Using “baby brain” undermines decisions made by women

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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