Amniotic fluid ingestion enhances opioid-mediated but not nonopioid-mediated analgesia

Placentophagia and the Tao of POEF

Placentophagia, ingestion of placenta and amniotic fluid, usually during parturition, is a behavioral feature of nearly all nonaquatic, placental mammals, and is a nexus for several interlocking behavioral phenomena. Placentophagia has not been typical of human cultures, but in recent years, some women in affluent societies have engaged in it, thereby bringing publicity to the behavior. First, we summarized benefits of placentophagia for nonhuman mammals, which include increased attractiveness of neonates, enhanced onset of maternal behavior, suppression of pseudopregnancy, and enhancement of opioid hypoalgesia by Placental Opioid-Enhancing Factor (POEF), a benefit that may extend well outside the context of parturition. The research on POEF in animals was discussed in detail. Then we discussed placentophagia (placentophagy) in humans, and whether there is validity to the claims of various benefits reported primarily in the pro-placentophagy literature, and, although human afterbirth shows POEF activity, the POEF effect has not yet been tested in humans. Finally, we discussed the general possible implications, for the management of pain and addiction, of isolating and characterizing POEF.

Placentophagia in humans and nonhuman mammals: causes and consequences

Afterbirth ingestion by nonhuman mammalian mothers has a number of benefits: (1) increasing the interaction between the mother and infant; (2) potentiating pregnancy-mediated analgesia in the delivering mother; (3) potentiating maternal brain opioid circuits that facilitate the onset of caretaking behavior; and (4) suppressing postpartum pseudopregnancy. Childbirth is fraught with additional problems for which there are no practical nonhuman animal models: postpartum depression, failure to bond, hostility toward infants. Ingested afterbirth may contain components that ameliorate these problems, but the issue has not been tested empirically. The results of such studies, if positive, will be medically relevant. If negative, speculations and recommendations will persist, as it is not possible to prove the negative. A more challenging anthropological question is "why don't humans engage in placentophagia as a biological imperative?" Is it possible that there is more adaptive advantage in not doing so?

Effect of amniotic-fluid ingestion on vaginal-cervical-stimulation-induced Fos expression in female rats during estrus

Placental Opioid-Enhancing Factor (POEF) is a substance found in amniotic fluid (AF) that, when ingested, potentiates opioid-mediated, but not non-opioid-mediated, hypoalgesia. Vaginal-cervical stimulation (VCS) produces a stimulus-bound, partially opioid-mediated hypoalgesia that previous research has shown to be potentiated by AF ingestion. To understand the mechanism of opioid enhancement by POEF we investigated the pattern of neural activation after a bout of VCS that produced hypoalgesia, with and without co-administration of AF. Specifically, virgin Long-Evans rats showing vaginal estrus were handled briefly (control) or received VCS (75g pressure, 1 min), in a pattern that approximated early parturition rather than copulation, using a spring-loaded glass-rod probe. Rats were given an orogastric infusion (0.25 ml) of either AF or 0.9% saline resulting in four groups (VCS or handling; AF or saline). Rats were perfused 90 min after treatment and tissue was processed by immunohistochemistry for Fos. The number of Fos-immunoreactive cells was counted in structures previously shown to express Fos in response to VCS (the medial preoptic area, MPOA; the ventrolateral portion of the ventromedial hypothalamic nucleus, vlVMH; the arcuate nucleus, ARC). We found that this pattern of VCS did not produce a significant increase in Fos expression in the MPOA and vlVMH unless it was paired with AF. VCS produced a significant increase in Fos in the ARC. The interaction of AF and VCS on Fos expression in the MPOA suggests that POEF may enhance vaginal-cervical sensory input at parturition to facilitate sensitization of the MPOA, and presumably facilitate maternal-behavior onset.

Ingestion of amniotic fluid enhances the facilitative effect of VTA morphine on the onset of maternal behavior in virgin rats

Previous research has shown that injection of morphine into the ventral tegmental area (VTA) facilitates the onset of maternal behavior in virgin female rats, and injection of the opioid antagonist naltrexone into the VTA disrupts the onset of maternal behavior in parturient rats. Placentophagia -- ingestion of placenta and amniotic fluid, usually at parturition -- modifies central opioid processes. Ingestion of the active substance in placenta and amniotic fluid, Placental Opioid-Enhancing Factor (POEF), enhances the hypoalgesic effect of centrally administered morphine, and more specifically, enhances delta- and kappa-opioid-receptor-mediated hypoalgesia and attenuates mu-opioid-receptor-mediated hypoalgesia. POEF (in placenta or amniotic fluid) ingestion does not, by itself, produce hypoalgesia. In the present study, we tested the hypothesis that ingestion of amniotic fluid enhances the facilitative effect of opioid activity (unilateral morphine injection) in the VTA on the rate of onset of maternal behavior. Virgin female Long-Evans rats were given one intra-VTA injection of morphine sulfate (0.0, 0.01, or 0.03 microg, in saline) and an orogastric infusion of 0.25 ml amniotic fluid or saline once each day of the first three days of the 10-day testing period. Subjects were continuously exposed to foster pups that were replaced every 12 h; replacement of pups was followed by a 15-min observation period. Maternal behavior latency was determined by the first of two consecutive tests wherein the subject displayed pup retrieval, pup licking in the nest, and crouching over all foster pups, during the 15-min observation. We confirmed the previous finding that the VTA injection, alone, of 0.03 microg morphine shortened the latency to show maternal behavior and that 0.0 microg and 0.01 microg morphine did not. Ingestion of amniotic fluid (and therefore POEF) facilitated the onset of maternal behavior in rats receiving an intra-VTA microinjection of an otherwise subthreshold dose of morphine (0.01 microg).

Amniotic fluid can act as an appetitive unconditioned stimulus in preweanling rats

Studies in humans and animals indicate that exposure to flavors in the amniotic fluid during the later gestational period may induce preferences for those flavors. Considering that during the last prenatal period the amniotic fluid contains substances that activate the opioid system, and that this system plays a critical role in the acquisition of olfactory preferences early in life, it has been hypothesized that the amniotic fluid may acquire appetitive unconditioned properties during this period. This has been tested in an experiment in which preweanling rats were exposed to alcohol odor (CS) paired or unpaired with the intraoral infusion of amniotic fluid (US) collected on gestational day 20. The pairing of these two stimuli induced an enhanced palatability of alcohol's flavor as well an increased intake of the drug. These results support the idea that amniotic fluid acquires appetitive unconditioned properties during the last days of gestation and suggest that associative mechanisms involving the amniotic fluid could be underlying odor and taste preferences acquired through fetal exposure.

Placenta ingestion by rats enhances δ- and κ-opioid antinociception, but suppresses μ-opioid antinociception

Ingestion of placenta or amniotic fluid produces a dramatic enhancement of centrally mediated opioid antinociception in the rat. The present experiments investigated the role of each opioid receptor type (mu, delta, kappa) in the antinociception-modulating effects of Placental Opioid-Enhancing Factor (POEF-presumably the active substance). Antinociception was measured on a 52 degrees C hotplate in adult, female rats after they ingested placenta or control substance (1.0 g) and after they received an intracerebroventricular injection of a delta-specific ([D-Pen2,D-Pen5]enkephalin (DPDPE); 0, 30, 50, 62, or 70 nmol), mu-specific ([D-Ala2,N-MePhe4,Gly5-ol]enkephalin (DAMGO); 0, 0.21, 0.29, or 0.39 nmol), or kappa-specific (U-62066; spiradoline; 0, 100, 150, or 200 nmol) opioid receptor agonist. The results showed that ingestion of placenta potentiated delta- and kappa-opioid antinociception, but attenuated mu-opioid antinociception. This finding of POEF action as both opioid receptor-specific and complex provides an important basis for understanding the intrinsic pain-suppression mechanisms that are activated during parturition and modified by placentophagia, and important information for the possible use of POEF as an adjunct to opioids in pain management.

Ingested bovine amniotic fluid enhances morphine antinociception in rats

Ingestion by rats of rat placenta or amniotic fluid enhances opioid-mediated, or partly opioid-mediated, antinociception produced by morphine injection, vaginal or cervical stimulation, late pregnancy, and foot shock. This phenomenon is believed to be produced by a placental opioid-enhancing factor (POEF). Ingestion by rats of human or dolphin placenta has also been shown to enhance opioid antinociception, suggesting that POEF may be common to many mammalian species. We tested bovine amniotic fluid (BAF) for its capacity to enhance morphine antinociception in female Long-Evans rats, as determined by percentage change from baseline tail-flick latency in response to radiant heat, and we report that 0.50 mL BAF effectively enhanced morphine antinociception but did not by itself produce antinociception. The efficacy of POEF across species suggests that POEF may have been functionally (and structurally) conserved during evolution. Furthermore, the availability of POEF at parturition, as well as its ability to enhance pregnancy-mediated antinociception without disrupting maternal behavior, offers a tenable explanation for the long-debated ultimate causality of placentophagia.

Physiology of pain in labour

Labour pain is the result of many complex interactions. Although not fully determined, the pain arises from distension of the lower uterine segment and cervical dilatation. The neural mechanism of labour has some features similar to other forms of acute pain; nociceptive information is relayed in small A delta and C afferent fibres to the dorsal horn of the spinal cord, mediated by neurotransmitters; from there it may be involved in the initiation of segmental spinal reflexes or pass through the spinothalamic tract to the brain. Many factors are activated during labour which may modify the nociceptive impulse at different stages of its passage. Some of these factors act synergistically to promote anti-nociception that peaks at delivery.

The analgesia-enhancing component of ingested amniotic fluid does not affect nicotine-induced antinociception in naltrexone-treated rats

Ingestion of amniotic fluid and placenta by rats has been shown to enhance opioid-mediated antinociception but not affect the nonopioid-mediated antinociception produced by aspirin, suggesting specificity for opioid-mediated processes. However, enhancement by the active substance(s) in amniotic fluid and placenta (POEF, for placental opioid-enhancing factor) of antinociception produced by other nonopioid mechanisms has yet to be examined. The present experiments tested whether ingestion of amniotic fluid enhances the antinociception produced by nicotine injection. In Experiment 1A, enhancement of morphine-mediated antinociception by ingestion of amniotic fluid was demonstrated in a hot-plate assay. In Experiment 1B, rats pretreated with naltrexone were given an orogastric infusion of amniotic fluid or control (0.25 ml), then injected with nicotine (0, 0.075, 0.125, or 0.225 mg/kg subcutaneously), then tested for antinociception in a hot-plate assay. Amniotic fluid ingestion did not enhance the antinociception produced by various doses of nicotine. In Experiment 2, rats pretreated with naltrexone were given an orogastric infusion of amniotic fluid (0, 0.125, 0.25, or 0.50 ml) and then injected with 0.125 mg/kg nicotine. None of the doses of amniotic fluid enhanced the nicotine-induced antinociception. The findings of these experiments lend support to our contention that the enhancement by POEF of antinociception is specific to opioid-mediated processes.

Ingestion of amniotic fluid by postpartum rats enhances morphine antinociception without liability to maternal behavior

Ingestion of amniotic fluid or placenta by rats has been shown to enhance opioid-mediated analgesia induced by morphine injection, foot shock, vaginal/cervical stimulation, or late pregnancy. The present study was designed to determine whether this mechanism might be a means of providing greater analgesia during the periparturitional period without contributing to the disruption of maternal behavior (measured primarily as retrieval) that can result from excessive opioid levels. Postpartum primiparous rats, injected with either 2 or 3 mg/kg morphine sulfate or vehicle and given orogastric infusions of either amniotic fluid or saline, were tested for maternal behavior. Pain threshold (determined by tail-flick latency test) in rats injected with 2 mg/kg morphine and infused with amniotic fluid was elevated to a level that did not differ significantly from that of a separate group of rats injected with 3 mg/kg morphine and infused with saline. This enhanced analgesia was not, however, accompanied by the significant disruption of maternal behavior found among the rats receiving the higher morphine dose.

An adaptable microcomputer program for monitoring behavior

We describe an improvement of a flexible and easy to use program for monitoring and recording behavior durations with IBM-compatible microcomputers and a companion program that provides additional versatility for handling data. Up to 35 behaviors or events can be monitored, and processing speed is fast enough to measure even very rapidly performed behaviors. No specialized hardware is required, and the data files that are created are compatible with commercially available software packages for statistical analysis.

The formalin test: an evaluation of the method

The formalin test for nociception, which is predominantly used with rats and mice, involves moderate, continuous pain generated by injured tissue. In this way it differs from most traditional tests of nociception which rely upon brief stimuli of threshold intensity. In this article we describe the main features of the formalin test, including the characteristics of the stimulus and how changes in nociceptive behaviour may be measured and interpreted. The response to formalin shows an early and a late phase. The early phase seems to be caused predominantly by C-fibre activation due to the peripheral stimulus, while the late phase appears to be dependent on the combination of an inflammatory reaction in the peripheral tissue and functional changes in the dorsal horn of the spinal cord. These functional changes seem to be initiated by the C-fibre barrage during the early phase. In mice, the behavioural response in the late phase depends on the ambient temperature. We argue that the peripheral tissue temperature as well as other factors influencing the peripheral inflammation may affect the response, possibly confounding the results obtained with the test. Furthermore, we discuss the methods of recording the response and the value of observing more than one aspect of behaviour. Scoring of several behavioural variables provides a means of assessing motor or sensorimotor function as possible causes for changes in behaviour. In conclusion, the formalin test is a valuable addition to the battery of methods available to study nociception.

Gastric vagotomy blocks opioid analgesia enhancement produced by placenta ingestion

Ingestion of amniotic fluid or placenta by rats has been shown to enhance opioid-mediated analgesia induced by morphine injection, footshock, vaginal/cervical stimulation, or late pregnancy. This enhancement by ingestion appears to be specific to the central actions of opioids. The present study was designed to examine the possibility that information traveling via the vagus nerve might be involved in mediating this effect. Rats that had undergone either selective gastric vagotomy or sham vagotomy were injected with either morphine sulfate or vehicle and fed either placenta or a meat control. Enhancement was observed in rats that had undergone sham vagotomy but not in those that had undergone gastric vagotomy. These results support an interpretation of vagal involvement in the enhancement of opioid-mediated analgesia by placenta.

Placental opioid-enhancing factor (POEF): generalizability of effects

A substance in amniotic fluid and placenta (POEF for Placental Opioid-Enhancing Factor) has been shown to enhance opiate- or opioid-mediated analgesia in rats. Recent studies have only touched on the generalizability of the phenomenon. The present studies further tested the generalizability of the POEF effect: they examined sex specificity of the mechanism; whether POEF activity exists in afterbirth material of species other than the rat; whether POEF activity exists in tissue other than afterbirth material; whether POEF activity could be demonstrated after injection rather than ingestion of afterbirth material; and whether POEF enhances all opioid-mediated phenomena. We found that (a) POEF is effective in male rats as well as in female rats; (b) POEF activity exists in human and dolphin afterbirth material; (c) ingestion of pregnant-rat liver does not produce enhancement of opioid-mediated analgesia; (d) POEF does not seem to be effective when amniotic fluid is injected either IP or SC; and (e) POEF does not modify morphine-induced hyperthermia.

Enhancement of opioid-mediated analgesia: a solution to the enigma of placentophagia

Two major consequences of placentophagia, the ingestion of afterbirth materials that occurs usually during mammalian parturition, have been uncovered in the past several years. The first is that increased contact, associated with ingesting placenta and amniotic fluid from the surface of the young, causes an accelerated onset of maternal behavior toward those young. The second, which probably has importance for a broader range of mammalian taxa than the first, is that ingestion of afterbirth materials produces enhancement of ongoing opioid-mediated analgesia. The active substance in placenta and amniotic fluid has been named POEF, for Placental Opioid-Enhancing Factor. Recent research on both consequences is summarized, with particular attention to POEF, the generalizability of the enhancement phenomenon, its locus and mode of action, and its significance for new approaches to the management of pain and addiction.

Amniotic-fluid ingestion enhances the central analgesic effect of morphine

Amniotic fluid and placenta contain a substance (POEF) that when ingested enhances opioid-mediated analgesia produced by several agents (morphine injection, vaginal/cervical stimulation, late pregnancy, footshock), but not that produced by aspirin injection. The present series of experiments employed quaternary naltrexone, an opioid antagonist that does not readily cross the blood-brain barrier, in conjunction with either peripheral or central administration of morphine, to determine whether amniotic-fluid ingestion (and therefore POEF ingestion) enhances opioid-mediated analgesia by affecting the central and/or peripheral actions of morphine. The results suggest that POEF affects only the central analgesic effects of morphine.

An adaptable microcomputer program for recording behavior durations

A versatile and easy to use program is described for monitoring and recording behavior durations on IBM-compatible microcomputers. The program also records frequencies and provides latency information. Among its more prominent attributes are its ability to accommodate a broad range of behavioral assays and the facility with which its operation can be mastered. It requires no specialized hardware and is capable of being used in conjunction with a number of commercially available software packages for statistical analysis.

Amniotic-fluid ingestion by parturient rats enhances pregnancy-mediated analgesia

Amniotic fluid and placenta contain a substance (POEF, for Placental Opioid-Enhancing Factor) that, when ingested, enhances opioid-mediated analgesia in nonpregnant rats; ingestion of the substance by rats not experiencing opioid-mediated analgesia, however, does not produce analgesia. It is highly likely that periparturitional analgesia-enhancement is a significant benefit of ingestion of the afterbirth (placentophagia) during delivery. Here we report that prepartum ingestion of amniotic fluid (via orogastric infusion) does indeed enhance the endogenous-opioid-mediated analgesia evident at the end of pregnancy and during delivery; that the degree of enhancement is greater with 0.75 ml than with 0.25 ml; and that the prepartum enhancement of analgesia can be blocked with the opioid antagonist naloxone.