The Role of Delivery Route on Colostrum Melatonin and Serum Il-6 Levels: a Prospective Controlled Study

Abstract

Introduction the aim of this study was to determine whether maternal serum IL-6 and postnatal melatonin levels change with the mode of delivery.

Materials and Methods a prospective controlled study was performed on pregnant women (17–43 years) over 37 weeks of pregnancy. Patients were divided into three groups according to the route of delivery: Group 1) 30 women delivering by vaginal route; Group 2) 30 delivering by iterative cesarean section (CS); Group 3) delivering by emergency CS. Maternal serum IL-6 levels were measured before and after delivery, and maternal colostrum melatonin levels after delivery, and the results between the 3 groups compared.

Results pre-delivery and post-delivery maternal serum IL-6 levels were significantly higher in patients who delivered vaginally than in patients who delivered by the abdominal route (p<0.01). Maternal colostrum melatonin levels of patients after delivery were significantly higher in patients who delivered vaginally (32.88±7.16 ng/L) than in patients who delivered by elective and emergent cesarean deliveries (24.86±2.40 ng/L and 23.73±4.03 ng/L, respectively) (p<0.01).

Conclusion These data support, should there ever be a further need, the benefit of vaginal delivery over cesarean section, in which cytokine and melatonin levels are reduced compared to vaginal delivery.

Key words

Interleukin 6 - melatonin - colostrum - vaginal delivery - cesarean section

• References

• 1 Tamura H, Nakamura Y, Terron PM. et al. Melatonin and pregnancy in the human. Reprod Toxicol 2008; 25: 291-303
• 2 La Fleur SE, Kalsbeek A, Wortel J. et al. Role for the pineal and melatonin in glucose homeostasis: pinealectomy increases night-time glucose concentrations. J Neuroendocrinol 2001; 13: 1025-1032
• 3 Lall GS, Atkinson LA, Corlett SA. et al. Circadian entrainment and its role in depression: a mechanistic review. J NeuralTransm (Vienna) 2012; 119: 1085-1096
• 4 Reitter JR, Calvo JRK, Karbownik M. et al. Melatonin and its relation to the immune system and inflammation. Ann N Y Acad Sci 2000; 917: 376-386
• 5 Namlı Kalemli M, Kalemli Z, Yüce T. et al. Comparison of melatonin levels in the colostrum between vaginal delivery and cesarean delivery. Am J Perinatol 2018; 35: 481-485
• 6 Renz-Polster H, David MR, Buist AS. et al. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy 2005; 35: 1466-1472
• 7 Cronin AJ, Keifer JC, Davies MF. et al. Melatonin secretion after surgery. Lancet 2000; 356: 1244-1245
• 8 Pontes NG, Cardoso CE, Carneiro-Sampaio MSM. et al. Pineal melatonin and the innate immune response: the TNF-∝increase after cesarean section suppresses nocturnal melatonin production. J Pineal Res 2007; 43: 365-371
• 9 Tamura EK, Silva CL, Markus RP. Melatonin inhibits endothelial nitric oxide production in vitro. J Pineal Res 2006; 41: 267-274
• 10 Silva CL, Tamura EK, Macedo SM. et al. Melatonin inhibits nitric oxide production by microvascular endothelial cells in vivo and in vitro. Br J Pharmacol 2007; 151: 195-205
• 11 Lissoni P, Rovelli F, Brivio F. et al. Circadian secretion of IL-2, IL-12, IL-6 and IL-10 in relation to the light/dark rhythm of the pineal hormone melatonin in healthy humans. Nat Immun 1998; 16: 1-5
• 12 Sothern RB, Roitman-Johnson B, Kanabrocki EL. et al. Circadian characteristicss of circulating IL-6 in men. J Allergy Clin Immunol 1995; 95: 1029-1035
• 13 Fernandes PA, Cecon E, Markus RP. et al. Effect of TNF-∝ on the melatonin synthetic pathway in the rat pineal gland: basis for a ‘feedback’ of immune response on circadian timing. J Pineal Res 2006; 41: 344-350
• 14 Pontes GN, Cardoso CE, Carneiro-Sampaio MSM. et al. Injury switches melatonin production source from endocrine (pineal) to paracrine (phagocytes) – melatonin in human colostrum and colostrum phagocytes. J Pineal Res 2006; 41: 136-141
• 15 Malamitsi-Puchner A, Protonotariou E, Boutsikou T. et al. The influence of the mode of delivery on circulating cytokine concentrations in the perinatal period. Early Hum Dev 2005; 81: 387-392
• 16 Barber EL, Lundsberg L, Belanger K. et al. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011; 118: 29-38
• 17 Berner R, Niemeyer CM, Leititis JU. et al. Plasma levels and gene expression of granulocyte colony-stimulating factor, tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-8, and soluble intercellular adhesion molecule-1 in neonatal early onset sepsis. Pediatr Res 1998; 44: 469-477
• 18 Winkler M, Kemp B, Fischer DC. et al. Tissue concentrations of cytokines in the lower uterine segment during preterm parturition. J Perinat Med 2001; 29: 519-527
• 19 Haghshshenas Mojaveri M, Mohammadzadeh I, Al-SadatBouzari Z. et al. The comparison of serum interleukin-6 of mothers in vaginal and iterative cesarean delivery. Caspian J Intern Med 2014; 5: 223-226
• 20 Rzehak P, Sausenthaler S, Koletzko S. et al. Period-specific growth, overweight and modification by breastfeeding in the GINI and LISA birth cohorts up to age 6 years. Eur J Epidemiol 2009; 24: 449-467
• 21 Zanardo V, Solda G, Trevisanuto D. Iterative cesarean section and fetal immune-endocrine response. Int J Gynaecol Obstet 2006; 95: 52-53
• 22 Hebisch G, Neumaier-Wagner PM. et al. Maternal serum interleukin-1 beta, -6 and -8 levels and potential determinants in pregnancy and peripartum. J Perinat Med 2004; 32: 475-480
• 23 Takahashi N, Uehara R, Kobayashi M. et al. Cytokine profiles of seventeen cytokines, growth factors and chemokines in cord blood and its relation to perinatal clinical findings. Cytokine 2010; 49: 331-337
• 24 Gitto E, Romeo C, Reiter RJ. et al. Melatonin reduces oxidative stress in surgical neonates. J Pediatr Surg 2004; 39: 184-189
• 25 Reiter JR, Tan DX, Korkmaz A. et al. Melatonin and stable circadian rhythms optimize maternal, placental and fetal physiology. Human Repr Update 2014; 20: 293-307
• 26 Lanoix D, Beghdadi H, Lafond J. et al. Human placental trophoblasts synthesize melatonin and express its receptors. J PinealRes 2008; 45: 50-60
• 27 Seron-Ferre M, Torres-Farfan C, Forcelledo ML. et al. The development of circadian rhythms in the fetus and neonate. Semin Perinatol 2001; 25: 363-370
• 28 Simonneaux V, Ribelayga C. Generation of the melatonin endocrine message in mammals: a review of the complex regulation of melatonin synthesis by norepinephrine, peptides and other pineal transmitters. Pharmacol Rev 2003; 55: 325-395
• 29 Skwarlo-Sonta K, Majewski P, Markowska M. et al. Bidirectional communication between the pineal gland and the immune system. Can J Physiol Pharmacol 2003; 81: 342-349
• 30 Carlosson B, Hanson LA Immunologic effects of breast-feeding on the infant.In Ogra P, Mestecky et al. (eds). Handbook of Mucosal Immunology. London: Academic Press; 1994: 653–666
• 31 Pires-Lapa MA, Tamura EK, Salustiano EMA. et al. Melatonin synthesis in human colostrum mononuclear cells enhances dectin-1-mediated phagocytosis by mononuclear cells. J Pineal Res 2013; 55: 240-246