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Chief Rain, what do you want to do tonight? The same thing we do every night, Pinky. Try to take over the world. The Pinky and the Brain. Yes, Pinky and the Brain. One is a genius, the other's ins. You remember the little weird Warner Brothers cartoon Pinky and the Brain? I love that. I used to watch that with my kids. Brain, brain, brain, Brain. All right, so Pinky and the Brain. There were two little lab mice. One was a genius, the other was insane. Pinky and the Brain. Nothing to do with what we could talk about, except when I came up with the title Pregnancy and the Brain, my ever illustrious and always sophisticated producer Michael said, oh, pregnancy in the brain. Is it like Pinky in the Brain? And we both stared at each other, like, without any kind of word exchange because that was so stupid and brilliant at the same time. So, yes, not Pinky and the Brain, but Pregnancy and the Brain. Wait for it. Wait for it. Pregnancy and the Brain. Brain, Brain. Oh, my goodness. Do you see the kind of quality education and entertainment that you get from our show here? All right. Pinky and the Brain. Not a sponsor. Pregnancy in the Brain. Pinky in the Brain. Huh? Huh? Kind of catchy. Oh, my goodness. The whole reason that we're covering the pregnant brain and we've touched on this before, is because, yeah, there are absolute structural and functional changes that the brain goes through, both from an anatomical standpoint, neurochemistry, as well as hormonal neuroendocrine changes. That. It's true. However, let me say this right now. However, the headlines of things, and this was picked up on ACOG in the news today, their little communication blib that came out today. And as point of reference, we're recording this on February 24, 2026, although we're recording a little bit ahead of schedule, so it probably won't come out for a couple of days. But that came out on ACOGs in the news today on February 24, even though the publication actually came out on February 19, 2026 out of nature Communications. If you read like the headline, I don't know if this is purposeful. I'd hate to think that. But, but kind of the, the, the subversive move there towards the headline is like, oh, pregnancy is going to change your brain. Pregnancy changes your brain. It's pregnancy and the brain, brain, brain. And so if you just read that, you're like, I don't want my brain to change. I don't want my gray matter to reduce. I need all my gray matter. True, we all need our gray matter, some more than others. But here's the catch. We got to pump the brakes here for a minute because like in life, and as a good motto, things happen for a reason. And there's always good to something bad. There's always a silver lining right in every gray cloud. And here's what's interesting. Too much of a good thing can also be bad. So while there's definitely some good in this kind of gray cloud, I'm gonna give you that silver lining here in a minute. Too much good. In other words, too many pregnancies may actually have an adverse cognitive effect. There's a U shaped distribution here, I'm gonna explain that. But this whole issue of pregnancy changes your brain. And it's somehow the thought is that it's bad is not the case. Amazingly, amazingly, the body's adaptation to pregnancy for women is that the changes that are in neural channels and in volume and in connectivity, the brain is changing for one main reason. Bond with the child, adapt to the child. That is called maternal neuroplasticity. I didn't make that up. That is a thing. So that's one thing that gets missed in this because when you read things like, oh, second pregnancy changes the brain even more than the first, which is what the headline is, you got to pump the brakes there to go, why is it doing that? And is that necessarily bad? And it's a very complicated, very complex question because we can't just all say it's bad and it's not all good. It meets in the middle with this U shaped distribution. I'm going to explain that U shaped distribution in a bit. I have not only the main reference which we're going to do here, this is the Strathoff paper from Nature Communications that was released on February 19, 2026. The title is the Effects of a Second Pregnancy. Women's brain Structure and Function. We're going to do that, but we also have an Additional six different references, which we're going to cover. So we have eight references. Wait, what do I have? Seven. Eight. Eight references. Sorry. So an additional seven references that we're going. Thank you, Michael. That we're going to cover here in this very quick episode. Famous last words. We're going to try to do this quick. The point is, when somebody asks you, does pregnancy physically change your brain? Yeah, absolutely. There's no question. And we have covered that in the past. The deeper question is, is that something that we should be worried about? Is that something that potentially is really bad and that's the thing that gets overlooked? I don't want to minimize these changes. I mean, there are true physical changes and sometimes it kind of freaks people out. And also, as a little bit of bias, I'm just going to say it right now. You all know my stance on this. I am a natalist. I believe in the wonder, in the beauty, in the complex of pregnancy and childbirth, which I guess is good because I'm an obstetrician. But. But this is, this is really something that we got to put into perspective here. And I think that this is going to freak people out. If you just read the, you know, the first headline, you know, pregnancy changes your brain. And it's even more so after the second. Yes, it is, but there is a real reason for that, and it's not necessarily all bad. It's a fascinating subject. We're going to get to it right after this intro. Coming up next. This is Dr. Chapa's OBGYN clinical Pearls no Spin podcast podcast family. I'm happy to share information from one of our corporate sponsors, Perspective Medical. In a C section, every second counts, especially when managing postpartum hemorrhage. But traditional surgical draping often hides the very signs that we need to see concealed bleeding around or under the patient. Introducing the OB GYN physician designed Hemorrhage View C section drape. It's designed to provide clear and direct visualization of the patient to allow assessment of any concealed bleeding. Now, you can recognize hemorrhage earlier and monitor bleeding in real time without compromising the sterile field. Whether you're placing a uterine balloon or administering utero tonics or assisting in a second stage C section. You now have clear visualization. You need to act fast. So let's be proactive, not reactive, in the recognition and management of hemorrhage. Visit perspectivemedical.org to learn more about the HemorrhageView C section drape or to request a trial option. Yes, we've definitely covered this subject in the past. I think we actually have an episode called like Pregnancy Brain Fog. And it's very difficult to just boil that down to structural changes. Those are big. No question, those are big. But then there's a lot of other things that are social adaptations. Like you're just tired when you're pregnant, you can't sleep well, you kind of have some baseline anxiety about the, you know, baby's outcome. These are all things that go into play here that also affect concentration and mental recall and things of that type. All right. I mean, a lot of things, social stressors, sociodemographics. So it's not just the structural changes, although I'm not minimizing that. They are very important. And remember, we're going to highlight two U shaped associations. One has to do with structural things, the other has to do with number of pregnancies and overall cognitive function. All right, we're going to get into the two U's, two Utes, two U's here in just a minute. Okay. So without question, though. Yes. It's not a, it's not a theoretical issue or a debate. We know pregnancy induces some widespread and also some selective structural changes in the maternal brain, mainly in the, in the tone or the lane of reduced gray matter in regions that, that are, that are controlling social cognition, maternal behavior and the default mode network. We're going to talk about that in a minute. Okay. Because the one that takes away the default mode network, which is kind of your, your brain wandering, that actually is reduced. It's amazing. It actually rewires part of your brain to concentrate on the child. So I'm going to give you this in a minute. Not all the adaptations are bad. Some of these changes are good. Okay, so we're going to talk about these things now. As I just mentioned, there are two U shaped relationships. The first has to do with the structural changes. And think about a U. Okay, so the first arm of the U is pregnant this baseline. And then as pregnancy progresses from late second really into the third trimester, there's kind of a drop in gray matter. So it kind of dips down. The good news is it starts to come up months after delivery or postpartum. Right. So that's the first U. The second U shaped trajectory has to do with the sweet spot for the brain in terms of number of pregnancies. And I'm gonna get to that. I'll give you that data in a minute. But it seems to be that the brain actually modifies and Quote unquote, evolves, so to speak, and or improve to your mom brain 2.0 with one to four pregnancies. And there is data, again, it's tricky data, but there is data that grand multi parity 5 or more. The brain's like, hey man, you're killing me. It's too much. So there's the U shaped there. All right, so it kind of drops a little bit and then it increases back in terms of a negative association. So it drops the negative association between one to four pregnancies and then increases with a negative association over five deliveries. Okay, not that somebody who's listening to this has six children, like they're doomed. Not, not at all. These were just kind of trends that they found. But the sweet spot for the brain seems to be one to four in terms of cognition and, and, and positive adaptability. And I'm going to talk to you about that because we can prove these with epigenetic changes that favor younger brain with 1 through 4 and then favor kind of older brain, so to speak, with five or more deliveries. Okay, so two U shaped things. One has to do with structure within the pregnancy and postpartum interval itself and then the other has to do with function. But very quickly, here's what this study out of Nature Communications did and it's not over thousands of patients. This was AN N of 110 women overall. 110. 110. And this included patients who had no children. Right. So there were nulliparas, those were the control, those with their first pregnancy and then those who are on their second pregnancy. Right. So they call them PRG1, so pregnancy two or their PRG1 meaning first time pregnant. And what they did is looked at their brains. They did this with multimodal MRIs to see what is going on with gray matter, white matter, functional neuronal networks and see how things change. So it was nice because you had three different groups here. No kids had one kid or on their first kid and then had their second child. Okay, now remember the title of this is the effects of a second pregnancy on a woman's brain structure and functions. That's what they're trying to get at. We know what happens with one, what happens when there's more than one. Okay, so the short answer is yes, there's continued changes as expected with each subsequent pregnancy. Here's the only looked at number two. And it was mainly in the default mode center of the brain and the frontal parietal network. Now you're like, wait, I'm not a Neurologist or neurosurgery. And I forgot all that from gross anatomy. The default mode is kind of like your basic kind of mind wandering, daydreaming stuff that actually kind of regressed. The thought is that that's an adaptation to better concentrate on the child. What? Now the frontal parietal networks also changed a little bit. And it's scary to hear that the frontal parietal lobe maybe had some decreasing gray matter. However, there's other adaptations there that were found to be beneficial. Now here's the catch. Now that was overall, but specifically in the second pregnancy, there were stronger alterations within the dorsal attention and the somatomotor network. All to say is each pregnancy, guys, I don't want you to remember the parts of the brain just each pregnancy affects the brain a little differently. That's the take home. Without knowing about the somatomotor network center or the dorsal attention center, we're not going to get into all that. We can if you want to. It's really boring. And all to say the take home message is, wow. Each pregnancy seems to at least up to number two in this study based on multimodal mri, affect the brain a little differently. Okay? Now as the author stated, these changes are not simply repeated one to the next pregnancy, but they have different neural adaptations because now you got another kid. Isn't that amazing? The brain says, all right, we already remodeled once, now you're doing something else. You're doing this again. You're going to need more help. Let's remodel a different way. It's pretty darn fascinating. Now the truth is, what wigs people out is the idea of less gray matter, but less gray matter. Remember, it's not forever. It does come back. It's like bone mass. In pregnancy, bone mass tends to go down a little bit. That's why patients should take extra vitamin D and calcium and do weight bearing exercise. But the child is taking extra calcium sources from the mom. But that bounces back again. Okay, so that's not necessarily a bad thing. But here's the nice thing. This actually can be protective. Again, there's several data. One is out of Korea, another one is out of the UK that found that compared to nola, Paris women. Watch this, guys. Paris women showed less evidence of brain aging with quote unquote, younger looking brains up to a certain number. Okay, now remember we already said that that's up to about number four, but that was published in 2019 out of the National Academy of Sciences for the U.S. so again, all of the References we'll put in our reference page. There was also a study in 2022 from Remember, we use the Rotterdam criteria for PCOS, but there is a Rotterdam brain study in 2022 that also looked at, quote unquote, older women. And I'm not going to give you an age of what that is because I'm not taking that kind of heat. Just older women who were pregnant and found that parity was associated with larger global gray matter volume that actually persisted for decades. In other words, while it went down during pregnancy, with time, the gray matter actually increased. So it kind of bounced back in this, in a, in a recoup type of fashion. Okay, this was published in 2022 and the title was the Rotterdam Study. European Journal of Epidemiology is where it was came out. And it was long term association of pregnancy and maternal brain structure. So yes, it can change in the short term. The good news is, at least According to the 2022 Rotterdam study, which was out of the European Journal of Epidemiology, the long term association tends to recoup itself.