Oxytocin: at birth and beyond. A systematic review of the long‐term effects of peripartum oxytocin
Oxytocin: at birth and beyond. A systematic review of the long‐term effects of peripartum oxytocin
复制标题
催产素：出生时及以后的系统评价围产期催产素的长期影响。
作者：
D. Monks;A. Palanisamy
催产素是分娩和分娩期间最常用的药物之一。来自基础神经科学研究的最新见解表明，与催产素对人类高级行为的深远影响相比，催产素的子宫强直效应可能微不足道。这篇综述的目的是强调在围产期操纵催产素能信号的潜在后果及其对母婴二元的长期影响。我们确定了催产素能信号调节的四个领域：产后抑郁、母乳喂养、神经发育和慢性疼痛，并进行了文献搜索，以解决围产期应用催产素的影响。我们已经展示了温和但不一致的证据，将围产期给予催产素与产后抑郁症联系起来。母乳喂养的成功似乎与围产期催产素的暴露呈负相关，可能继而受到原始新生儿反射和母婴纽带的损害。围产期接触催产素与后代患上自闭症等神经发育障碍的相关性很弱，但这些研究因缺乏累积剂量的信息而受到限制。最后，我们确定了催产素的止痛和抗过敏作用的充分证据，这可能部分解释了剖腹产后慢性疼痛的低发生率。尽管本文提供的大多数数据都是观察性的，但我们的综述指出，迫切需要进行强有力的临床研究，以更好地剖析围产期催产素使用的影响，并作为催产素使用的管理者，提高给药的精确度，以防止药物的过度使用。
Oxytocin is one of the most commonly used medications during labour and delivery. Recent insights from basic neuroscience research suggest that the uterotonic effects of oxytocin may arguably be trivial when compared with its profound effects on higher‐order human behaviour. The purpose of this review is to highlight the potential consequences of manipulating oxytocinergic signalling during the peripartum period and its long‐term impact on the maternal‐infant dyad. We identified four domains where modulation of oxytocinergic signalling might be consequential: postpartum depression; breastfeeding; neurodevelopment; and chronic pain, and performed a literature search to address the impact of peripartum oxytocin administration. We have shown modest, but inconsistent, evidence linking peripartum oxytocin administration with postpartum depression. Breastfeeding success appeared to be negatively correlated with peripartum oxytocin exposure, perhaps secondary to impaired primitive neonatal reflexes and maternal‐infant bonding. The association between perinatal oxytocin exposure and subsequent development of neurodevelopmental disorders such as autism in the offspring was weak, but these studies were limited by the lack of information on the cumulative dose. Finally, we identified substantial evidence for analgesic and anti‐hypersensitivity effects of oxytocin which might partly explain the low incidence of chronic pain after caesarean birth. Although most data presented here are observational, our review points to a compelling need for robust clinical studies to better dissect the impact of peripartum oxytocin administration, and as stewards of its use, increase the precision with which we administer oxytocin to prevent overuse of the drug.