The puzzle of pulsatile oxytocin secretion during lactation: some new pieces

Commentary on the Adaptive Significance of Sociality Around Parturition Events, and Conspecific Support of Parturient Females in Some Social Mammals

In recent decades, it has become apparent that during parturition events in a number of social mammals, social support behaviours from group mates can be directed to parturient females (and their newborn neonates). Such behaviour has been documented in diverse taxa, across non-human primates, Elephantidae, Cetacea, and Chiroptera, living in a range of social group organisations, from matrilineal groups to cooperatively breeding groups and multi-male, multi-female groups. Since sociality, in association with parturition, has been demonstrated to confer several health benefits to human mothers and neonates, here, we also consider the potential adaptive significance of social support behaviours for other, non-human, social mammals. If appropriate social environments reduce a parturient female's dystocia risk and improve her responsiveness to her neonate following a successful birth, then the impacts of the peri-parturient social environment may ultimately have far-reaching impacts on the mother-neonate dyad's fitness. This seems a logical sequela since the health condition of a neonate at birth and the successful establishment of a strong maternal-neonate bond are often the most critical factors influencing mammalian offspring survival to independence. The principles of kin selection and alliance enhancement may serve to explain the fitness benefits to individuals who support group mates during their parturition and thus the selective advantage conferred to those exhibiting such behaviours. Older, multiparous females appear to hold a particularly important role in the assistance they can provide during the parturition of their group mates, given their greater level of experience of these events. Furthermore, a social birth may have an important influence on horizontal information transfer within a group. In particular, in long-lived, cognitively advanced social mammals (e.g., non-human primates, Elephantidae, Cetacea), witnessing birth events, early neonate responses, and maternal care, and engaging in allomaternal care with young neonates may be essential for nulliparous females' normal development. Such events may serve to prepare them for their own parturition and may improve their own parturition-related survivorship and that of their first-born offspring. Thus, it is vital that a better understanding is gained of the importance and salient features of social births in improving the health and survivorship outcomes for both the mother and her offspring in highly social species. The aim of this commentary is to assemble our current understanding of these highly interconnected themes. We suggest in the future, insights gained through observation of non-human social parturition in domestic and non-domestic species, by a wide and highly interdisciplinary range of stakeholders (including zookeepers, wildlife tourism guides, breeders of domestic animals, indigenous people, and ethologists), will be critical for enhancing our understanding of the influence of social environment on this rarely witnessed, yet highly important life event.

Stimulation Therapy to Induce Mothers: Protocol for a Multicenter Randomized Controlled Trial

BACKGROUND

More than 1 million women have their labor induced in the United States each year, and synthetic oxytocin infusion is the most common method used. However, compared to spontaneous labor, medical induction is resource intensive, has increased obstetric risks, and is associated with less successful breastfeeding. In contrast to the endogenous oxytocin hormone, which is released in a pulsatile fashion in the brain, synthetic oxytocin is continuously infused intravenously, resulting in important limitations related to efficacy, safety, and cost. Akin to spontaneous labor contractions, infant suckling of the breast nipple is known to stimulate the pulsatile release of endogenous oxytocin from the posterior pituitary gland. Nipple stimulation therapy via an electric breast pump similarly stimulates endogenous oxytocin release and may be a favorable inpatient method for patients undergoing labor induction.

OBJECTIVE

This study aims to examine whether inpatient nipple stimulation therapy is an efficacious labor induction method that increases the likelihood of spontaneous vaginal delivery and sustained breastfeeding and determine whether it is a cost-effective approach.

METHODS

This is a multicenter, pragmatic, open-label, parallel-group randomized controlled trial of nulliparous patients with singleton gestations ≥36 weeks undergoing labor induction. This trial compares inpatient nipple stimulation therapy via an electric breast pump versus immediate synthetic oxytocin infusion without nipple stimulation. This trial including 988 nulliparas will provide adequate statistical power to detect clinically meaningful differences in delivery mode and breast milk as the sole source of nutrition for newborns at hospital discharge or 72 hours after birth.

RESULTS

The project received pilot funding in 2021 and full funding in 2023. Enrollment for this study began in November 2021 at a single site, and as of May 2024, recruitment is underway at 3 study sites. It is anticipated that enrollment will be completed by late 2026.

CONCLUSIONS

Successful completion of this trial will provide rigorous data to determine whether inpatient nipple stimulation therapy with an electric breast pump can improve the way we induce labor and positively impact breastfeeding success and early infant nutrition through lactation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05079841; https://clinicaltrials.gov/study/NCT05079841.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63463.

The Role of Oxytocin in Domestic Animal’s Maternal Care: Parturition, Bonding, and Lactation

Oxytocin (OXT) is one of the essential hormones in the birth process; however, estradiol, prolactin, cortisol, relaxin, connexin, and prostaglandin are also present. In addition to parturition, the functions in which OXT is also involved in mammals include the induction of maternal behavior, including imprinting and maternal care, social cognition, and affiliative behavior, which can affect allo-parental care. The present article aimed to analyze the role of OXT and the neurophysiologic regulation of this hormone during parturition, how it can promote or impair maternal behavior and bonding, and its importance in lactation in domestic animals.

Roles of Oxytocin in Stress Responses, Allostasis and Resilience

Oxytocin has been revealed to work for anxiety suppression and anti-stress as well as for psychosocial behavior and reproductive functions. Oxytocin neurons are activated by various stressful stimuli. The oxytocin receptor is widely distributed within the brain, and oxytocin that is released or diffused affects behavioral and neuroendocrine stress responses. On the other hand, there has been an increasing number of reports on the role of oxytocin in allostasis and resilience. It has been shown that oxytocin maintains homeostasis, shifts the set point for adaptation to a changing environment (allostasis) and contributes to recovery from the shifted set point by inducing active coping responses to stressful stimuli (resilience). Recent studies have suggested that oxytocin is also involved in stress-related disorders, and it has been shown in clinical trials that oxytocin provides therapeutic benefits for patients diagnosed with stress-related disorders. This review includes the latest information on the role of oxytocin in stress responses and adaptation.

The Effects of Intrapartum Administration of Synthetic Oxytocin on Breastfeeding in the First 9 Months Postpartum: A Longitudinal Prospective Study

Background and Objective: Synthetic oxytocin (synOT) is a widely used drug to induce or accelerate labor and to prevent postpartum hemorrhage. Although some studies indicate there are associations between intrapartum synOT and impaired breastfeeding initiation or earlier cessation, the long-term effects of synOT on breastfeeding are largely understudied. The aim of this study was to examine the effects of synOT on breastfeeding status during the first 9 months postpartum. Materials and Methods: The women were recruited from five maternity hospitals during prenatal medical checkups or postpartum hospital stay. They reported their breastfeeding status on discharge from maternity hospital (mean 4.54 days postpartum) (N = 439), at 6 weeks (N = 439), and at 9 months postpartum (N = 274). The data related to synOT administration were extracted from the medical records. Results: In the analysis adjusted for maternal age, parity, educational level, marital status, child's sex, delivery mode, and labor analgesia/anesthesia, intrapartum administration of synOT predicted a lower probability of exclusive breastfeeding on discharge from maternity hospital (odds ratio = 0.37; p = 0.006), but we observed no effect on breastfeeding status at 6 weeks or 9 months postpartum. Conclusion: Our results suggest that adverse effects of synOT on breastfeeding do not persist beyond the first postpartum days.

Oxytocin: at birth and beyond. A systematic review of the long-term effects of peripartum oxytocin

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.

Oxytocin and vasopressin increase male-directed threats and vocalizations in female macaques

In a previous study, we reported that intranasal delivery of both oxytocin (OT) and arginine vasopressin (AVP) to male macaques relaxes spontaneous social interactions, flattens the existing dominance hierarchy, and increases behavioral synchrony with other monkeys. Here we report that intranasal OT and AVP administration modulates the behaviors of female macaque monkeys, but in robustly different ways from males. Most notably, both neuropeptides increase threatening and vocalization behaviors of females when they encounter males, and these behaviors effectively increase the social status of females over males. While OT and AVP heighten the confrontational nature of intersexual encounters, both peptides relax interactions between females. Finally, as previously reported for males, treating an individual female monkey with OT or AVP significantly modulates the behavior of her non-treated partner. Together, these findings show that OT and AVP can either inhibit or promote aggression, depending on sex and behavioral context, and call for a more careful, systematic examination of the functions of these neuropeptides in both sexes, especially in the context of therapeutics for human social disorders.

Neuroendocrine regulation of lactation and milk production

Prolactin (PRL) released from lactotrophs of the anterior pituitary gland in response to the suckling by the offspring is the major hormonal signal responsible for stimulation of milk synthesis in the mammary glands. PRL secretion is under chronic inhibition exerted by dopamine (DA), which is released from neurons of the arcuate nucleus of the hypothalamus into the hypophyseal portal vasculature. Suckling by the young activates ascending systems that decrease the release of DA from this system, resulting in enhanced responsiveness to one or more PRL-releasing hormones, such as thyrotropin-releasing hormone. The neuropeptide oxytocin (OT), synthesized in magnocellular neurons of the hypothalamic supraoptic, paraventricular, and several accessory nuclei, is responsible for contracting the myoepithelial cells of the mammary gland to produce milk ejection. Electrophysiological recordings demonstrate that shortly before each milk ejection, the entire neurosecretory OT population fires a synchronized burst of action potentials (the milk ejection burst), resulting in release of OT from nerve terminals in the neurohypophysis. Both of these neuroendocrine systems undergo alterations in late gestation that prepare them for the secretory demands of lactation, and that reduce their responsiveness to stimuli other than suckling, especially physical stressors. The demands of milk synthesis and release produce a condition of negative energy balance in the suckled mother, and, in laboratory rodents, are accompanied by a dramatic hyperphagia. The reduction in secretion of the adipocyte hormone, leptin, a hallmark of negative energy balance, may be an important endocrine signal to hypothalamic systems that integrate lactation-associated food intake with neuroendocrine systems.

Lack of association between human plasma oxytocin and interpersonal trust in a Prisoner's Dilemma paradigm

Expanding interest in oxytocin, particularly the role of endogenous oxytocin in human social behavior, has created a pressing need for replication of results and verification of assay methods. In this study, we sought to replicate and extend previous results correlating plasma oxytocin with trust and trustworthy behavior. As a necessary first step, the two most commonly used commercial assays were compared in human plasma via the addition of a known quantity of exogenous oxytocin, with and without sample extraction. Plasma sample extraction was found to be critical in obtaining repeatable concentrations of oxytocin. In the subsequent trust experiment, twelve samples in duplicate, from each of 82 participants, were collected over approximately six hours during the performance of a Prisoner’s Dilemma task paradigm that stressed human interpersonal trust. We found no significant relationship between plasma oxytocin concentrations and trusting or trustworthy behavior. In light of these findings, previous published work that used oxytocin immunoassays without sample extraction should be reexamined and future research exploring links between endogenous human oxytocin and trust or social behavior should proceed with careful consideration of methods and appropriate biofluids for analysis.

The role of oxytocin in male and female reproductive behavior

Oxytocin (OT) is a nonapeptide with an impressive variety of physiological functions. Among them, the 'prosocial' effects have been discussed in several recent reviews, but the direct effects on male and female sexual behavior did receive much less attention so far. As our contribution to honor the lifelong interest of Berend Olivier in the control mechanisms of sexual behavior, we decided to explore the role of OT in the present review. In the successive sections, some physiological mechanisms and the 'pair-bonding' effects of OT will be discussed, followed by sections about desire, female appetitive and copulatory behavior, including lordosis and orgasm. At the male side, the effects on erection and ejaculation are reviewed, followed by a section about 'premature ejaculation' and a possible role of OT in its treatment. In addition to OT, serotonin receives some attention as one of the main mechanisms controlling the effects of OT. In the succeeding sections, the importance of OT for 'the fruits of labor' is discussed, as it plays an important role in both maternal and paternal behavior. Finally, we pay attention to an intriguing brain area, the ventrolateral part of the ventromedial hypothalamic nucleus (VMHvl), apparently functioning in both sexual and aggressive behavior, which are at first view completely opposite behavioral systems.

Intranasal administration of oxytocin: behavioral and clinical effects, a review

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The mechanisms behind the effects of IN-applied substances need more attention.

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The mechanisms involved in the brain-distribution of IN-OT are completely unexplored.

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The possibly cascading effects of IN-OT on the intrinsic OT-system require serious investigation.

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IN-OT induces clear and specific changes in neural activation.

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IN-OT is a promising approach to treat certain clinical symptoms.

The intranasal (IN-) administration of substances is attracting attention from scientists as well as pharmaceutical companies. The effects are surprisingly fast and specific. The present review explores our current knowledge about the routes of access to the cranial cavity. ‘Direct-access-pathways’ from the nasal cavity have been described but many additional experiments are needed to answer a variety of open questions regarding anatomy and physiology.

Among the IN-applied substances oxytocin (OT) has an extensive history. Originally applied in women for its physiological effects related to lactation and parturition, over the last decade most studies focused on their behavioral ‘prosocial’ effects: from social relations and ‘trust’ to treatment of ‘autism’.

Only very recently in a microdialysis study in rats and mice, the ‘direct-nose-brain-pathways’ of IN-OT have been investigated directly, implying that we are strongly dependent on results obtained from other IN-applied substances. Especially the possibility that IN-OT activates the ‘intrinsic’ OT-system in the hypothalamus as well needs further clarification.

We conclude that IN-OT administration may be a promising approach to influence human communication but that the existing lack of information about the neural and physiological mechanisms involved is a serious problem for the proper understanding and interpretation of the observed effects.

A brief history of oxytocin and its role in modulating psychostimulant effects

Over the past century, the polypeptide oxytocin has played an important role in medicine with major highlights including the identification of its involvement in parturition and the milk let-down reflex. Oxytocin is now implicated in an extensive range of psychological phenomena including reward and memory processes and has been investigated as a treatment for several psychiatric disorders including addiction, anxiety, autism, and schizophrenia. In this review, we first provide an historical overview of oxytocin and describe key aspects of its physiological activity. We then outline some pharmacological limitations in this field of research before highlighting the role of oxytocin in a wide range of behavioral and neuronal processes. Finally, we review evidence for a modulatory role of oxytocin with regard to psychostimulant effects. Key findings suggest that oxytocin attenuates a broad number of cocaine and methamphetamine induced behaviors and associated neuronal activity in rodents. Evidence also outlines a role for oxytocin in the prosocial effects of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) in both rodents and humans. Clinical trials should now investigate the effectiveness of oxytocin as a novel intervention for psychostimulant addiction and should aim to determine its specific role in the therapeutic properties of MDMA that are currently being investigated.

Neuropeptide transmission in brain circuits

Neuropeptides are found in many mammalian CNS neurons where they play key roles in modulating neuronal activity. In contrast to amino acid transmitter release at the synapse, neuropeptide release is not restricted to the synaptic specialization, and after release, a neuropeptide may diffuse some distance to exert its action through a G protein-coupled receptor. Some neuropeptides such as hypocretin/orexin are synthesized only in single regions of the brain, and the neurons releasing these peptides probably have similar functional roles. Other peptides such as neuropeptide Y (NPY) are synthesized throughout the brain, and neurons that synthesize the peptide in one region have no anatomical or functional connection with NPY neurons in other brain regions. Here, I review converging data revealing a complex interaction between slow-acting neuromodulator peptides and fast-acting amino acid transmitters in the control of energy homeostasis, drug addiction, mood and motivation, sleep-wake states, and neuroendocrine regulation.

Recent findings on neuroprotection against excitotoxicity in the hippocampus of female rats

Newborn mammals are totally dependent on maternal milk and care for survival. The mother's brain undergoes different behavioural, physiological and emotional adaptations that make the mother more likely to satisfy the demands of the offspring. Recent reports from our group show that, compared to nulliparous rats, lactation diminishes cell damage induced by excitotoxicity in the dorsal hippocampus of the dam after systemic or i.c. administration of kainic acid (KA) and the resulting motor seizures. Elevated levels of prolactin (PRL), oxytocin, progesterone and glucocorticoids are characteristics of lactation, and the pronounced fluctuation of these hormones occurring in this phase may play a role protecting the hippocampus. Indeed, PRL administration to ovariectomised rats significantly diminishes the deleterious effects of KA in the dorsal hippocampus and reduces the progression of KA-induced seizures. Thus, lactation is a natural model for neuroprotection because it effectively prevents acute and chronic cell damage of the hippocampus induced by excitotoxicity.

Mesolimbic dopamine transients in motivated behaviors: focus on maternal behavior

Phasic activity of the mesolimbic dopamine pathway - burst-firing of dopamine neurons and the resulting dopamine release events at striatal targets - have been associated with a variety of motivational events, such as novelty, salient stimuli, social interaction, and reward prediction. Over the past decade, advances in electrochemical techniques have allowed measurement of naturally occurring dopamine release events, or dopamine transients, in awake animals during ongoing behavior. Thus, a growing body of studies has revealed dynamic dopamine input to ventral striatum during motivated behavior in a variety of experimental paradigms. We propose that dopamine transients may be important neural signals in pup-directed aspects of maternal behavior, as preliminary data suggest that dopamine transients in dams are associated with pup cues. Measurements of dopamine transients may be useful to investigate not only typical maternal behavior but also maternal inattention induced by drug exposure or stress.

Neuroprotective effects of lactation against kainic acid treatment in the dorsal hippocampus of the rat

Marked hippocampal changes in response to excitatory amino acid agonists occur during pregnancy (e.g. decreased frequency in spontaneous recurrent seizures in rats with KA lesions of the hippocampus) and lactation (e.g. reduced c-Fos expression in response to N-methyl-d,l-aspartic acid but not to kainic acid). In this study, the possibility that lactation protects against the excitotoxic damage induced by KA in hippocampal areas was explored. We compared cell damage induced 24 h after a single systemic administration of KA (5 or 7.5 mg/kg bw) in regions CA1, CA3, and CA4 of the dorsal hippocampus of rats in the final week of lactation to that in diestrus phase. To determine cellular damage in a rostro-caudal segment of the dorsal hippocampus, we used NISSL and Fluorojade staining, immunohistochemistry for active caspase-3 and TUNEL, and we observed that the KA treatment provoked a significant loss of neurons in diestrus rats, principally in the pyramidal cells of CA1 region. In contrast, in lactating rats, pyramidal neurons from CA1, CA3, and CA4 in the dorsal hippocampus were significantly protected against KA-induced neuronal damage, indicating that lactation may be a natural model of neuroprotection.