Washington University School of Medicine in St. Louis, St Louis, MO, USA.
Anaesthesia. 2021 Nov;76(11):1526-1537. doi: 10.1111/anae.15553. Epub 2021 Aug 12.
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.
催产素是分娩过程中最常用的药物之一。基础神经科学研究的新发现表明，与催产素对人类高级行为的深远影响相比，其子宫收缩作用可能微不足道。本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对子的长期影响。我们确定了四个可能具有重要意义的领域：产后抑郁症；母乳喂养；神经发育；以及慢性疼痛，并进行了文献检索以探讨围产期催产素给药的影响。我们已经证明了适度但不一致的证据，将围产期催产素给药与产后抑郁症联系起来。母乳喂养的成功率似乎与围产期催产素暴露呈负相关，这可能是由于原始新生儿反射和母婴结合受损所致。围产期催产素暴露与后代神经发育障碍（如自闭症）之间的关联较弱，但这些研究受到关于累积剂量信息缺乏的限制。最后，我们确定了催产素具有镇痛和抗超敏反应的大量证据，这可能部分解释了剖宫产术后慢性疼痛发生率较低的原因。虽然这里提出的大多数数据都是观察性的，但我们的综述表明，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给药的影响，并作为其使用的管理者，提高我们给药的精确性，以防止药物滥用。
