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Postpartum neuroendocrinology — MRCPsych Paper A MCQ

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ModerateNeuroimaging, neuroendocrinology and psychoneuroimmunologyPostpartum neuroendocrinologyMRCPsych Paper A

On the fourth day after an uncomplicated childbirth, a 32-year-old woman becomes tearful, emotionally labile and anxious, with difficulty sleeping even when given an opportunity to rest. She remains able to care for her baby and has no pervasive anhedonia, suicidal thoughts, delusions or hallucinations. Her symptoms resolve by the tenth postpartum day. Which neuroendocrine change most likely contributes to this presentation?

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Correct answer: E — Abrupt withdrawal of oestrogen, progesterone and neurosteroid signalling

Explanation lettering: B = shown as A · C = shown as B · A = shown as C

This is postpartum or maternity blues: transient emotional lability, anxiety and tearfulness beginning within days of delivery and resolving within two weeks, without marked functional impairment, a depressive syndrome or psychosis. **E is correct.** Delivery produces an abrupt fall in oestrogen and progesterone, including progesterone-derived neurosteroids, requiring rapid adaptation of neuroendocrine and GABAergic signalling. Sleep disruption and psychosocial factors may also contribute. Placental CRH falls rather than remaining persistently elevated (A), while prolactin normally rises with lactation but reduced tuberoinfundibular dopamine signalling is not the principal explanation (B). Oxytocin release generally increases during breastfeeding (C). The hypothalamic–pituitary–gonadal axis is suppressed rather than persistently activated in the early postpartum period (D).

Reference: Harris B et al. Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II. BMJ. 1994;308:949–953. https://pubmed.ncbi.nlm.nih.gov/8173402/