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Palanisamy A, Toftlund SA, Giri T, Strandberg-Larsen K, Lønfeldt NN. Birth with synthetic oxytocin and the risk of being overweight or obese during childhood. Pediatr Obes 2022; 17:e12871. [PMID: 34783173 DOI: 10.1111/ijpo.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/30/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the importance of oxytocinergic signalling for satiety regulation and energy balance, the impact of exposure to synthetic oxytocin during childbirth on obesity during childhood remains unknown. OBJECTIVES To examine the association between oxytocin exposure during labour and the risk of being overweight or obese during childhood. METHODS Synthetic oxytocin exposure data of mothers from the Danish Medical Birth Registry were linked with self-reported anthropometric data of their children from the Danish National Birth Cohort (5 months-11 years of age). Multinomial logistic regression and latent class growth analyses were performed to determine the association between oxytocin exposure and obesity during childhood. RESULTS With the exception of the normal weight-to-overweight group between ages 5 and 12 months, none of the other analyses revealed a significant association between synthetic oxytocin use and the risk of being overweight until the age of 11 years. Furthermore, latent class growth analysis did not reveal an association between oxytocin exposure at birth and the risk of being overweight or obese during childhood. CONCLUSIONS Our analysis of a large cohort of children who varied in their synthetic oxytocin exposure status at childbirth did not reveal an association between oxytocin exposure and the risk of childhood overweight/obesity.
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Affiliation(s)
- Arvind Palanisamy
- Department of Anesthesiology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sarah A Toftlund
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tusar Giri
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Nicole N Lønfeldt
- Child and Adolescent Mental Health Centre - Research Unit, Department of Psychiatry, Capital Region of Denmark, Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Lønfeldt NN, Strandberg-Larsen K, Verhulst FC, Plessen KJ, Lebowitz ER. Birth with Synthetic Oxytocin and Risk of Childhood Emotional Disorders: A Danish Population-based Study. J Affect Disord 2020; 274:112-117. [PMID: 32469793 DOI: 10.1016/j.jad.2020.04.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Concerns have been raised that synthetic oxytocin, a widely used obstetric tool for labor induction and augmentation, may have deleterious effects on the neuropsychological development of children. Few studies have examined the relationship between oxytocin-stimulated labor and emotional disorders. METHODS We conducted a nationwide register-based cohort study including 677,629 singletons born in Denmark in the years 2000 to 2012 and followed through 2016 (median age = 10.6 years). Data on oxytocin-stimulation were obtained from the Danish Medical Birth Register. Cases of emotional disorders - anxiety, obsessive-compulsive disorder, mood or traumatic stress disorders or a redeemed prescription for a selective serotonin reuptake inhibitor - were identified using Danish patient and prescription registries. RESULTS Oxytocin was used to stimulate 31% of births, and oxytocin-stimulated labor was not associated with childhood emotional disorders (HR = 1.05, 95% CI 0.99, 1.11) after adjustment for maternal history of psychopathology, antidepressants during pregnancy, cohabitation status, highest educational attainment, smoking status during pregnancy, birth year, and indications for labor stimulation. The crude cox model was also small and close to unity (HR = 1.09, 95% CI 1.03, 1.15). LIMITATIONS About 50% of our population had reached the age of 10 years, but the outcome included disorders with later average debut ages. Oxytocin dosage levels are not recorded in the registers. CONCLUSIONS Our small effect size estimates suggest that perinatal synthetic oxytocin does not contribute to the development of emotional disorders. Current evidence does not warrant revision of guidelines for the use of oxytocin in obstetrics.
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Affiliation(s)
- Nicole Nadine Lønfeldt
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | | | - Frank Cornelis Verhulst
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Stokholm L, Juhl M, Talge NM, Gissler M, Obel C, Strandberg-Larsen K. Obstetric oxytocin exposure and ADHD and ASD among Danish and Finnish children. Int J Epidemiol 2020; 50:446-456. [DOI: 10.1093/ije/dyaa076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Some studies have indicated an increased risk of attention deficit hyperactivity disorder (ADHD) and a small, sex-specific association with autism spectrum disorder (ASD) among children prenatally exposed to obstetric oxytocin. Since oxytocin is widely used in the obstetric ward, these potentially deleterious effects are of concern. Thus, we aimed to examine whether obstetric oxytocin treatment for labour induction or augmentation is associated with ADHD and ASD in offspring born in a two-country design based on data from Denmark and Finland.
Methods
This population-based study used data from national registers in Denmark and Finland. Singletons born in Denmark 2000–10 (n = 577 380) and Finland 1991–2010 (n = 945 543), who survived infancy, were followed until 31 December 2015. ADHD and ASD were defined using diagnostic codes. For ADHD, we also included information on prescribed and redeemed ADHD medication in the definition. Hazards ratios (HRs) with 95% confidence intervals (CI), modelled with age as the underlying time scale, were calculated to estimate the associations.
Results
Oxytocin was used in 31% and 46% of the included deliveries in Denmark and Finland, respectively. In crude analyses, prenatal oxytocin was associated with an approximately 20% increased risk of ADHD and ASD, but confounder adjustment attenuated the association. The adjusted HR was 1.03, 95% CI 1.01–1.05, for ADHD and 1.05, 95% CI 1.02–1.08, for ASD. The results were similar in across country and gender.
Conclusions
We found an association between synthetic oxytocin and ADHD or ASD which is unlikely to reflect a causal association and thus should not support the concern of clinical use. Our results help to allay concerns of obstetric use of oxytocin causing ADHD or ASD.
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Affiliation(s)
- Lonny Stokholm
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette Juhl
- Department of Midwifery, Copenhagen University College, Copenhagen, Denmark
| | - Nicole M Talge
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Mika Gissler
- Department of Information Services, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Carsten Obel
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Perspectives of Pitocin administration on behavioral outcomes in the pediatric population: recent insights and future implications. Heliyon 2020; 6:e04047. [PMID: 32509991 PMCID: PMC7264063 DOI: 10.1016/j.heliyon.2020.e04047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/18/2020] [Accepted: 05/19/2020] [Indexed: 01/23/2023] Open
Abstract
Oxytocin plays an important role in the regulation of parturition as this peptide hormone promotes uterine smooth muscle contractility in gravid women undergoing labor. Here, we review the impact of Pitocin administration on behavioral outcomes in the pediatric population. Pitocin is a synthetic preparation of oxytocin widely used in the obstetric practice for the management of labor and postpartum hemorrhage. We begin by tracing the neuroanatomy of oxytocin-containing cells from an evolutionary perspective and then summarize key findings on behavioral and neural activity reported from offspring dosed with Pitocin during vaginal delivery. Finally, we discuss future directions that are experimentally tractable for understanding the developmental consequences of Pitocin administration on a small but growing subset of children worldwide. Given that fetal past experiences can shape the future behavior of the adult, further work on oxytocin signaling pathways will provide valuable references and insights for early-brain development and state-dependent regulation of behavioral outcome.
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Helbig S, Petersen A, Sitter E, Daly D, Gross MM. Inter-institutional variations in oxytocin augmentation during labour in German university hospitals: a national survey. BMC Pregnancy Childbirth 2019; 19:238. [PMID: 31288780 PMCID: PMC6617790 DOI: 10.1186/s12884-019-2348-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/31/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There are several international guidelines on oxytocin regimens for induction and augmentation of labour, but no agreement on a standardised regimen in Germany. This study collated and reviewed the oxytocin regimens used for labour augmentation in university hospitals, with the long-term aim of contributing to the development of a national clinical guideline. METHODS Germany has 34 university hospital compounds, representing 39 maternity units. In this observational study we asked units to provide standard operational procedures on oxytocin augmentation during labour or provide the details in a structured survey. Data were collected on the dosage of oxytocin, type and volume of solutions used, indications and contraindications for use and discontinuation, case-specific administration, and on who developed the procedures. Findings were analysed descriptively. RESULTS A total of 35 (90%) units participated in this study. Standard operating procedures were available in 24 units (69%), seven units (20%) did not have procedures and information was missing from four units (11%). Midwives participated in the development of standard operating procedures in 15 units (43%). Infusions were most commonly prepared using six units of oxytocin in 500 ml 0.9% normal saline solution (12 mU/ml). The infusions were started at 120 mU/hour and increased by 120 mU/hour at 20-min intervals up to a maximum dosage of 1200 mU/hour. The most common indication for use was delayed progress in labour. Infusions were stopped when uterine contractions became hypertonic and/or the fetal heart rate showed signs of distress. Most of the practices described aligned with international guidance. All units used reduced oxytocin dosages for women with a history of previous caesareans section, as recommended in the international guidelines, and restrictive use was advised in multiparous women. The main difference between units related to combined use of amniotomy and oxytocin, recommended by three guidelines but used in only four maternity units (11%). CONCLUSIONS While there was considerable variation in the oxytocin augmentation procedures, most but not all practices used in these 35 German maternity units were comparable. Establishing a national guideline on the criteria for and administration of oxytocin for augmentation of labour would eliminate the observed differences and minimise risk of administration and medication error.
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Affiliation(s)
- Sonja Helbig
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
| | - Antje Petersen
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
| | - Erika Sitter
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
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Lønfeldt NN, Verhulst FC, Strandberg-Larsen K, Plessen KJ, Lebowitz ER. Assessing risk of neurodevelopmental disorders after birth with oxytocin: a systematic review and meta-analysis. Psychol Med 2019; 49:881-890. [PMID: 30444210 DOI: 10.1017/s0033291718003021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Experts have raised concerns that oxytocin for labor induction and augmentation may have detrimental effects on the neurodevelopment of children. To investigate whether there is the reason for concern, we reviewed and evaluated the available evidence by searching databases with no language or date restrictions up to 9 September 2018. We included English-language studies reporting results on the association between perinatal oxytocin exposure and any cognitive impairment, psychiatric symptoms or disorders in childhood. We assessed the quality of studies using the Newcastle-Ottawa Quality Assessment Scales. Independent risk estimates were pooled using random-effects meta-analyses when at least two independent datasets provided data on the same symptom or disorder. Otherwise, we provided narrative summaries. Two studies examined cognitive impairment, one examined problem behavior, three examined attention-deficit/hyperactivity disorder (ADHD) and seven focused on autism spectrum disorders (ASD). We provided narrative summaries of the studies on cognitive impairment. For ADHD, the pooled risk estimate was 1.17; 95% confidence interval (CI) 0.77-1.78, based on a pooled sample size of 5 47 278 offspring. For ASD, the pooled risk estimate was 1.10; 95% CI 1.04-1.17, based on 8 87 470 offspring. Conclusions that perinatal oxytocin increases the risks of neurodevelopmental problems are premature. Observational studies of low to high quality comprise the evidence-base, and confounding, especially by the genetic or environmental vulnerability, remains an issue. Current evidence is insufficient to justify modifying obstetric guidelines for the use of oxytocin, which state that it should only be used when clinically indicated.
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Affiliation(s)
- Nicole N Lønfeldt
- Child and Adolescent Mental Health Services,Capital Region of Denmark, Copenhagen,Denmark
| | - Frank C Verhulst
- Child and Adolescent Mental Health Services,Capital Region of Denmark, Copenhagen,Denmark
| | | | - Kerstin J Plessen
- Child and Adolescent Mental Health Services,Capital Region of Denmark, Copenhagen,Denmark
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