She Got Hips Like Cinderella
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29 June 2009 Wiley - Blackwell
Swedish researchers have discovered that babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery, according to the July issue of Acta Paediatrica.
It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.
Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells - a vital part of the immune system.
This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.
“Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.
“That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells.”
The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed.
“Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress.
“We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery. When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb.”
The authors point out that the surgical procedure itself may play a role in DNA-methylation and that factors other than the delivery method need to be explored in more detail.
“In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels - proteins that provide a key marker for inflammation” says Professor Norman. “However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues.”
Professor Norman states that the Karolinska study clearly shows that gene-environment interaction through DNA-methylation is more dynamic around birth than previously known.
“The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications” he says.
“C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early ‘epigenetic’ programming of the immune system may have a role to play.”
The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.
“Although we do not know yet how specific gene expression is affected after C-section deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research” concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet.• Epigenetic modulation at birth – altered DNA-methylation in white blood cells after Caesarean section. Schlinzig et al. Acta Paediatrica. 98, 1096-1099. (July 2009).
From The Globe and Mail:
C-section not best option for breech birthBy, Carla Wintersgill
Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.
Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first.
“The safest way to deliver has always been the natural way,” said Dr. Lalonde.
“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”
The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.
We agreed that a kidney biopsy is necessary for proper diagnosis. This is higher risk to me because of the von Willebrands. But I feel it is necessary for proper diagnosis and (therefore) treatment.
The biopsy will take place some time next week. I'll have to be in the hossy overnight, so that blows. We are figuring out what to do with the kids and stuff...
There is a drug called desmopressin (DDAVP) that can be given to me to help my blood to clot, it worked well for Gabe's cesarean, so I think it will work again. Pray that I don't bleed to death. I will.
The kidneys are functioning fine for now, according to the creatinine blood test. There are both protein and blood in my pee still- not a whole lot, but enough to cause concern.
Dr. Warden gave me prescriptions but I am going to wait to fill them until after the blood work and biopsy is done.
Here is a little bit about how WG is diagnosed:
From The Cleveland Clinic:
A positive blood test for antineutrophil cytoplasmic antibodies (ANCA) can support a suspected diagnosis of the disease. However, this blood test does not by itself prove the diagnosis of Wegener's granulomatosis or determine disease activity.
Other tests that influence a doctor's judgment of disease activity include:
Measures of anemia (red blood cell count)
Sedimentation rate (the speed in which blood cells settle in a vertical glass tube)
Chest or sinus X-rays
From The Vasculitis Foundation:
Diagnosis is established by clinical and laboratory findings such as the ANCA blood test, other blood and urine tests, x-rays, and tissue biopsy, if needed.