In the last decade in the U.S., the highest rates of postpartum depression were among racial and ethnic minority women.
Prof. Sandraluz Lara-Cinisomo, center, worked with fellow researchers Melany Romero, left, and Sudhamshi Beeram on a study investigating links between postpartum depression and pain during and after childbirth in racial/ethnic minority women.
(Photo by Fred Zwicky / University of Illinois Urbana-Champaign)
A woman’s risk of developing postpartum depression is influenced by several pain-related factors before and after childbirth, including poor pain management, their prenatal mental health and the quality of patient-provider communication, researchers at the College of Applied Health Sciences at the University of Illinois Urbana-Champaign say.
Health and Kinesiology Associate Professor Sandraluz Lara-Cinisomo and her co-authors, graduate students Sudhamshi Beeram and Melany E. Romero, spoke to the Illinois News Bureau’s Sharita Forrest to share the findings of their analysis of postpartum literature: they identified seven interrelated risk factors of postpartum depression in racial and ethnic minority women.
Postpartum depression linked to heightened pain perception in mothers’ brains
Sandraluz Lara-Cinisomo
Bringing a new baby into the world is often described as joyful, overwhelming, and exhausting all at once. But what’s less often talked about is how the postpartum body—and brain—handle pain, especially for mothers dealing with postpartum depression.
A team of researchers led by Sandraluz Lara-Cinisomo, an associate professor in the Department of Health and Kinesiology at Illinois, recently took a bold step to explore that question. Their study, published in Psychiatry Research: Neuroimaging, asked: Can we measure how new moms’ brains respond to pain using fMRI ? And would moms even be willing to do it?
It turns out the answer is yes.
The study focused on 13 women, 11 without depression and 2 with postpartum depression. The point was to see if the idea would work: Would new moms come into a lab, be willing to experience a controlled pain test while researchers measured their brain activity?
The “pain test” was simple but effective: participants were exposed to a cold-pain device while in the scanner, enough to be uncomfortable but not unsafe. The experiment was repeated five times, during which the women reported how intense and how unpleasant the pain felt.
“Although there is growing interest in the postpartum brain, including in the context of depression, the focus on postpartum pain has stalled,” Lara-Cinisomo said. “Birthing people experience changes that are not often observable. fMRI offers an opportunity to measure their minds process pain while creating a space for them to tell us how it feels to be in pain. This study is the first step toward unveiling how postpartum depression affects pain perception.”
The researchers then compared those reports to what was happening in their brains.
For the women without depression, the scans showed activation in the places you’d expect:
The amygdala (linked to the assessment of pain intensity)
The insula (a key hub for processing physical sensations of pain)
The anterior cingulate cortex, or ACC (involved in emotional components of pain)
When the researchers compared women with depression to those without, they found higher brain responses in the depressed group. Still, those differences were not significant, likely due to the small sample size.
Where things got interesting was in how the women described their pain.
Even though the numbers didn’t hit statistical significance, there was a clear pattern: women with higher depression symptoms tended to find the pain more unpleasant and intense. The depressed group also tended to report the onset of pain earlier in the experiment than the non-depressed group.
So, what is the takeaway from this study?
First, it proved the concept. Postpartum women were willing to take part and found the process acceptable. That matters because there’s often concern about asking new moms to volunteer for time-consuming or physically demanding studies.
Second, it showed that fMRI can capture real brain activity linked to pain in this group. That opens the door to larger-sample studies that could dig deeper into how PPD changes the pain experience—and maybe test which treatments (such as therapy, medication or support programs) improve mood and pain.
The study also adds to the growing recognition that postpartum health is complex. It’s not just about healing physically or adjusting emotionally—it’s about how those two processes interact in ways that can shape daily life for mothers.
Lara-Cinisomo and her co-authors are clear about what’s next: larger studies, with more women experiencing postpartum depression, and identifying interventions to help alleviate their physical and psychological discomfort. That way, they can track how the brain responds to pain might shift as symptoms improve.
Mothers of Mexican descent living in southern California discussed the hardships they faced during the COVID-19 pandemic obtaining food, up-to-date medical information and health care with a team of researchers led by kinesiology and community health professor Sandraluz Lara-Cinisomo. (Photo by Brian L. Stauffer)
Public policies blocked many families of Mexican descent living in the U.S. from accessing vital services such as food and mental health care during the COVID-19 pandemic, even though these communities experienced some of the highest infection and mortality rates.
Thirty-eight perinatal women and mothers of young children were interviewed about the challenges they faced during the pandemic and proposed solutions to better meet the needs of their communities during future large-scale crises in a study led by KCH Associate Professor Sandraluz Lara-Cinisomo.
Co-authors of the study are molecular anthropologist Amy L. Non of the University of California-San Diego; Kimberly D-Anna-Hernandez, a professor of psychology at Marquette University; and U. of I. graduate student Mary Ellen Mendy and undergraduate students Jessica Avalos and Jacqueline Marquez.
The women in the study discussed the stressors they encountered during the pandemic, including their difficulties accessing mental health treatment, child care and food. Their suggestions and insights were used to identify actionable policies and programs that could help meet the needs of Latino communities during future emergencies.
The participants, who were interviewed between September 2021 and December 2022, were part of a longitudinal study that recruited them from a clinic in San Diego, one of the U.S. cities with large Latino populations of Mexican heritage.
The women were about 36 years old on average. Although about 81% of them were born in Mexico, many had resided in the U.S. for 17 years or more. About 31% reported having an annual household income of less than $21,000, while a similar percentage earned $40,000 or more, according to the study.
Lara-Cinisomo said participants faced complex stressors during the pandemic. Half of the women in the study said their families had challenges obtaining food due to loss of income and subsidies such as school lunches, as well as supply chain shortages and consumer stockpiling.
“While early in the pandemic various federal and state programs and policies were deployed to mitigate people’s risks for exposure and enhance families’ economic security, millions of tax-paying families of Mexican descent and other Latino backgrounds were excluded because of restrictions and exclusions set by those programs,” Lara-Cinisomo said.
The researchers found that more than twice as many Spanish speakers reported food-related issues compared with their English-speaking counterparts.
“Policymakers should consider how language barriers increase the risks of Spanish-speaking families losing out on benefits designed to meet their needs, such as CalFresh,” California’s iteration of the federal SNAP food assistance program for low-income people, Lara-Cinisomo said.
“Communicating food and health and safety information in linguistically appropriate media, such as texts, videos or commercials, is vital to ensure accessibility to people with differing literacy and technological skills and should be carefully considered by policymakers.”
Involving trusted sources in disseminating relevant and critical information was also recommended by the participants. For marginalized communities that have experienced historical discrimination and anti-immigrant propaganda, trust in these sources is vital, Lara-Cinisomo said.
“Research has shown that community engagement is critical in emergency preparedness and increases the likelihood of meeting the needs of marginalized communities,” Lara-Cinisomo said. Accordingly, she and her team recommended developing a contingency plan to train culturally and linguistically competent community health workers to cultivate networks of trusted community members to assist in crisis communication efforts.
Some women discussed feeling anxiety about the uncertainties associated with the pandemic, such as lockdowns and conflicting health information. These feelings were exacerbated by employment disruptions, pregnancy, and food access problems, and their concerns extended to family members residing in other households and those living in Mexico, participants told the researchers.
The majority of those interviewed advocated broadening access to food subsidy programs such as WIC and SNAP to offset income losses and food shortages during large-scale crises, along with providing public awareness campaigns about local food banks and assistance programs.
Even though California provides more services for undocumented immigrants—including paid family leave and one year of emergency coverage with mental health services under Medi-Cal, the state’s Medicaid plan, for pregnant women—caring for their mental health needs was a significant problem for many participants. Fifteen women reported needing mental health care, but twice as many of the English-speaking women mentioned these issues compared with their Spanish-speaking counterparts, the researchers found.
The researchers hypothesized that this difference may have been associated with cultural beliefs, with Spanish-speaking women feeling less comfortable disclosing mental health problems because of stigmatization compared with those who spoke English. Or, it may have been that those who spoke Spanish were more resilient or more concerned about immediate needs such as food assistance, the team said.
Participants recommended broadening access to mental health services for mothers and their families, promoting awareness with providers and patients, and disseminating mental health information and resources through videos and other media and via programs such as WIC.
Many of the women—largely those who spoke only Spanish—reported difficulties obtaining personal protective equipment and sanitization supplies because of shortages, consumer stockpiling, and price gouging, in keeping with other studies that showed low-income and marginalized communities were disproportionately affected.
Although the study sample was small, Lara-Cinisomo said it highlighted critical needs for responsive, culturally appropriate policies and programs to ensure the well-being of Mexican-descent perinatal women and mothers of young children during public health crises.
Lara-Cinisomo discussed the team’s findings and study participants’ recommendations during a virtual Briefing on Perinatal Health and Well-being on April 3 hosted by the journal Health Affairs, which published the study.
Authors Recommend Ways to Improve Latinas’ Perinatal Mental Health During COVID-19 Crisis. (Image provided)
Authors recommend culturally appropriate communication while providing anxiety resources
Experiencing anxiety during pregnancy is associated with pregnancy complications, and Latinas today face many stressors related to COVID-19 as well as pre-existing racism and intolerance. A new commentary from KCH Assistant Professor Sandraluz Lara-Cinisomo in Women’s Health Issues recommends ways for clinical practice, research, and policy to better support the mental health of pregnant and postpartum Latinas.
The commentary was published in Women’s Health Issues, the official journal of the Jacobs Institute of Women’s Health, which is based at the George Washington University Milken Institute School of Public Health.
Lara-Cinisomo and colleagues explain that high rates of COVID-19 cases and pandemic-related job losses in Latino communities can exacerbate the ongoing immigrant and minority-related stressors affecting perinatal Latinas. They note that research has found a relationship between immigration policies and anxiety in Latinas, and that some communities report fearing deportation more than COVID-19.
The authors’ recommendations for clinical practice include using culturally appropriate communication—both one-on-one and over social media—to provide information about anxiety symptoms and resources. To allow for research into the combined effects of psychosocial, cultural, sociopolitical, and socioeconomic stressors, they suggest that the National Institutes of Health and other funders direct grants to investigators who have records of working with Latino communities; they also highlight the importance of examining different subgroups of Latinas, rather than treating them as a monolith.
The commentary’s policy recommendations include suggestions for improving health care as well as stressors in the larger environment. Lara-Cinisomo and her colleagues urge policymakers to direct additional funding toward bilingual and diversity-trained professionals, and toward increasing access to telemedicine and language services. They also advise officials to improve workplace health and safety (noting that structural racism leaves both Black and Latino workers disproportionately likely to work in jobs with high risks of COVID-19 exposure), halt deportations, and reunite families separated at the U.S.-Mexico border.
“As the Biden-Harris administration begins implementing its policy priorities, we urge all elected officials to provide much-needed resources to clinicians working directly with perinatal Latinas, researchers working to understand the effects of the pandemic on these women, and the perinatal Latinas who are fighting to keep themselves and their families safe on all fronts,” the authors conclude. “Improving mental health for perinatal and postpartum Latinas has long been an important public health priority, and COVID-19 has made it even more pressing,” said Amita Vyas, Editor-in-Chief of Women’s Health Issues and associate professor of prevention and community health at Milken Institute SPH. “This commentary helps move the work forward by offering concrete recommendations for clinicians, researchers, funders, and elected officials.”
“Recommendations for clinical practice, research, and policy to address the effects of the COVID-19 pandemic on anxiety symptoms in immigrant and U.S.-born Latina mothers” has been published online as an article in press and will appear in a future issue of Women’s Health Issues.
