Childbirth and consequent atopic disease: emerging evidence on epigenetic effects based on the hygiene and EPIIC hypotheses

Background: In most high and middle income countries across the world, at least 1:4 women give birth by cesarean section. Rates of labour induction and augmentation are rising steeply; and in some countries up to 50 % of laboring women and newborns are given antibiotics. Governments and international agencies are increasingly concerned about the clinical, economic and psychosocial effects of these interventions. Discussion: There is emerging evidence that certain intrapartum and early neonatal interventions might affect the neonatal immune response in the longer term, and perhaps trans-generationally. Two theories lead the debate in this area. Those aligned with the hygiene (or ‘Old Friends’) hypothesis have examined the effect of gut microbiome colonization secondary to mode of birth and intrapartum/neonatal pharmacological interventions on immune response and epigenetic phenomena. Those working with the EPIIC (Epigenetic Impact of Childbirth) hypothesis are concerned with the effects of eustress and dys-stress on the epigenome, secondary to mode of birth and labour interventions. Summary: This paper examines the current and emerging findings relating to childbirth and atopic/autoimmune disease from the perspective of both theories, and proposes an alliance of research effort. This is likely to accelerate the discovery of important findings arising from both approaches, and to maximize the timely understanding of the longer-term consequences of childbirth practices

Labor augmentation during birth and later cognitive ability in young adulthood

Lonny Stokholm,1 Nicole M Talge,2 Gunhild Tidemann Christensen,3–5 Mette Juhl,6 Laust Hvas Mortensen,1,7Katrine Strandberg-Larsen1 1Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 2Department of Epidemiology and Biostatistics, Michigan State University, Michigan, USA; 3Department of Public Health, University of Southern Denmark, Danish Aging Research Center, Odense, Denmark; 4Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark; 5Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 6Department of Midwifery, Copenhagen University College, Copenhagen, Denmark; 7Methods and Analysis, Statistics Denmark, Copenhagen, Denmark Purpose: Synthetic oxytocin for labor augmentation during birth has been linked to negative neurodevelopment effects in children. We examined whether maternal labor augmentation was associated with lower cognitive ability in young adulthoods. Patients and methods: We identified 330,107 individuals (96.6% were men), with noninduced labor and with a cognitive ability test score, the Børge Priens Prøve (BPP) score, from draft board examinations in 1995–2015 (mean age, 18.8 years). Information on maternal labor augmentation was ascertained from the Danish Medical Birth Register, and we calculated mean differences in the BPP score according to maternal labor augmentation. We repeated our analyses in a sub-sample of siblings to control for unmeasured familial confounding. Results: Maternal labor augmentation was not associated with any noticeable decline in cognitive ability. However, the difference in the mean BPP score for exposure to maternal labor augmentation varied according to maternal parity, as the mean difference in BPP scores increased with increasing parity, in nulliparous: mean difference=–0.14 (95% CI=–0.23 to –0.04); in maternal parity 4+: mean difference=–1.21 (95% CI=–2.905 to –0.37). The sibling analysis showed little influence of shared familial factors on the association. Conclusion: The mean BPP was slightly lower among labor augmented compared to nonaugmented and with an increasing difference with increasing parity. However, the differences were small and could not be considered of any clinical relevance. Furthermore, the sibling analyses suggested little confounding by familial factors. Keywords: Børge Priens Prøve, dystocia, neurodevelopment, oxytocin, sibling