Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2017 | Research article

Placenta response of inflammation and oxidative stress in low-risk term childbirth: the implication of delivery mode

Authors: Yabin Hu, Kun Huang, Yuanfang Sun, Jianqing Wang, Yeqing Xu, Shuangqin Yan, Peng Zhu, Fangbiao Tao

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

Abstract

Background

Caesarean delivery rate is increasing gradually in China and there is no doubt that delivery mode is closely associated with the maternal health and infant development.This study examined the independent effect of delivery mode on placenta inflammation response and oxidative stress response.

Methods

A total of 3474 pregnant women recruited in Ma’anshan Birth Cohort Study were the initial study population. Data on maternal socio-demographic characteristics and pre-pregnancy BMI were collected at their 1st antenatal checkups. Pregnancy-specific anxiety was assessed during the three trimesters of pregnancy. Common pregnant complications were monitored in the whole pregnancy period. Delivery modes, as well as newborn characteristics were abstracted from medical records. Delivery modes included vaginal deliveries (VD), caesarean delivery with medical indications (CDMI), caesarean delivery on maternal request (CDMR) and urgent cesarean delivery (UCD). Placentas were collected during childbirth. The mRNA expression of IL-1β, TNF-a, IL-6, IFN-γ, IL-4, IL-10, IL-8, and HO-1 were assessed in the final sample of 1978 low-risk women with singleton term-births.

Results

The overall rate of caesarean delivery (CD) was 50.5% (1650/3265) in singleton term childbirths in this study. Among women who reported definite CD reasons, 56.8%of them chose the surgery without any medical indications.It shows a non-linear relationship between cytokines related with placenta inflammatory response, oxidative stress response and different delivery modes. At high percentiles of IL-1β, IFN-γ and IL-8, women with CDMR had higher expression levels compared to women with VD. Women with CDMI had higher levels at median percentiles of IL-1β, IFN-γ and IL-8. Women with CDMR had higher expression compared with VD at high percentiles of IL-6 and HO-1, and women with CDMI had higher levels of these two cytokines at their low percentiles. It is worth noting that at high percentiles, compared with normal delivery, the expression of IL-1β, IFN-γ, IL-8 and HO-1 have significantly altered in women with CDMR.

Conclusion

A high overall CD rate was found in this study, and caesarean delivery on maternal request was the major contributor to the high prevalence. Maternal placental oxidative stress and inflammatory response were closely associated with delivery mode. The effect is much amplified at high levels of expression in women who chose CD on maternal request.Such difference needs to be noticed and may have important implications for obstetricians, midwives and other perinatal health care workers.

Blanchette H. The rising cesarean delivery rate in America: what are the consequences? Obstet Gynecol. 2011;118(3):687–90.CrossRefPubMed

Lumbiganon P, Laopaiboon M, Gülmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet. 2010;375(9713):490–9.CrossRefPubMed

Vogel JP, Betrán AP, Vindevoghel N, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(5):e260–70.CrossRefPubMed

Xiong C, Zhou A, Cao Z, et al. Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China. Sci Rep. 2016;6:37168.CrossRefPubMedPubMedCentral

Zhang J, Liu Y, Meikle S, et al. Cesarean delivery on maternal request in southeast China. Obstet Gynecol. 2008;111(5):1077–82.CrossRefPubMed

Feng XL, Wang Y, An L, et al. Cesarean section in the People's Republic of China: current perspectives. Int J Womens Health. 2014;6:59–74.CrossRefPubMedPubMedCentral

Wang E. Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China. Soc Sci Med. 2017;173:1–8.

Liu X, Landon MB, Cheng W, et al. Cesarean delivery on maternal request in China: what are the risks and benefits? Am J Obstet Gynecol. 2015;212(6):817.e1–9.

Yu Y, Zhang X, Sun C, et al. Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China. PLoS One. 2017;12(11):e0186304.

10.

Armstrong-Wells J, Donnelly M, Post MD, et al. Inflammatory predictors of neurologic disability after preterm premature rupture of membranes. Am J Obstet Gynecol. 2015;212(2):212.e1–9.

11.

Joosten LA, Netea MG, Dinarello CA. Interleukin-1β in innate inflammation, autophagy and immunity. Semin Immuno. 2013;25:416–24.CrossRef

12.

Al-Gubory KH, Fowler PA, Garrel C. The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes. Int J Biochem Cell Biol. 2010;42:1634–50.CrossRefPubMed

13.

Malamitsi-Puchner A, Protonotariou E, Boutsikou T, et al. The influence of the mode of delivery on circulating cytokine concentrations in the perinatal period. Early Hum Dev. 2005;81(4):387–92.CrossRefPubMed

14.

Gitto E, Reiter RJ, Karbownik M, et al. Causes of oxidative stress in the pre-and perinatal period. Biol Neonate. 2002;81:146–57.CrossRefPubMed

15.

Hung TH, Chen SF, Hsieh TT, et al. The associations between labor and delivery mode and maternal and placental oxidative stress. Reprod Toxicol. 2011;31(2):144–50.CrossRefPubMed

16.

Bakheit KH, Bayoumi NK, Adam I. Peripheral, placental and cord cytokines profile in spontaneous labor and elective caesarean section. Iran J Immunol. 2008;5(3):185–8.PubMed

17.

Yu J, Zhou Y, Gui J, et al. Assessment of the number and function of macrophages in the placenta of gestational diabetes mellitus patients. J Huazhong Univ Sci Technolog Med Sci. 2013;33(5):725–9.CrossRefPubMed

18.

Radaelli T, Varastehpour A, Catalano P, et al. Gestational diabetes induces placental genes for chronic stress and inflammatory pathways. Diabetes. 2003;52(12):2951–8.CrossRefPubMed

19.

Bronson SL, Bale TL. Prenatal stress-induced increases in placental inflammation and offspring hyperactivity are male-specific and ameliorated by maternal antiinflammatory treatment. Endocrinology. 2014;155(7):2635–46.CrossRefPubMedPubMedCentral

20.

Xiao LM, Tao FB, Zhang JL, et al. Design of pregnancy - related anxiety scale and reliability evaluation. Chin J Public Health. 2012;28(3):275–7.

21.

Yadav AK, Chaudhari H, Warke H, et al. Differential expression of Collectins in human placenta and role in inflammation during spontaneous labor. PLoS One. 2014;9(10):e108815.CrossRefPubMedPubMedCentral

22.

Latendresse G, Ruiz RJ, Wong B. Psychological distress and SSRI use predict variation in inflammatory cytokines during pregnancy. Open J ObstetGynecol. 2013;3(1A):184–91.

23.

Girard S, Heazell AE, Derricott H, et al. Circulating cytokines and alarmins associated with placental inflammation in high-risk pregnancies. Am J Reprod Immunol. 2014;72(4):422–34.CrossRefPubMedPubMedCentral

24.

Chatterjee P, Chiasson VL, Seerangan G, et al. Combined treatment with IL-4 and IL-10 modulates immune cells and prevents hypertension in pregnant mice. Am J Hypertens. 2015;28(1):135–42.CrossRefPubMed

25.

Lappas M. GSK3β is increased in adipose tissue and skeletal muscle from women with gestational diabetes where it regulates the inflammatory response. PLoS One. 2014;9(12):e115854.CrossRefPubMedPubMedCentral

26.

Charo IF, Ransohoff RM. The many roles of chemokines and chemokine receptors in inflammation. N Engl J Med. 2006;354(6):610–21.CrossRefPubMed

27.

Huang K, Tao F, Faragher B, et al. A mixed-method study of factors associated with differences in caesarean section rates at community level: the case of rural China. Midwifery. 2013;29(8):911–20.CrossRefPubMed

28.

Zhao J, Liu XJ, Ma JW, et al. DNA damage in healthy term neonate. Early Hum Dev. 2004;77(1–2):89–98.CrossRefPubMed

29.

Keelan JA, Marvin KW, Sato TA, et al. Cytokine abundance in placental tissues: evidence of inflammatory activation in gestational membranes with term and preterm parturition. Am J Obstet Gynecol. 1999;181(6):1530–6.CrossRefPubMed

30.

Gedikbaşi A, Salihoğlu Ö, Çankaya A, et al. The evaluation of cord blood interleukin-1β levels in normal and caesarean deliveries. Hum Exp Toxicol. 2014;33(12):1193–8.CrossRefPubMed

31.

Mutlu B, Aksoy N, Cakir H, et al. The effects of the mode of delivery on oxidative-antioxidative balance. J Matern Fetal Neonatal Med. 2011;24(11):1367–70.CrossRefPubMed

32.

Ozen M, Zhao H, Lewis DB, et al. Hemeoxygenase and the immune system in normal and pathological pregnancies. Front Pharmacol. 2015;6:84.CrossRefPubMedPubMedCentral

33.

Zerón HM, Flores AP, Chávez AA, et al. Pregnancy weight gainlimitation by a supervised nutritional program influences placental NF-κB/IKK complexexpression and oxidative stress. Oman Med J. 2013;28(3):167–72.CrossRefPubMedPubMedCentral

34.

Aye IL, Waddell BJ, Mark PJ, et al. Oxysterols exert proinflammatory effects in placental trophoblasts via TLR4-dependent, cholesterol-sensitive activation of NF-κB. Mol Hum Reprod. 2012;18(7):341–53.CrossRefPubMed

35.

Cindrova-Davies T, Yung HW, Johns J, et al. Oxidative stress, gene expression, and protein changes induced in the human placenta during labor. Am J Pathol. 2007;171(4):1168–79.CrossRefPubMedPubMedCentral

36.

Offner H, Subramanian S, Parker SM, et al. Experimental stroke induces massive, rapid activation of the peripheral immune system. J Cereb Blood Flow Metab. 2006;26(5):654–65.CrossRefPubMed

Title: Placenta response of inflammation and oxidative stress in low-risk term childbirth: the implication of delivery mode
Authors: Yabin Hu
Kun Huang
Yuanfang Sun
Jianqing Wang
Yeqing Xu
Shuangqin Yan
Peng Zhu
Fangbiao Tao
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-017-1589-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Placenta response of inflammation and oxidative stress in low-risk term childbirth: the implication of delivery mode

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

Maternal depression in Syrian refugee women recently moved to Canada: a preliminary study

Do experiences with pregnancy, birth and postnatal care in Norway vary by the women’s geographic origin? a comparison of cross-sectional survey results

An evaluation of Interprofessional group antenatal care: a prospective comparative study

Impact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre- vs. post-intervention study

Economic evaluation of a behavioral intervention versus brief advice for substance use treatment in pregnant women: results from a randomized controlled trial

Measuring women’s childbirth experiences: a systematic review for identification and analysis of validated instruments