Are There Epigenetic Oxytocin-Mediated Effects on the Mother and Infant during Physiological Childbirth?

INTRODUCTION: Studies have shown that long-term positive behavioural and physiological changes are induced in connection with vaginal, physiological birth, and skin-to-skin contact after birth in mothers and babies. Some of these effects are consistent with the effect profile of oxytocin. This scoping review explores whether epigenetic changes of the oxytocin gene and of the oxytocin receptor gene (OTR) are involved in these effects. METHODS: We searched Pubmed, Medline, BioMed Central, Cochrane Library, OVID, and Web of Science for evidence of epigenetic changes in connection with childbirth in humans, with a particular focus on the oxytocin system. RESULTS: There were no published studies identified that were related to epigenetic changes of oxytocin and its receptor in connection with labour, birth, and skin-to-skin contact after birth in mothers and babies. However, some studies were identified that showed polymorphisms of the oxytocin receptor influenced the progress of labour. We also identified studies in which the level of global methylation was measured in vaginal birth and caesarean section, with conflicting results. Some studies identified differences in the level of methylation of single genes linked to various effects, for example, immune response, metabolism, and inflammation. In some of these cases, the level of methylation was associated with the duration of labour or mode of birth. We also identified some studies that demonstrated long-term effects of mode of birth and of skin-to-skin contact linked to changes in oxytocin function. CONCLUSION: There were no studies identified that showed epigenetic changes of the oxytocin system in connection with physiological birth. The lack of evidence, so far, regarding epigenetic changes did not exclude future demonstrations of such effects, as there was a definite role of oxytocin in creating long-term effects during the perinatal period. Such studies may not have been performed. Alternatively, the oxytocin linked effects might be indirectly mediated via other receptors and signalling systems. We conclude that there is a significant lack of research examining long-term changes of oxytocin function and long-term oxytocin mediated adaptive effects induced during physiological birth and skin-to-skin contact after birth in mothers and their infants.

Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth?

INTRODUCTION: Perineal trauma at birth is distressing for women and can cause serious short and long term morbidity. AIM: Investigate the prevalence and predictive factors of intact perineum after normal vaginal birth among Portuguese women who had spontaneous vaginal births. METHODS: A descriptive, cross-sectional, retrospective study was carried out among pregnant women who had spontaneous vaginal births, between January 1, 2017, and December 31, 2017, in a single birth centre in Portugal. Following ethical approval, the prevalence of intact perineum was calculated and multivariate analysis with logistic regression was carried out, to identify the predictive factors of having an intact perineum after spontaneous vaginal birth. RESULTS: A total of 1748 pregnant women had spontaneous vaginal births. Four hundred and forty-one women (25.2%) had intact perineum whereas in 1307 (74.8%) of women, the perineum was not intact. First-degree tears occurred in 23.2% (405/1748) of women, second-degree tears occurred in 4% (70/1748) of women while three women (0.2%) experienced a third-degree tear. The rate of episiotomies was 43.8% (766/1748). Episiotomy and first-degree tears occurred in 2.6% (45/1748), episiotomy and second-degree tears occurred in 0.7% (12/1748), while episiotomy and third-degree tears occurred in 0.3% (6/1748) of women. Having a previous caesarean section reduced the odds of intact perineum by 60%, while nulliparity reduced the odds by 70%. For every 250 grams increase in birth weight, the odds of sustaining an intact perineum were decreased by 13%. Alternative birth positions (excluding lithotomy) doubled the odds of maintaining an intact perineum. CONCLUSION: The prevalence of intact perineum is 25,2%. Predictive factors for intact perineum include birth weight, parity, previous caesarean section and birthing position. Recognizing these factors could support and facilitate the management of spontaneous vaginal birth to promote an intact perineum. Further research is needed to gain better understanding of this phenomenon.

Undergraduate peer assisted learning tutors' performance in summative anatomy examinations: a pilot study.

OBJECTIVES: To compare summative anatomy examination results of Peer Assisted Learning (PAL) tutors and learners in the same undergraduate classroom. METHODS: Comparative study of Year-1 medical students who did/did not serve as PAL tutors. PAL tutors gave six hours of teaching in lower limb anatomy. Percent marks for written and spotting examinations were compared between PAL tutors and PAL learners. RESULTS: The 12 self-selected PAL tutors were not significantly different from their peers (n=191) in terms of age or nationality, but 20% were female compared to 51% of PAL learners. Except for upper limb anatomy, PAL tutors performed at the same level as their tutees in all basic science examinations taken before PAL was introduced. PAL tutors performed better (M=89.0, SD=8.2) in the lower limb examinations than PAL learners (M=79.7, SD=13.0), but these differences were only statistically significantly bigger in the subject they had taught (t(184) = 2.40, p=0.002). Overall PAL tutors performed better in all anatomy spotting exams in both pre-clinical years (Year-1: M=80.4, SD=7.4; Year-2: M=74.8, SD=3.4) compared to PAL learners (Year-1: M=75.1, SD=6.6; Year-2: M=67.2, SD=3.0; (t(1) = 4.2, p=0.07). CONCLUSIONS: Undergraduate PAL tutors performed better than PAL learners in the subject they taught and continued to do so in all anatomy spotting exams, even after the PAL experience had ended, suggesting that actively involving anatomy students as PAL tutors should be encouraged especially among undergraduate medical students.

An update on the genetics of pre-eclampsia.

Pre-eclampsia is a progressive multisystem disorder that is exclusive to human pregnancy and defined as new hypertension presenting after 20 weeks with significant proteinuria. It is a multifactorial condition with a strong genetic component and several genes have been linked with this disorder. The main players implicated in the pathogenesis of pre-eclampsia include immune maladaptation, hemodynamics, endothelial function, thrombophilic disorders, oxidative stress and lipid metabolism. All of these mechanisms encompass genetic factors that might be responsible for the pathogenic changes taking place. Pre-eclampsia has been referred to as a primipaternity disease. A number of studies examined the contribution of paternal genes in pre-eclampsia. Although there is evidence that paternal genes significantly increase the risk of pre-eclampsia, there is still inconclusive evidence whether having the same partner is a protective factor. Gene expression, through imprinting and epistasis, also play an important role in the pathogenesis of this disorder. Pre-eclampsia remains a disease of theories. Despite the growing body of research exploring this complex disorder, the etiology of pre-eclampsia remains elusive and the struggle is still ongoing to find an effective predictive test that can detect this disorder at an early stage where intervention can prevent the progression of the disorder. Research is still ongoing. Prevention and early detection of pre-eclampsia remain the ultimate goal.

The effectiveness of psychosocial assessment in the detection and management of postpartum depression: a systematic review.

INTRODUCTION: Perinatal mental disorders remain a public health concern. A psychosocial assessment gives a comprehensive understanding of a woman's circumstances by identifying risk factors that affect the overall mental state and function of the woman. The aim was to evaluate the current international evidence regarding the effectiveness of psychosocial assessments in the detection and management of postpartum depression. EVIDENCE ACQUISITION: Six health related databases were systematically searched from January 2000 to June 2016. Full papers reporting the effectiveness of psychosocial assessment on the detection and management of postpartum depression were included. A data extraction form was designed and piloted on two studies. Data were extracted on study design, population, study context, intervention/s and outcome/s. The methods of all the studies selected were critically appraised using the Quality Assessment Tool for Quantitative Studies. EVIDENCE SYNTHESIS: A total of 692 citations were found. Four randomized control trials (RCTs) met full inclusion criteria and qualified for full paper review and data extraction. Due to the heterogeneity of the data retrieved a narrative synthesis was carried out. Overall, when compared to routine care, psychosocial assessments were found to be sensitive to detect risk factors associated with postnatal depression. Results from two of the included studies reported no statistically significant difference in outcomes amongst those who screened positive and received the intervention compared to those who screened positive and were given standard care. CONCLUSIONS: Presently there is a paucity of published data on the effectiveness of psychosocial assessment in the detection and management of postnatal depression and results show conflicting evidence. Further RCTs are recommended to further elucidate the effectiveness of psychosocial assessments.

Perceptions of first-year medical students towards learning anatomy using cadaveric specimens through peer teaching.

During the last decade, global interest in the multiple benefits of formal peer teaching has increased. This study aimed to explore the perceptions of first-year medical students towards the use of peer teaching to learn anatomy using cadaveric specimens. A descriptive, cross-sectional, retrospective survey was carried out. Data were collected using an online questionnaire which was administered to all medical students who were in their second year of their medical school curriculum and who had participated in sessions taught by their peers during their first year. Peer teaching was perceived as an effective method of learning anatomy by more than half of the participants. Analysis of mean responses revealed that the peer teachers created a positive, non-intimidating learning environment. Overall, participants gave positive feedback on their peer teachers. Six categories emerged from the responses given by participants as to why they would or would not recommend peer teaching. Ways of improvement as suggested by the respondents were also reported. Variables found to be significantly associated with the perceived benefits of the peer teaching program included sex differences, educational level and recommendations for peer teaching. This study brings to light the merits and demerits of peer teaching as viewed through the eyes of the peer learners. Peer teaching provides a sound platform for teaching and learning anatomy. Further discussions at higher levels are encouraged in order to explore the feasibility of introducing formal peer teaching in the medical curriculum. Anat Sci Educ 11: 346-357. © 2017 American Association of Anatomists.

The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: A systematic review.

OBJECTIVE: to identify and appraise the current international evidence regarding the presence and prevalence of the co-existence of depression, anxiety and post-traumatic stress symptoms in the antenatal and post partum period. METHODS: using a list of keywords, Medline, CINHAL, Cochrane Library, EMBASE, PsychINFO, Web of Science and the Index of Theses and Conference Proceedings (Jan 1960 - Jan 2015) were systematically searched. Experts in the field were contacted to locate papers that were in progress or in press. Reference lists from relevant review articles were searched. Inclusion criteria included full papers published in English reporting concurrent depression, anxiety and post-traumatic stress symptoms in pregnant and post partum women. A validated data extraction review tool was used. FINDINGS: 3424 citations were identified. Three studies met the full inclusion criteria. All reported findings in the postnatal period. No antenatal studies were identified. The prevalence of triple co-morbidity was relatively low ranging from 2% to 3%. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: triple co-morbidity does occur, although the prevalence appears to be low. Due to the presentation of complex symptoms, women with triple co-morbidity are likely to be difficult to identify, diagnose and treat. Clinical staff should be aware of the potential of complex symptomatology.