Background
Although oxytocin is commonly used to augment or induce labor, it is difficult to predict its effectiveness because oxytocin dose requirements vary significantly amongst women. One possibility is that women requiring high or low doses of oxytocin have variations in the oxytocin receptor gene.
Objectives
This work aims to identify oxytocin receptor gene variants in laboring women with low and high oxytocin dosage requirements.
Study Design
Term, nulliparous women requiring oxytocin doses of ≤4 milliunits/minute (low-dose requiring, n=83) or ≥20 milliunits/minute (high-dose requiring, n=104) for labor augmentation or induction were consented to a post-partum blood draw as a source of genomic DNA. Targeted-amplicon sequencing (coverage > 30X) with Illumina MiSeq was performed to discover variants in the coding exons of the oxytocin receptor gene. Baseline relevant clinical history, outcomes, demographics, and oxytocin receptor gene sequence variants and their allele frequencies were compared between low-dose-requiring and high-dose-requiring women. The Scale-Invariant Feature Transform algorithm was used to predict the effect of variants on oxytocin receptor function. Fisher’s exact or chi-squared tests were used for categorical variables, and Student t-tests or Wilcoxon rank sum tests were used for continuous variables. A P-value < 0.05 was considered statistically significant.
Results
The high-dose-requiring women had higher rates of obesity and diabetes and were more likely to have undergone labor induction and required prostaglandins. High-dose-requiring women were more likely to undergo cesarean for first stage arrest and less likely to undergo cesarean for non-reassuring fetal status. Targeted sequencing of the oxytocin receptor gene in the total cohort (n=187) revealed 30 distinct coding variants: 17 non-synonymous, 11 synonymous, and two small structural variations. One novel variant (A243T) was found in both the low- and high-dose-requiring groups. Three novel variants (Y106H, A240_A249del, and P197delfs*206) resulting in an amino acid substitution, loss of 9 amino acids, and a frameshift stop mutation, respectively, were identified only in low-dose-requiring women. Nine non-synonymous variants were unique to the high-dose-requiring group. These included three known variants (R151C, G221S, and W228C) and six novel variants not found in Ensembl or ExAC (M133V, R150L, H173R, A248V, G253R, and I266V). Of these, R150L, R151C, and H173R were predicted to damage oxytocin receptor function. There was no statistically significant association between the numbers of synonymous and non-synonymous substitutions in the patient groups.
Conclusions
Obesity, diabetes, and labor induction were associated with the requirement for high doses of oxytocin. We did not identify significant differences in the prevalence of oxytocin receptor variants between low-dose-requiring and high-dose-requiring women, but novel oxytocin receptor variants were enriched in the high-dose-requiring women. Additionally, we fou...