Oxytocin receptor DNA methylation is associated with exogenous oxytocin needs during parturition and postpartum hemorrhage

Plain language summaryOxytocin is a hormone produced by the body during childbirth and can cause contractions of the uterus (womb). Synthetic oxytocin is used as a medicine for stimulating or increasing uterine contractions and controlling bleeding after birth. The oxytocin receptor gene, which enables the body to use oxytocin, can be altered by a chemical modification called DNA methylation. We found that the those who bled more during childbirth had higher oxytocin receptor gene DNA methylation compared to those who had normal bleeding. Higher methylation was also linked to needing greater amounts of oxytocin during labor to achieve vaginal birth and control bleeding. These findings identify that certain problems during birth may be related to oxytocin receptor gene methylation. This research could lead to improvements in how versions of oxytocin are used during the birth process by using the amount of oxytocin receptor gene methylation to predict people who may have problems with uterine contractions or bleeding. BackgroundThe oxytocin receptor gene (OXTR) is regulated, in part, by DNA methylation. This mechanism has implications for uterine contractility during labor and for prevention or treatment of postpartum hemorrhage, an important contributor to global maternal morbidity and mortality.MethodsWe measured and compared the level of OXTR DNA methylation between matched blood and uterine myometrium to evaluate blood as an indicator of uterine methylation status using targeted pyrosequencing and sites from the Illumina EPIC Array. Next, we tested for OXTR DNA methylation differences in blood between individuals who experienced a postpartum hemorrhage arising from uterine atony and matched controls following vaginal birth. Bivariate statistical tests, generalized linear modeling and Poisson regression were used in the analyses.ResultsHere we show a significant positive correlation between blood and uterine DNA methylation levels at several OXTR loci. Females with higher OXTR DNA methylation in blood had required significantly more exogenous oxytocin during parturition. With higher DNA methylation, those who had oxytocin administered during labor had significantly greater relative risk for postpartum hemorrhage (IRR 2.95, 95% CI 1.53-5.71).ConclusionsWe provide evidence that epigenetic variability in OXTR is associated with the amount of oxytocin administered during parturition and moderates subsequent postpartum hemorrhage. Methylation can be measured using a peripheral tissue, suggesting potential use in identifying individuals susceptible to postpartum hemorrhage. Future studies are needed to quantify myometrial gene expression in connection with OXTR methylation. Erickson et al. compare OXTR DNA methylation in individuals who experienced a postpartum hemorrhage arising from uterine atony and matched controls. Those with higher OXTR DNA methylation required more oxytocin during parturition and had a higher risk of postpartum hemorrhage.