Intrapartum synthetic oxytocin, behavioral and emotional problems in children, and the role of postnatal depressive symptoms, postnatal anxiety and mother-to-infant bonding: A Dutch prospective cohort study

Elke Tichelman,Willemijn Warmink-Perdijk,Jens Henrichs,Lillian Peters,Francois G Schellevis,Marjolein Y Berger,Huibert Burger

doi:10.1016/j.midw.2021.103045

Elke Tichelman, Willemijn Warmink-Perdijk + Show 5 more

Open Access

https://doi.org/10.1016/j.midw.2021.103045

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Abstract

ObjectiveTo examine the association between intrapartum synthetic oxytocin and child behavioral and emotional problems and to assess if maternal depressive or anxious symptoms or mother-to-infant bonding play a mediating role in this association. DesignProspective cohort study. SettingPopulation-based Pregnancy Anxiety and Depression Study. ParticipantsPregnant women in their first trimester of pregnancy visiting a total of 109 primary and nine secondary obstetric care centers in the Netherlands between 2010 and 2014 were invited to participate. Follow-up measures used for the present study were collected from May 2010 to January 2019. Women with multiple gestations and with a preterm birth were excluded. MeasurementsIntrapartum synthetic oxytocin exposure status was based on medical birth records and was defined as its administration (Yes/No), either for labour induction or augmentation. Child behavioral and emotional problems were measured with the Child Behavior Checklist at up to 60 months postpartum. Maternal depressive symptoms, anxiety and mother-to infant bonding were measured with the Edinburgh Postnatal Depression Scale, State Trait Anxiety Inventory and the Mother-to-Infant Bonding Scale from 6 months postpartum. We used multivariable linear regression models to estimate standardized beta coefficients and unique variance explained. Findings1,528 women responded. In total 607 women received intrapartum synthetic oxytocin. Intrapartum synthetic oxytocin administration was not associated with child behavioral and emotional problems, mother-to-infant bonding nor with postnatal anxiety. Intrapartum synthetic oxytocin was however significantly but weakly associated with more postnatal depressive symptoms (β=0.17, 95%CI of 0.03 to 0.30) explaining 0.6% of unique variance. Maternal postnatal depressive symptoms, postnatal anxiety symptoms and suboptimal mother-to-infant bonding were positively associated with child behavioral and emotional problems. Key conclusions and implications for practiceWe found no evidence that intrapartum synthetic oxytocin is associated with child behavioral and emotional problems, mother-to-infant bonding, or with postnatal anxiety symptoms. Because there was no association between intrapartum synthetic oxytocin and behavioral and emotional problems in children no mediation analysis was carried out. However, intrapartum synthetic oxytocin was positively but weakly associated with postnatal depressive symptoms. The clinical relevance of this finding is negligible in the general population, but unknown in a population with a high risk of depression

Highlights

IntroductionThe natural process of birth can be interfered by intrapartum synthetic oxytocin via several pathways, with potential impact on the child (Cadwell and Brimdyr, 2017)
Non-responders on CBCL did not differ from responders on CBCL on educational attainment level, cultural background, parity, prenatal depressive symptoms, mode of birth, gestational age at birth, breastfeeding six months postpartum, intrapartum synthetic oxytocin administration, postnatal depressive symptoms, postnatal anxiety and mother-to-infant bonding
Comparison of characteristics between participants with and without intrapartum synthetic oxytocin is presented in table 1

Summary

Introduction

The natural process of birth can be interfered by intrapartum synthetic oxytocin via several pathways, with potential impact on the child (Cadwell and Brimdyr, 2017). The administration of synthetic oxytocin may inhibit the action of maternal natural oxytocin immediately postpartum through desensitization of oxytocin receptors, and via negative feedback mechanisms (Cadwell and Brimdyr, 2017; Conti et al, 2008). Intrapartum synthetic oxytocin is able to cross the placenta (Wahl, 2004; Cadwell and Brimdyr, 2017) and may permanently alter and downregulate fetal oxytocin receptors (Wahl, 2004). The resulting fetal distress may have long-term consequences for development of the brain (Rees and Inder, 2005)

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