susanna realise, uh, she, she wanted to like, um, create this lab and, um, really like, um, undergo this research, and then I started working with her. But before that, in 2017, she published this paper where they, um, they scanned first time mothers again before pregnancy. So at preconception and then in the postpartum period. And that was the first study. So no pregnancy scans, but it was like before and after pregnancy.

[00:10:55] And that was the first study that demonstrated the pregnancy, entails this, uh, really pronounced, uh, gray matter changes. Let me know if you need like clarification.

[00:11:08] Dr Renee White: Yeah. I mean, we, we hear about the gray matter changes and it's funny because people synonymously hear, gray matter and your brain shrinks during pregnancy and you hear people talk about, Oh, baby brain and fogginess and things like that. So when, when we hear about gray matter shrinking, what is actually going on there? Why do we know why it's shrinking?

[00:11:35] Dr. Magdalena Martínez García: Um, I don't think we know quite sure why it's, um, shrinking or why the gray matter is decreasing. As I was explaining in this first article, they observed really pronounced gray matter, uh, decreases.

[00:11:52] It was not a widespread phenomenon, meaning that, uh, these gray matter reductions were more pronounced in specific regions of the brain, uh, namely the regions that are involved in, in. social cognition and the theory of mind and all this like cognitive empathy that is hypothesised to kind of like help mothers to attune with their babies.

[00:12:21] But having said that, with a human neuroimaging study, it's really difficult to understand the biological meaning or the functionality of a structural change. We are still like five years later, we are still trying to understand what this reduction means. We know, we have some hints. Um, we, we do know that these gray matter reduction does not seem to be associated with cognitive changes.

[00:12:51] So you mentioned that, um, you know, there's, I think there's a whole debate in the public around what's known as mummy brain and, um, just mothers having these like cognitive, um, environment during pregnancy. Um, that literature is being kind of debunked right now. It's the literature say that there is like a slight declining cognition during pregnancy, but it doesn't affect the, you know, the daily, functioning.

[00:13:27] So yeah, we can talk about that later if you want, but we haven't found any association between the structural changes and commission. Yes, we're we're also trying to refine the cognitive measures that we include in our studies. So they are more valid for mothers, so for instance, instead of like making them, uh, complete like a standard cognitive questionnaire, maybe we should start considering doing maybe virtual reality with settings that are more, uh, like relatable to a maternal environment.

[00:14:06] Yeah, for instance. Yeah. Like. Um, uh, some memory test that involves, uh, things that have to do with just being a parent, right? So, yeah, we are, we are there trying to refine that. Um, what else could I say in terms of functioning? So we did find an association and we found this association a couple of times, meaning in different cohorts, independent cohorts.

[00:14:36] Between these decreases in brain matter and then things like maternal attachment. So we found that the more the decreasing brain matter before and after pregnancy, the higher the early postpartum attachment that the mother feels for, for the baby. So, so these kinds of associations kind of like suggest that this might be like an adaptive structural change.

[00:15:03] Not to say that this structural change is preparing someone's brain to be a parent, because I think that being a parent, this is like a learning process, but I'm talking more about maternal behavior and that like maternal bonding between the mother and the baby, um, which in the animal literature in rodents, Um, there's a lot of papers and literature showing how the pregnancy hormones, um, activate these maternal behavior circuit so that the mum after the childbirth displays these, um, these immediate maternal behavior.

[00:15:44] So the bub can survive. So yeah, that's one of the hypotheses we have right now is tricky because every time we say this, it gets tricked in the media.

[00:15:56] Dr Renee White: Yeah,

[00:15:57] Dr. Magdalena Martínez García: We are trying to be super careful in how to frame our findings because we've been misinterpreted again and again by the media. We are not saying or suggesting that mothers have this advantage to be parents or to parenting or be a caregiver. Um,

[00:16:19] Dr Renee White: Yeah,

[00:16:20] Dr. Magdalena Martínez García: Our studies actually do not measure parenting variables. Um, we only measure neuroimaging metrics and then some questionnaires that indicate how, you know, how like attached you feel to your baby or like how much anxiety you have surrounding motherhood of things like this, but we haven't Yeah, we have no evidence supporting that these changes have to do with the actual parental involvement.

[00:16:51] Dr Renee White: Yeah, absolutely. And, and, you know, you kind of see that we saw actually, I think it was last year or the year before we saw a study come out and the, it was a classic case of the media grabbing like a single sentence out of the publication and running with it and it was the case where I think she might have even been an Australian researcher.

[00:17:18] She had found a, a, uh, bio indicator of SIDS, uh, like a predisposition and the media went mad and was like, That's it, we've solved it. Like we know exactly what it is done, dusted, like stamped and approved. And it was really interesting because I contacted her to come on the podcast and she politely refused and just said, I have to actually stop giving oxygen to this because I'd never said that this was like the case.

[00:17:52] It was just, here's, here's something that we saw that was kind of cool. And yes, there seems to be some sort of like alignment with it. It's not X equals Y, which is what everyone was trying to like put out into the media. So I totally hear you. And I think the other thing that I like, I do say this a lot in our interviews.

[00:18:17] You know, when we're talking about science, as you said, like it's, you've been working on this for like years and years and years, we still don't know a hundred percent what this gray matter shrinkage means. It's a continual evolution and as scientists, when we answer one question, there's 10 more questions that come out of the research.

[00:18:40] So everyone just cool, cool your gates and just, um, you know, just appreciate what, what the researchers have just found out. Um, yeah. Okay.

[00:18:52] Dr. Magdalena Martínez García: I would also like to add that, um, I would ask the people to appreciate, um, the maternal transition and, and what's being a mother or being a parent is because I think that often we tend to focus on the negative aspect of, uh, you know, going through pregnancy and postpartum, uh, in terms of the psychological and cognitive changes you might have, or maybe you just focus on the outcome, like, Oh, you I don't know.

[00:19:24] She forgot, uh, her kids or whatever, but we are not appreciating the massive metamorphosis that that woman is going through that is making her reprioritise everything. And it's like multitask, multi planning, you have some, something growing inside. Um, it's mentally challenging and also metabolically challenging.

[00:19:49] So it's a huge effort. And I, I always like to frame it like that as I'm more, you know, it's. Yeah. It's a challenge, uh, with a pro and the cons, but it's a challenge.

[00:20:03] Dr Renee White: Yeah, absolutely. Absolutely. Okay. Well, we might, we might dive into actually, before we go into the, the, the research research, I'd love to know how, how did you get into this? Because I mean, for me, I have a personal kind of, you know, story behind how I got into research and why I kind of chased what I chased. But is there, do you have any kind of personal connection or what is it that drew you to this particular field?

[00:20:33] Dr. Magdalena Martínez García: To this particular field, it was pure chance.

[00:20:37] Dr Renee White: Yeah ok.

[00:20:37] Dr. Magdalena Martínez García: Um, and I'm so grateful. Um, it was not like, I don't know. I would, I would say it was not like, uh, I didn't pursue this. It was. I met Susanna when I was, uh, when I was trying to, um, get into my graduate program. And then, um, I have a bio, uh, biology background, but I also have a master in neuroscience. So, um, she was looking for someone with my profile. And yeah, she introduced me to this world and then it was, it was like love at first sight. But it was, I think because I've, I've always been very feminist and to be able to work with women and for women is really fulfilling for me. And then I've always been really curious as a person. So I think being a researcher it was very like natural to me because I'm like, I, one of the best things of my job is to be able to read all this, you know, new literature, like, there's nothing better that uh, reading this new article with, uh, um, with why you are drinking tea, you know, like learning, I think the process of learning new things.

[00:22:06] Dr Renee White: Yeah.

[00:22:06] Dr. Magdalena Martínez García: And at the same time being humble enough to know what, you know, and what you don't know, um, it's very refreshing. I like that so I think that's why I chose this career, but the specific topic of the maternal brain, it was, it was given to me and now I just, I cannot see myself researching any other thing. I've, I've right now I'm, I'm, I've like broadened a little bit more my research and I'm not just focused on pregnancy and the maternal brain. I'm working with, uh, Emily Jacobs here and, um, at UCSD and, uh, they their lab is, uh, I would say like female neurocriminology is not only female, but they have different studies and doing a studies covering the whole reproductive period from the menstrual cycle to menopause.

[00:23:04] So that's amazing. And that's what I wanted. I wanted to kind of like take a step back and be able to look at women's brain health from a more comprehensive perspective. And that's what I'm doing in my postdoc, but the mothers and pregnancy is always in my heart.

[00:23:26] Dr Renee White: That's really fascinating. I was talking to a nutritionist the other day on the podcast, and we were talking about perimenopause and menopause, which is also a very big hot topic at the moment. And I promise everyone, we will talk about the research in a minute, but this is from a personal perspective, because I would love to know, we were talking about, um, you know, the fact that there seems to be a bit of like brain fog and like, you know, that kind of feeling of change and things like that through perimenopause and menopause.

[00:23:57] And I wasn't aware I said at the time in the interview, I'm going to have to dive into PubMed and have a look. Do you, is there research that there are other neuroplastic kind of events with perimenopause or menopause? Is that something that has been investigated or is going to be investigated?

[00:24:17] Dr. Magdalena Martínez García: I think it's like people are right now researching that. Like,

[00:24:21] Dr Renee White: okay.

[00:24:22] Dr. Magdalena Martínez García: It's not my area of expertise, but I don't think there's like a big paper as we have.

[00:24:29] Dr Renee White: Yeah. There's not a, there's no solid paper yet.

[00:24:33] Dr. Magdalena Martínez García: No. I don't think so well, forgive me if someone is listening.

[00:24:37] Dr Renee White: Yeah. If anyone's listening, actually, please tell us.

[00:24:41] Dr. Magdalena Martínez García: Not that, not that I know, not that I know, but I do know that there are multiple researchers right now trying to characterise, uh, characterise the menopause transition from perimenopause to post menopause. Um, and also in the longterm, because there seems to be associations between, uh, the menopause transition and then the, the um, rate of occurrence of like later neurodegenerative diseases as, um, Alzheimer's disease.

[00:25:13] Dr Renee White: Right.

[00:25:14] Dr. Magdalena Martínez García: Yeah. So it's kind of like, we are seeing it, we are now seeing pregnancy and menopause as two key inflection points for our health for our long term health. Yeah. And there's, um, there's also some preliminary preliminary evidence that even like how many pregnancies that you've had, it's also like, uh, it affects your brain health in the long term. There's there's a paper and several papers suggesting that. So, I think that right now, all of us who are in the women's brain health sphere, we are so eager to collaborate and to try to do this, like, longitudinal studies, or maybe, I don't know, like, it would be a dream even to have, like, a longitudinal study from reproductive years to menopause, like following for decades.

[00:26:12]

[00:26:12] Dr Renee White: Can you imagine! That'll be like a mecca, just a mecca of data

[00:26:17] Dr. Magdalena Martínez García: I think, I think it's not a utopia. I think we can do it. Um, we've done it before with infants and adolescents. Um, the ABCD, uh, data set is following adolescence for a decade. So we could do it for women. Um, yeah, we are there. We are there trying to get there. Okay.

[00:26:38] Dr Renee White: I love that. So that would be so exciting. I'd be fascinated by that. Cause yeah, it just like my brain just logically thinks, okay, perimenopause and menopause is another huge kind of, as you say, inflection point in our women's health. There's a huge kind of hormonal event. To me, it stands to reason that there has to be some other neuroplasticity going on, but look to be continued. We'll, we'll find out about that. I'd love to continue. Yeah. And then you can come back on the show and we can talk about it. We would love to play the research.

[00:27:16] Let's talk about the recent paper. Um, who we had Laura Pritchett and Emily Jacobs who were kind of head heading that up, um, published in Nature Neuroscience in September. Let's dive into this. As we kind of alluded to, we had previously had studies where there was kind of single time points and we thought we knew what was going on and there was some, you know, beautiful data that came out of that. Can you explain to us what this particular study was and how it was different? And again, what did the research show? What were the unexpected things that happened?

[00:28:01] Dr. Magdalena Martínez García: Yeah. So before in the beginning, I was explaining you the cohorts that we, um, had. Uh, when we say cohort, we are referring to a longitudinal study where we follow, uh, in this case, women at different time points. So in my lab in Spain, we did have, uh, different studies, um, that followed first time mothers at critical time points. So, we followed them before pregnancy, then maybe during pregnancy once or twice, and then during the postpartum again, once or twice, and we even followed them up, up to six years postpartum.

[00:28:44] But, like, I would say, single time points that are kind of like, apart from each other. And with these articles, we really generated the evidence, the statistical with the statistical power. Um, there was, uh, neural, uh, remodeling, uh, really pronounced neural remodeling happening there that deserve to be characterised with precision imaging. Um, so this is when Laura Pritchett and Emily Jacobs came in and in 2021, we had the first call. I presented our, uh, studies. And they before doing this study, they've done other beautiful, uh, precision imaging studies of the menstrual cycle with and without contraceptives. I recommend everyone also to go to these papers.

[00:29:38] They are beautiful. Their love is really, um, expert on designing these. Then sampling they call they call them then sampling precision imaging studies, meaning that they select maybe just one participant or a few participants, and then they scan them multiple times. So even like with with a daily resolution with the menstrual cycle paper, it was daily resolution.

[00:30:09] They scanned that woman who was Laura, um, every day for a month. And in this case, for this article, they wanted to do, like, bi-monthly scams, which is also like incredible temporal resolution for gestation. So that's the uniqueness of this article is that they based on the, all the evidence that we had, they said like, okay, now that we know that there's something going on there, we're going to scan one woman first time mother, um, with really fine, uh, resolution.

[00:30:51] So we can capture all the, uh, nonlinear trajectories that are happening in different tissues in the brain. And they also included, um, blood draws so they could also see if these brain changes were in parallel with hormonal fluctuations, um it's the hormonal fluctuations. So that was an absolute honor for me to be an advisor of this paper.

[00:31:22] They did a great job. Laura is a rising star and yeah, very honored to be working with her right now in other projects.

[00:31:33] Dr Renee White: So what, because what was the major finding around that? Because my understanding was that there was something that previously they had never seen before because they weren't actually capturing around this specific time point.

[00:31:49] Um, so they, like they saw, you know, similar things that validated previous studies, you know, the gray matter shrinking and things like that, but there was something, there was a few other things that happened, which they hadn't previously seen, which they would have, uh, which previously they would have missed, right?

[00:32:05] Dr. Magdalena Martínez García: The thing is that, um, for those of you who are not familiar with neuroimaging and with magnetic resonance imaging, which is the technique that we use to capture brain structure changes or brain functional changes, you can include different sequences of this MRI to capture, let's say, different brain states. So I think one of the, you know, So one of the unique things of Laura's paper was also that they not only try to capture the gray matter, but they also try to capture what we call the white matter microstructure. So white matter is another brain tissue, and they included an additional sequence in the neuroimaging protocol to capture the changes in white matter.

[00:32:57] They also captured changes in, uh, in the CSF of the brain in the hippocampus, which is like, um, specific subcortical structure that has been involved in memory and cognition. Um, so what they found that was really novel was like different trajectories in all these different sequences. So for example, they did replicate the gray matter reduction and then partial recovery, but then they observed that with weight matter microstructure, the, the trajectory was like increases during the first trimester up to the second trimester and then slowly decreases.

[00:33:43] So this was really, a proof of concept paper to say that that proved that pregnancy entails really time sensitive trajectories in the brain and probably different things are happening on this at the same time. It's not just one single process because they captured different trajectories that peaked at different points. Some of them peaked the prepartum, some of them peaked a little bit earlier or a little bit before after. So that means that different biological processes are happening at the same time, and that had not been seen before the studies. The previous studies were really focused on this gray matter. also because it was like the first and really striking finding. So we followed up on that to really characterise what happened in that particular issue. Um,

[00:34:49] Dr Renee White: And is there any hypotheses around that change in white matter? Like, do we know what might be going on there?

[00:35:00] Dr. Magdalena Martínez García: I mean, I think that the finding on gray matter, gray matter and white matter together, Suggests a fine tuning of brain circuits, but we're still trying to really understand what's going on there. Like, uh, I don't think, uh, we are, uh, quite there yet to really understand, uh, what's going on in terms of, in terms of functionality, but yeah, the primary hypothesis, I think it's still that the maternal brain is fine tuning during pregnancy and during postpartum as well. Yeah.

[00:35:38] Dr Renee White: I think when I was reading the paper, one of the things that I loved about it was the fact that obviously the, as you say, this is kind of like a pilot study of, okay, we've done this with one person, but the data is fully open access. I love that. Um, and also in the discussion, I think, uh, they were talking about the fact that this is possibly a springboard for other researchers to look at, you know, changes in the brain that may be instrumental for things like postpartum depression and or anxiety. I'm not sure what the stats are currently in the United States or, you know, Spain from where you're from. But, um, here in Australia it's reported that one in five mothers experience that post postnatal depression. Um, I would argue that, that's probably outdated data from someone who works on the front line with mums. Um, I'd probably say it's closer to one in two, one in three, just based off your reading and research.

[00:36:50] Are there any indicators around the neuroplasticity and the changes that you're seeing in the brain that could be connected to that? And then, you know, do you perceive that this is something where we can utilise that for, I don't know, drug discovery or, you know, therapy, you know, psychological therapy and, and things like that?

[00:37:13] Dr. Magdalena Martínez García: So the current state of the literature in terms of brain change is linked to postnatal depression or prenatal depression. I wouldn't say it's a scars. It's not a scars. I think there's a good deal of papers, um, scanning with MRI mothers with and without depression, but I think that as of right now, there's like, one design that is really predominant in the literature that is cross sectional design, meaning like single time point during the postpartum scanning a group of women with and without, uh, prenatal depression. We have, uh, several reviews and meta analysis, um, summarising the findings of these papers. Um, but I feel like the future is in longitudinal designs. I mean, maybe it's because it's, uh, where I come from, but I do think that if we want to end up, uh, doing, uh, drug discovery if we want to discover, uh, risks, uh, for postnatal depression that can be detected during pregnancy or even before pregnancy.

[00:38:31] I think that it's crucial for, for us to develop these longitudinal databases, which are, which we are continuing to do both in California, both in Spain, and hopefully in more sites around the world. So we get to have, uh, high enough sample size, doing now some like design to, um, have like a fair amount of, uh, women with prenatal depression because that's the key part of longitudinal designs that if you are following women when they have not, uh, they have not developed the disease.

[00:39:11] Um, it's kind of like a lot. We do know that it's one in five, but, um, when you do cohort studies, sometimes just, uh, because you are just selecting a sample from the population, you do not get those stats. So it's kind of difficult, so what we are, what I think is needed right now and we are also trying to, um, lead efforts on that front. Is to be large scale databases to collaborate between researchers that are collecting data and try to build something bigger where we can find rare outcomes where it's, uh, it's not rare, but you know what I mean?

[00:39:52] Dr Renee White: Yeah.

[00:39:52] Dr. Magdalena Martínez García: Like prenatal depression. Uh, but, yeah, I do think that it's really like, our cohorts, the ones that, uh, Emily is leading to all these longitudinal studies that we are conducting they have multiple benefits. We can use them to test our specific hypotheses, but then we can, we can put them open access, um, so that researchers can use them to, you know, test many other hypotheses. And I think one of the main values is to be able to, to build, um, predictive models with these  longitudinal studies. So the more we are interested in this, the better we need analysts, we need stats people to be looking at this. So yeah, I think it's really valuable too.

[00:40:47] Dr Renee White: Yeah, that's, that's good to know that we're kind of like, we're, we are going in that direction. But yeah, I, I, I agree. Predictive models is, is probably what we want. Hmm. Just going to shift gears now. We, I'd love to talk to you about your paper that you published at the start of this year in January, another Nature paper, which for all those playing at home, for people who don't know, Nature papers are a huge deal. Like it is such an amazing achievement. So first of all, congratulations.

[00:41:22] That's a huge, I think, career milestone and, um, It's just amazing. So your paper was looking at the neuroplasticity during gestation, childbirth and postpartum and you were focusing on, um, if there was any difference between a c section versus vaginal birth. I would love for you to talk the listeners through what did that research look like and then what did you find?

[00:41:55] Dr. Magdalena Martínez García: Okay. So to put everyone in context, before we were talking about this, uh, paper that was a dense sampling study of one participant, but then the paper I'm going to talk about that we published, uh, a few months before, uh, it's also a longitudinal study, but we had two time points and the really good thing about this paper was that we achieved a sample size of 110 mothers, which was yeah, really a challenge. But, um, I feel like in Spain we have community like engagement. Yeah, from social media and, and everything. So we could achieve this, um, sample size. So we scan first time mothers, at late pregnancy and then early postpartum, and we, uh, split them, um, depending on the type of childbirth they had, but the trick that we did here is that our hypothesis was not to find differences between, uh, vaginal childbirth and C section. But it was more about labor. We hypothesised that if a woman, uh, goes into labor, uh, like regardless of that childbirth, ended up ending up in C section, you know, if you experience, uh, at least the 1st part of labor, you would experience also different brain changes because our hypothesis was that labor is kind of like the last stage of the pregnancy neuroplasticity

[00:43:40] Dr Renee White: right

[00:43:41] Dr. Magdalena Martínez García: before, before starting to reverse during the postpartum. So we, we thought that labor was that like, like, um, the, the deep point, right. Or the, the inflection point of the trajectory. So yeah, we found, we found differences in, in the brain matter changes between mothers that had scheduled C sections. And all the rest of the mothers who have either vaginal childbirth or an emergency section, but with the first part being labor.

[00:44:18] Dr Renee White: Did you look at, sorry, did you look at if a, if a woman had been induced or not, or was it spontaneous?

[00:44:27] Dr. Magdalena Martínez García: Very good question.

[00:44:28] Dr Renee White: Yeah.

[00:44:30] Dr. Magdalena Martínez García: We, now I'm not remembering if we did explore that and we didn't find anything or maybe we didn't capture induction. Well, I think I'm not quite sure. I think it's the second option. I think. We realised how important it was to ask properly about induction, like after, um, so right now we are incorporating for information about induction because we do know that, um, it makes a difference, right?

[00:45:00] Dr Renee White: Yeah,

[00:45:00] Dr. Magdalena Martínez García: I mean, these are not being used and also the rates of C section change if you are induced or not. So, yeah, probably that's, uh, like, uh, another variable to take into account in this like neuroplasticity model, whether you have been induced or not. But in this particular paper, we just focused on the kind of like the outcome variable. But the only thing is, i, I must say that the schedule C section group was just 11 mothers.

[00:45:34] It's just a very rare outcome. So we did find significant differences, but we are now trying to see if they replicate with other cohorts. We still don't want to make like really strong conclusions on that finding. But I mean, from a biological perspective, it makes sense.

[00:45:54] Dr Renee White: Yeah.

[00:45:55] Dr. Magdalena Martínez García: Um, It's not the same going through a labor and not going through a labor, but yeah, we still need more, more data, more evidence to kind of like agree on that.

[00:46:05] Dr Renee White: And so what were, what were the actual change, like the differences? So it was the gray matter again.

[00:46:11] Dr. Magdalena Martínez García: So, uh, in general, what we found from late pregnancy to early postpartum was, so we found that in late pregnancy, gray matter change was reduced, right. Like that, that was coherent with our previous findings.

[00:46:27] And then we saw like an increase from late pregnancy to early postpartum. And what we saw is that this increase, was higher in the schedule C section, uh, group compared to the labor group.

[00:46:44] Dr Renee White: Right.

[00:46:45] Dr. Magdalena Martínez García: So, we still need to, we still need to figure out if that's because the schedule C section is kind of like recovering, uh, at a, at a faster rate.

[00:46:59] Dr Renee White: Yeah,

[00:47:00] Dr. Magdalena Martínez García: Or our primary hypothesis, which is that, the schedule C section does not go so low as the labor ones during pregnancy.

[00:47:15] Dr Renee White: Yeah. Yeah.

[00:47:16] Dr. Magdalena Martínez García: Um, so right now with, with these, um, studies, these things happening studies of Emily Jacobs and some others that we are also undergoing um, we might be able to see to test that hypothesis. So, like, is it like, uh, faster recovery or is it that labor really makes you go lower.

[00:47:44] Dr Renee White: Okay, that's going to be very interesting. Very interesting. We are going to jump into our rapid fire now, um, was there anything else that actually before we do that? So we've kind of touched on a few things that you're starting to explore as well. Was there anything else that you wanted to give us a little, um, sneak peek of what's on the horizon for the lab?

[00:48:07] Dr. Magdalena Martínez García: Um, I think my main thing right now is establishing international collaborations. I'm really interested in, uh, not working just for a single lab and a single cohort, but being able to connect with different researchers decide on a harmonised protocol and then collect data so that, maybe in five years, we can combine that data and we can start exploring things that we just can't right now, such as postpartum depression or, for instance, things related to the different parental leave policies that the countries have or just other cultural differences that we haven't been able to capture in any of these papers just because they are, you know, from a single, Um, like city or culture.

[00:49:04] Dr Renee White: Yeah.

[00:49:05] Dr. Magdalena Martínez García: Um, so that would be the sneak peek of what I'm like, what my horizon looks like. I think that's my main goal to create large scale databases. Um, and we are trying to do that with the, um, Bowers women's brain health initiative led by, um, Emily Jacobs and also with, um, the Enigma Neuroendocrinology working group. Yeah.

[00:49:29] Dr Renee White: That's, that's amazing.

[00:49:31] Dr. Magdalena Martínez García: Of course, we are working on different, um, I'm sure that the listeners may be wondering about like, what about adoptive parents? What about second pregnancies? What about like those are all, um, uh, questions that we, we are also intrigued about, and we are also working on that.

[00:49:52] Dr Renee White: I love that. Cause yeah, my understanding is that, um, in each and every pregnancy that you still get that beautiful remodeling of your brain. It's not just first time mums and then that's it, right?

[00:50:09] Dr. Magdalena Martínez García: We still don't know because all the research has been done with first time mothers. Yeah. Yeah. We, we are now follow following up these mums to see what happens during second pregnancies. Um, but we still don't know.

[00:50:23] Dr Renee White: Okay. Another to be continued. I love that. Okay. Let's jump into our rapid fire. What is your top tip for mums? And you can come at it from like a neuro kind of angle if you want to,

[00:50:39] Dr. Magdalena Martínez García: I, I think my recommendation is, and this is from my personal experience with people from my community, my friends, my family is talk about your childbirth and find that person that you can trust too. And immediately after childbirth, call that person to tell everything that happened and how you felt about it. Um, and how, like the good parts, the bad parts, it's like tell the story to someone. So your brain remembers. I think that it's very important to process childbirth. Sometimes I feel like I'm not a mother, but I've worked with mothers. I think sometimes it happens so fast that you don't have time to process it. So talking about it, it's just. a way to kind of like process what happened. And I feel like it's a way to minimise the negative, you know, psychological outcomes you could have from a traumatic experience.

[00:51:48] Dr Renee White: Yeah.

[00:51:48] Dr. Magdalena Martínez García: So yeah, that would be my,

[00:51:50] Dr Renee White: That's a great tip. That's a great tip. Um, yeah, we highly encourage, I always say that to the mums that I work with good, bad, or ugly, talk about your childbirth. It's nice to process that as well. Do you have like a go to resource? Like you, you know, as you said, you've been working with mums and things like that. Is there anything that you found along the way that, you know, is helpful for mums, whether it be a book, a workshop, you know, some people have offered poetry or, you know, even a quote or anything like that. Is there anything that you've seen that kind of stands out for you?

[00:52:28] Dr. Magdalena Martínez García: I mean, I can talk about several books that are, have been published in, in my field. I know there's an Australian author, Sarah McKay that published, um, a book, uh, that summarises all the literature. I think that she's done a wonderful job with her book. She interviewed us, um, so if you want to know more about this research in a like non experts way, um, go to her book. And then for those of you who speak Spanish, um, Susana Carmona just published another book summarising particularly our, our research through these, I would say 10 years. Um, and also including, uh, some like findings from other researchers, but, um, her book is called Neuromaternal and right now it's in Spanish, but I think her idea is to maybe, uh, translate it.

[00:53:28] And I, that, that book, I think it's also like, she, she talks from a personal perspective. She's a mum of, uh, uh, eight year old daughter and yeah, everyone that has read it, um, has felt really emotional about it. Um, just because of the way that she combines her personal story and her research. So, yeah, I also recommend that one.

[00:53:55] Dr Renee White: But that makes me think of Lucy's book. I've forgotten her last name.

[00:53:59] Dr. Magdalena Martínez García: Yeah. Yeah. I haven't read it. I'm just trying to see if it's on my list. I mean, there are several books, uh, Lucy Jones, uh, Jodi Pawluski also published a book. I think it's called mummy brain. No, uh, Chelsea Conaboy, I think she also published another book on this. Um, so yeah, I, I feel like all these books, um, I really like them because the authors have interviewed the researchers and they are reflecting the study that all the research that we are doing. So

[00:54:46] Dr Renee White: Yeah. Yeah. Great suggestions. Last question that we always ask our guests and it's a bit a little bit left field and we borrow this one from Brene Brown. What do you keep on your bedside table?

[00:54:59] Dr. Magdalena Martínez García: Oh, what do I keep? Um, I think, just my phone

[00:55:06] Dr Renee White: Yeah. No, that's okay.

[00:55:08] Dr. Magdalena Martínez García: I'm not, I'm not, um, yeah, I don't, uh, read in, in the bed, um, when I'm in the bed, I'm just sleeping. Yeah. Okay. I think I just have my phone.

[00:55:21] Dr Renee White: Yeah. True. I love that. True researcher. It's like when I'm off and out, I'm out, I'm not reading anymore. Like research.

[00:55:29] Dr. Magdalena Martínez García: I'm off. But then when I wake up, I'm one of those persons that, first thing in the morning, I check my notifications.

[00:55:37] Dr Renee White: Your PubMed notifications. Yep.

[00:55:40] Dr. Magdalena Martínez García: Not PubMed, but I check Slack. I check Gmail. I check like, I don't know. I like it. I just to prepare for the day. I just quickly check it. And then it's like, okay, I know more or less.

[00:55:55] Dr Renee White: Exactly. I'm the same.

[00:55:57] Dr. Magdalena Martínez García: Like, unexpected things are. Yeah. It's going to happen today. And then I'm more prepared. Yeah.

[00:56:03] Dr Renee White: Yeah. I'm the same. Cause I, I don't know about you, but I do all my really good thinking and great ideas in the shower. So I'm like, once I kind of have, I'm like, okay, I've got all the information. I have breakfast. I have a cup of tea and then I shower and then I process, it's like, how is the day going to happen? You know, how many fires do I need to put out today?

[00:56:27] Dr. Magdalena Martínez García: Yeah. And I'm the same. I'm the same. I think I need to check my phone first time in the morning, because then in these, in the next two hours, while I have breakfast and everything, I start to process everything, like what's, what's going to look like.

[00:56:42] Dr Renee White: Yeah, absolutely. Thank you so much for your time today. It's been extremely interesting. These papers, I think as we've discussed, they are great like springboards for what is about to happen next, I think. And it's a truly exciting research area. I hope that this, you know, area of research continues to get funding.

[00:57:06] I know we always kind of whinge, particularly here in Australia, that women's health research does not get enough funding, but I think we're kind of slowly, slowly, you know, chipping away at that. But this is really, truly exciting stuff and I can't wait to see what you do personally. And as well as the lab in the next, you know, five to 10 years, it's going to be really exciting.

[00:57:29] Dr. Magdalena Martínez García: Yeah. Yeah. No, the funding thing is, uh, we're always struggling, but I think that right now we're gaining momentum.

[00:57:36] Dr Renee White: Yeah.

[00:57:37] Dr. Magdalena Martínez García: And yeah, I'm, I'm honored to kind of like elevate the mothers and the maternal brain research to, you know, nature's and nature neuroscience. It's, it's a, for us, it's a way to dignify motherhood. So yeah.

[00:57:54] Dr Renee White: I love that. That's really beautiful. Okay then we'll thank you so much for your time and to the listeners, we will see you next week. Bye.

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[00:58:19] You've just listened to another episode of the Science of Motherhood proudly presented by Fill Your Cup, Australia's first doula village. Head to our website, ifillyourcup.com to learn more about our birth and postpartum doula offerings, where every mother, we pledge to be the steady hand that guides you back to yourself. Ensuring you feel nurtured, informed, and empowered so you can fully embrace the joy of motherhood with confidence. Until next time, bye.