Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin
Abstract Background Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infus...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-08-01
|
| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12884-019-2365-9 |
| _version_ | 1828836889504776192 |
|---|---|
| author | Kerstin Uvnäs-Moberg Anette Ekström-Bergström Marie Berg Sarah Buckley Zada Pajalic Eleni Hadjigeorgiou Alicja Kotłowska Luise Lengler Bogumila Kielbratowska Fatima Leon-Larios Claudia Meier Magistretti Soo Downe Bengt Lindström Anna Dencker |
| author_facet | Kerstin Uvnäs-Moberg Anette Ekström-Bergström Marie Berg Sarah Buckley Zada Pajalic Eleni Hadjigeorgiou Alicja Kotłowska Luise Lengler Bogumila Kielbratowska Fatima Leon-Larios Claudia Meier Magistretti Soo Downe Bengt Lindström Anna Dencker |
| author_sort | Kerstin Uvnäs-Moberg |
| collection | DOAJ |
| description | Abstract Background Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies. Methods An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects. Results Basal levels of oxytocin increased 3–4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin. Conclusions Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother’s brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does. |
| first_indexed | 2024-12-12T18:31:48Z |
| format | Article |
| id | doaj.art-4a274258d49a482781107070165ab864 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-12T18:31:48Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-4a274258d49a482781107070165ab8642022-12-22T00:15:55ZengBMCBMC Pregnancy and Childbirth1471-23932019-08-0119111710.1186/s12884-019-2365-9Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocinKerstin Uvnäs-Moberg0Anette Ekström-Bergström1Marie Berg2Sarah Buckley3Zada Pajalic4Eleni Hadjigeorgiou5Alicja Kotłowska6Luise Lengler7Bogumila Kielbratowska8Fatima Leon-Larios9Claudia Meier Magistretti10Soo Downe11Bengt Lindström12Anna Dencker13University of Agriculture (SLU)School of Health and Education, University of SkövdeInstitute of Health and Care Sciences, University of GothenburgSchool of Public Health, The University of QueenslandFaculty of Health Sciences, Oslo and Akershus University College of Applied SciencesFaculty of Health Sciences, Cyprus, University of TechnologyFaculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of GdańskMidwifery Research and Education Unit, Hannover Medical SchoolFaculty of Medical Sciences, Medical University of GdańskFaculty of Nursing, Physiotherapy and Podiatry, University of SevilleDepartment of Social Work Center for Health Promotion and Social Participation, Lucerne University of Applied Sciences and ArtsResearch in Childbirth and Health (ReaCH) group, University of Central LancashireNorwegian University of Science and TechnologyInstitute of Health and Care Sciences, University of GothenburgAbstract Background Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies. Methods An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects. Results Basal levels of oxytocin increased 3–4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin. Conclusions Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother’s brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does.http://link.springer.com/article/10.1186/s12884-019-2365-9OxytocinPlasma levelsPregnancyPhysiological labourBirthUterine contractions |
| spellingShingle | Kerstin Uvnäs-Moberg Anette Ekström-Bergström Marie Berg Sarah Buckley Zada Pajalic Eleni Hadjigeorgiou Alicja Kotłowska Luise Lengler Bogumila Kielbratowska Fatima Leon-Larios Claudia Meier Magistretti Soo Downe Bengt Lindström Anna Dencker Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin BMC Pregnancy and Childbirth Oxytocin Plasma levels Pregnancy Physiological labour Birth Uterine contractions |
| title | Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin |
| title_full | Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin |
| title_fullStr | Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin |
| title_full_unstemmed | Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin |
| title_short | Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin |
| title_sort | maternal plasma levels of oxytocin during physiological childbirth a systematic review with implications for uterine contractions and central actions of oxytocin |
| topic | Oxytocin Plasma levels Pregnancy Physiological labour Birth Uterine contractions |
| url | http://link.springer.com/article/10.1186/s12884-019-2365-9 |
| work_keys_str_mv | AT kerstinuvnasmoberg maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT anetteekstrombergstrom maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT marieberg maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT sarahbuckley maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT zadapajalic maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT elenihadjigeorgiou maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT alicjakotłowska maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT luiselengler maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT bogumilakielbratowska maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT fatimaleonlarios maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT claudiameiermagistretti maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT soodowne maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT bengtlindstrom maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin AT annadencker maternalplasmalevelsofoxytocinduringphysiologicalchildbirthasystematicreviewwithimplicationsforuterinecontractionsandcentralactionsofoxytocin |