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I WAS disappointed at the publication and validation of the popular phrase “baby brain” in the 15 January 2018 edition of MJA InSight (“Baby brain”: it’s a thing). The term “baby brain” is used in both the original research article in the MJA, which was referenced by the MJA InSight article, and also in the accompanying podcast with co-author Associate Professor Linda Byrne.
The terminology is also popularly employed to isolate, discriminate and gaslight pregnant women within professional and social contexts (here, here, here, and here). As such, perhaps some more thought could have been applied before the term is presented as a “thing”.
The MJA article is a meta-analysis, which showed a decrease in cognitive function in pregnancy compared with non-stressed controls, but the results showed high heterogeneity, and cognitive function remained within normal range. The authors do rightly suggest a cautious interpretation of the results; however, this need for caution was noted in the discussion and not mentioned in the abstract, and thus may be missed by the casual reader.
Meanwhile, the MJA InSight article and podcast go on to suggest that “baby brain” is an actual syndrome and, in doing so, suggest that pregnant women are cognitively impaired. What’s next? Could this lead to us trying to validate that women “on the rag” really are unapproachable or women “going through the change” really do have a change in personality?
In the podcast, Associate Professor Byrne mentions some highly contentious research suggesting a correlation between decreased cognitive function in pregnancy and grey matter deficits. Bypassing the import of the complexity of the neuroendocrine network, this suggests that something is missing from the brain of a pregnant woman. “Grey matter differences” have been correlated with everything from maths ability to depression, gender, intensive physical training and playing Super Mario 64 (here, here, here, here, and here). The division between cat and dog lovers could probably be correlated to a grey matter difference. But despite the tempting and widespread conjecture in the literature, blaming grey matter differences for a psychological state is still akin to blaming a butterfly for a hurricane.
To me, contrary to the publicity around the MJA meta-analysis, the interpretation of its results is the opposite: although the meta-analysis found objective evidence of cognitive decline in pregnancy, they also noted that pregnant women are, in fact, still cognitively normal. Despite the 30–50% increase in cardiac output, the loss of lung volume, the respiratory alkalosis, the increase in blood volume, the chronic pain syndromes, the increase in axial load coupled with joint laxity, the sleep deprivation, the nausea and the emotional and psychological anticipation of delivery and motherhood, pregnant women have normal functional cognition. To me, these physiological demands seem enough to cause a cognitive impairment.
I agree that it is hard to imagine that the neural networks aren’t altered, as every other organ system in pregnancy, but why not translate the results of this meta-analysis positively, rather than ascribing pregnant women with more deficits? I think normal cognition under these physiological circumstances should be publicised like it’s a superpower.
Why does it matter? The validation by the medical literature of findings that suggest women are cognitively impaired in pregnancy could affect medical women in professional environments in a number of ways. It could affect our ability to continue working through pregnancy, and have an impact on our insurances, such as medical indemnity. It could affect our patients’ trust in our decision making.
We rely on the medical literature for some objectivity in this world of false news. Validating social stigmas with the stamp of medical objectivity is potentially very damaging. One need not look far to see how expert medical literature has been manipulated in popular culture to discriminate. The headlines following this research publication include “Pregnancy really does make women more forgetful” by The Sydney Morning Herald, The Age went with “Baby brain is real, Australian researchers find”, and, shockingly, The Advertiser published “Baby brain is real: pregnancy affects a woman’s memory and shrinks her brain”. Pregnant women are your local surgeons, GPs, pilots and political leaders. By publishing click bait such as “‘Baby brain’: it’s a thing”, MJA InSight is undermining the decisions made by these women, threatening our doctor–patient trust and opening the door for discrimination and loss of autonomy for pregnant women. Let’s not forget to highlight the fact that these women function normally.
Dr Cynthia Bierl is an intensive care staff specialist in Newcastle, NSW. Before medicine, she achieved an MSc from the London School of Hygiene and Tropical Medicine and worked as an epidemiologist in public health.
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Speaking from recent personal experience I did use the term “baby brain” to describe myself at times when I was forgetful or distracted (so as a deficit of function), however I would indeed be offended if someone else, from the medical profession or otherwise described me as such with the negative connotations Dr. Bierl addresses. There were also many, many more beautiful n positive experiences I had during my pregnancy which Im sure both contributed to or enhanced the heady cocktail of hormonal and other physiological changes. Thankyou Dr. Bierl for addressing the pervasive use of derogatory sexist language in what should be professional, objective, scientific reading.
I dont profess to have any expertise in this area but have been interested in the negative ( mainly female ) responses to this research. Pregnancy produces massive physiological changes so why is it hard to accept that the brain may be affected as well ? Lets respond scientifically, not turn it into another political gender/feminist cause.
Thanks for the article. There are all sorts of life experiences that could potentially be reflected in fMRI changes. We could look for Divorce Brain, Financial Strain Brain, Androgen Brain, Gambling addiction Diabetic Brain, Elderly White Male Brain, Cranky Older Woman Brain… the list is limitless. What really matters in work performance is whether the person is performing to an acceptable standard.
What’s interesting here is what would make someone look at a pregnant woman’s brain and not all the other cirucmstances.
Great response Cynthia. You have highlighted how the relentless quest for publicity and relevance by a medical journal PR team (and/or authors) often gets in the way of balanced reporting. We were all sucked in by the “click bait” headlines which should remain the property of the tabloids and not be used by scientific journals keen to expand their public profile.
Wonderful response, Cynthia
I think some of the comments above are missing the point.
This response really emphasises the importance of appropriate scientific language and the harms of overstating and sensationalising medical research. It does not deny that whole population-level gender differences may exist.
I expect more from a scientific publication, and am surprised that the reviewers/editors of MJA didn’t demand that the original article had an abstract and media release that were more balanced and representative of the actual data.
“Despite the demands of pregnancy, even changes shown on MRI, women are still cognitively normal and perform at their normal level.”
It’s not as exciting, but it’s a more accurate representation of the study results. #stopmisrepresentation #fakedrama #spindoctors
Cynthia,
I agree with your comments. We should jist stop publishing research showing that here are any gender differences. We should stop assuming that being male is a risk factor for heart disease (who would employ a male ready to drop dead of a heart attack). We should stop assuming that older women are higher risk for osteoporosis (so what you’re saying is they’re so frail they’re ready to fall apart!)
I am fed up with research that shows any difference between men and women. It’s all biased!
“Statistically normal” and “normal for me” are not the same thing, and the author conflates them. If someone is tired, stressed, hungry, sleep-deprived, a little tipsy or angry, their cognitive function will still probably be in the normal range. That does not mean that the person will be still have normal cognitive abilities for them. It does not mean that they will not need to take that into account in their work life.
This story is a little like someone saying “Oh, great, now women have to feel guilty if they smoke when they are pregnant”. Don’t like my straw man? Well, I don’t like the author’s
I had to come to Australia to hear the notion that women who are pregnant are somehow impaired. I have lived in three other continents, and have been intensively exposed to a variety of cultures and societies as a medical anthropologist, without ever having heard such negativity about pregnancy. The data in the original article were poorly analysed lacking context. Thank you to Dr. Bierl for placing some context to the state of pregnancy, both physiologically and socially. In the 60s, medical doctor Robert Wilson wrote a book called Feminine Forever in which he argued that menopause was a disease state needing redress through HRT if women were to avoid becoming like “living decay”. His broad stroke approach to menopause was erroneous medically (not every woman benefits from HRT and some can be harmed by it), but also had the effect of situating women as somehow defective in what is a natural life course event. Pathologising the female body is a passe nonsense and it saddens me to see such poorly thought out work published in the MJA. How about putting some medical anthropologists in your reviewer database?
Thanks Cynthia, great article and agree with your perspective. I had never heard the term “baby brain” until a few years ago. It wasn’t a “thing” when I and my friends were working and studying for our specialty exams or completing higher degrees while having children. We had other more pressing issues to worry about than our own normal (tired) cognitive function.
“The validation by the medical literature of findings that suggest women are cognitively impaired in pregnancy could affect medical women in professional environments in a number of ways”
Yes it may. Just like pregnancy may effect women who are professional sports-persons. Or women who are models. Or women who are surf lifesavers or Police officers.
So what. Just because the author doesn’t like it and is “dissapointed” why should we not acknowledge it?
watch jacinda arden in NZ-interesting to see what happens with NZ economy