The EPIIC hypothesis: Intrapartum effects on the neonatal epigenome and consequent health outcomes

Abstract

There are many published studies about the epigenetic effects of the prenatal and infant periods on health outcomes. However, there is very little knowledge regarding the effects of the intrapartum period (labor and birth) on health and epigenetic remodeling. Although the intrapartum period is relatively short compared to the complete perinatal period, there is emerging evidence that this time frame may be a critical formative phase for the human genome. Given the debates from the National Institutes of Health and World Health Organization regarding routine childbirth procedures, it is essential to establish the state of the science concerning normal intrapartum epigenetic physiology. EPIIC (Epigenetic Impact of Childbirth) is an international, interdisciplinary research collaboration with expertise in the fields of genetics, physiology, developmental biology, epidemiology, medicine, midwifery, and nursing. We hypothesize that events during the intrapartum period – specifically the use of synthetic oxytocin, antibiotics, and cesarean section – affect the epigenetic remodeling processes and subsequent health of the mother and offspring. The rationale for this hypothesis is based on recent evidence and current best practice.

The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population‐based cohort study

“…This may potentially affect the neonatal immune response 8, 9. The EPIgenetic Impact of Childbirth (EPIIC) hypothesis raises concern over the effects of stress (too high and too low) caused by medical and operative birth interventions to the epigenetic regulation of gene expression in the immune system 10, 11…”

Natural Childbirth and Breastfeeding as Preventive Measures of Immune- Microbiome Dysbiosis and Misregulated Inflammation

“…In a recent paper, Dahlen et al [78] raised the issue of whether the lack of exposure to diverse microorganismsin early childhood (known as the "hygiene hypothesis") could fully explain the array of adverse health outcomes associated with CD such as those illustrated here in Table 1.…”

“…In a model known as epigenetic impact of childbirth (EPIIC), these investigators argue that labor is a critical life event and labor interventions such as CD could alter perinatal stress-driven physiology and epigenetic imprinting that can program for later-life immune and health problems [78]. Dahlen et al [78] suggest that childbirth, rather than being viewed as a supportive event of prenatal development, is itself a significant formative event capable of physiologically reprogramming the fetal epigenome.…”

“…Dahlen et al [78] suggest that childbirth, rather than being viewed as a supportive event of prenatal development, is itself a significant formative event capable of physiologically reprogramming the fetal epigenome. As with other example of epigenetic programming, there is the potential for transgenerational health implications.…”

Reduzindo intervenções de rotina durante o trabalho de parto e parto: primeiro, não causar dano

“…However, they are now given special urgency by the growing evidence base arising from a range of disciplines that associates interventions in labour and birth, including mode of birth, use of oxytocin, and use of antibiotics to increased risk of longer-term non-communicable autoimmune disorders, such as type one diabetes, multiple sclerosis, asthma, eczema, and even some cancers, and to so-called 'lifestyle' disorders, such as obesity 11 .…”