The Effect of Type of Delivery on the Nitric Oxide Metabolites and Endothelial Dysfunction in Pregnant Women

Maedeh Mojiri, Maryam Kianpour, Mehdi Nematbakhsh, Parvin Bahadoran

Abstract


Background: Since endothelial dysfunction is related to atherosclerosis, this study was planned to determine the effect of type of delivery on Nitric Oxide (NO) metabolites and endothelial function.

Materials and Methods: This Cohort study was conducted in 2015 in selected hospitals of Isfahan. 88 nulliparous women with gestational age of 39 weeks and above were enrolled in this study using convenience sampling method and finally, after giving birth, 51 mothers with vaginal delivery, 21 with urgent C‑section and 13 with elective C‑section were considered for data analysis. The serum levels of NO metabolites were measured in the laboratory with standard kits and data was analyzed using student and paired t‑test, one‑way ANOVA, and Chi‑square test. The significance level was considered less than 0.05 for all tests.

Results: The NO metabolites levels in mothers who had vaginal delivery or urgent C‑section showed a significant difference before and after delivery (normal vaginal delivery (NVD): t50 = 5.61, p < 0.001, Urgent C‑section: t23 = 5.38, p < 0.001). But those with elective C‑section showed no significant difference in the nitrate and total nitrite levels before and after delivery (p > 0.05).

Conclusions: Since reduction in serum levels of NO metabolites may possibly indicate endothelial dysfunction and predict cardiovascular disease, especially atherosclerosis in the future, it could be concluded that, childbirth, regardless of the type of delivery, could damage the endothelial cells but C‑section (urgent or elective) could cause more disruption than vaginal delivery.


Keywords


Cesarean section, natural childbirth, nitrates, nitric oxide, nitrites

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References


Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics—2018 Update: A report from the American Heart Association. Circulation 2018;137:e67‑492.

Tabas I, García‑Cardeña G, Owens GK. Recent insights into the cellular biology of atherosclerosis. J Cell Biol 2015;209:13‑22.

Daiber A, Steven S, Weber A, Shuvaev VV, Muzykantov VR, Laher I, et al. Targeting vascular (endothelial) dysfunction. Br J Pharmacol 2017;174:1591‑619.

Coletta C, Módis K, Oláh G, Brunyánszki A, Herzig DS, Sherwood ER, et al. Endothelial dysfunction is a potential contributor to multiple organ failure and mortality in aged mice subjected to septic shock: Preclinical studies in a murine model of cecal ligation and puncture. Crit Care 2014;18:511.

Brandes RP. Endothelial dysfunction and hypertension. Hypertension 2014;64:924‑8.

Cheng H, Harris RC. Renal endothelial dysfunction in diabetic nephropathy. Cardiovasc Haematol Disord Drug Targets 2014;14:22‑33.

Muñoz M, Sánchez A, Pilar Martínez M, Benedito S, López‑Oliva M‑E, García‑Sacristán A, et al. COX‑2 is involved in vascular oxidative stress and endothelial dysfunction of renal interlobar arteries from obese Zucker rats. Free Radic Biol Med 2015;84:77‑90.

Di Marco LY, Venneri A, Farkas E, Evans PC, Marzo A, Frangi AF. Vascular dysfunction in the pathogenesis of Alzheimer’s disease — A review of endothelium‑mediated mechanisms and ensuing vicious circles. Neurobiol Dis 2015;82:593‑606.

de Resende Guimarães MF, Brandão AH, de Lima Rezende CA, Cabral AC, Brum AP, Leite HV, et al. Assessment of endothelial function in pregnant women with preeclampsia and gestational diabetes mellitus by flow‑mediated dilation of brachial artery. Arch Gynecol Obstet 2014;290:441‑7.

Tatsch E, Bochi GV, Pereira R da S, Kober H, Agertt VA, Anraku de Campos MM, et al. A simple and inexpensive automated technique for measurement of serum nitrite/nitrate. Clin Biochem 2011;44:348‑50.

Kobayashi H, Reid G, Hadfield M. Effects of vaginal delivery, cesarean section and exposure to labor on endothelial function of pregnant women. Thromb Res 2014;134:1004‑7.

Mao D, Che J, Li K, Han S, Yue Q, Zhu L, et al. Association of homocysteine, asymmetric dimethylarginine, and nitric oxide with preeclampsia. Arch Gynecol Obstet 2010;282:371‑5.

Zanardo V, Caroni G, Burlina A. Higher homocysteine concentrations in women undergoing caesarean section under general anesthesia. Thromb Res 2003;112:33‑6.

Buhimschi IA, Buhimschi CS, Pupkin M, Weiner CP. Beneficial impact of term labor: Nonenzymatic antioxidant reserve in the human fetus. Am J Obstet Gynecol 2003;189:181‑8.

Chitra M, Mathangi D, Johnson P, Sembulingam P. Maternal oxidative stress and antioxidant defence during labour. IOSR J Dent Med Sci 2015;14:10‑5.

Hung TH, Chen SF, Hsieh TT, Lo LM, Li MJ, Yeh YL. The associations between labor and delivery mode and maternal and placental oxidative stress. Reprod Toxicol 2011;31:144‑50.

Vakilian K, Ranjbar A, Zarganjfard A, Mortazavi M, Vosough‑Ghanbari S, Mashaiee S, et al. On the relation of oxidative stress in delivery mode in pregnant women; A toxicological concern. Toxicol Mech Methods 2009;:94‑9.

Bruno RM, Virdis A, Taddei S. Endothelial function. In: Berbari AE, Giuseppe M, editors. Disorders of Blood Pressure Regulation. Cham: Springer; 2018. p. 127‑34.

Jafari E, Mohebbi P, Mazloomzadeh S. Factors related to women’s childbirth satisfaction in physiologic and routine childbirth groups. Iran J Nurs Midwifery Res 2017;22:219‑24.

Gyurkovits Z, Hracskó Z, Zimányi M, Varga IS, Németh G, Pál A, et al. Comparison of oxidative stress markers in vaginal deliveries with or without epidural analgesia. Redox Rep 2013;18:8‑11.

Mehmetoglu I, Kart A, Caglayan O, Caprar M, Gokce R. Oxidative stress in mothers and their newborns in different types of labour. Turk J Med Sci 2002;32:427‑9.

Reimann M, Hamer M, Malan NT, Schlaich MP, Lambert GW, Ziemssen T, et al. Effects of acute and chronic stress on the L‑arginine nitric oxide pathway in black and white South Africans: The sympathetic activity and ambulatory blood pressure in Africans study. Psychosom Med 2013;75:751‑8.

Stjernholm YV, Nyberg A, Cardell M, Höybye C. Circulating maternal cortisol levels during vaginal delivery and elective cesarean section. Arch Gynecol Obstet 2016;294:267‑71.

Hu Y, Huang K, Sun Y, Wang J, Xu Y, Yan S, et al. Placenta response of inflammation and oxidative stress in low‑risk term childbirth: The implication of delivery mode. BMC Pregnancy Childbirth 2017;17:407.

Schulpis KH, Lazaropoulou C, Vlachos GD, Partsinevelos GA, Michalakakou K, Gavrili S, et al. Maternal‑neonatal 8‑hydroxy‑deoxyguanosine serum concentrations as an index of DNA oxidation in association with the mode of labour and delivery. Acta Obstet Gynecol Scand 2007;86:320‑6.

Nagababu E, Scott AV, Johnson DJ, Goyal A, Lipsitz JA, Barodka VM, et al. The impact of surgery and stored red blood cell transfusions on nitric oxide homeostasis. Anesth Analg 2016;123:274‑82.

Uggeri MJ, Proctor GJ, Johns RA. Halothane, enflurane, and isoflurane attenuate both receptor‑ and non‑ receptor‑mediated EDRF production in rat thoracic aorta. Anesthesiology 1992;76:1012‑7.

Hol JW, van Lier F, Valk M, Klimek M, Stolker RJ, Fekkes D. Effect of major and minor surgery on plasma levels of arginine, citrulline, nitric oxide metabolites, and ornithine in humans. Ann Surg 2013;258:1072‑8.

Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of venous thromboembolism after cesarean sections: A meta‑analysis. In: Chest. Elsevier B.V.; 2016. p. 572‑96. 30. Su JB. Vascular endothelial dysfunction and


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