Objectives: The purpose of this study was to evaluate differences in the metabolic pathways activated in late-pregnancy serum samples among African American women who went on to have term (≥37 weeks) labor induction requiring high total oxytocin doses to complete first-stage labor compared to those in similar women with low-oxytocin labor inductions.
Study design: Case-control study (N = 27 women with labor induction with successful cervical ripening: 13 requiring the highest total doses of synthetic oxytocin to progress from 4- to 10-cm cervical dilation and 14 requiring the lowest total doses) with groups balanced on parity and gestational age. Serum samples obtained between 24 and 30 weeks' gestation were analyzed using ultra-high-resolution metabolomics. Differentially expressed metabolites between high-oxytocin induction cases and low-oxytocin induction comparison subjects were evaluated using linear regression with xmsPANDA. Metabolic pathways analysis was conducted using Mummichog Version 2.0, with discriminating metabolites annotated using xMSannotator Version 1.3.
Results: Labor processes were similar by group with the exception that cases received over 6 times more oxytocin between 4- and 10-cm cervical dilation than comparison women. Induction requiring high total doses of synthetic oxytocin was associated with late-pregnancy serum levels of metabolites from the linoleate and fatty acid activation pathways in term, African American women.
Conclusion: Serum levels of several lipid metabolites predicted more complicated labor induction involving higher doses of synthetic oxytocin to complete first-stage labor. Further investigation in larger, more diverse cohorts of women is needed to identify potential targets to prevent failed labor induction.
Keywords: induction of labor; mechanisms; metabolomics; oxytocin; parturition.
Cervical dilation balloon combined with intravenous drip of oxytocin for induction of term labor: a multicenter clinical trial.Arch Gynecol Obstet. 2018 Jan;297(1):77-83. doi: 10.1007/s00404-017-4564-9. Epub 2017 Oct 17. Arch Gynecol Obstet. 2018. PMID: 29043436 Clinical Trial.
Cervical ripening before medical induction of labor: a comparison of prostaglandin E2, estradiol, and oxytocin.Am J Obstet Gynecol. 1995 Jun;172(6):1702-6; discussion 1704-8. doi: 10.1016/0002-9378(95)91401-3. Am J Obstet Gynecol. 1995. PMID: 7778622 Clinical Trial.
Induction of labor with misoprostol for premature rupture of membranes beyond thirty-six weeks' gestation.Am J Obstet Gynecol. 1998 Jul;179(1):94-9. doi: 10.1016/s0002-9378(98)70256-x. Am J Obstet Gynecol. 1998. PMID: 9704771 Clinical Trial.
Maternal and neonatal outcomes of elective induction of labor.Evid Rep Technol Assess (Full Rep). 2009 Mar;(176):1-257. Evid Rep Technol Assess (Full Rep). 2009. PMID: 19408970 Free PMC article. Review.
Prostaglandin E2 gel for cervical ripening and induction of labor: a critical analysis.Am J Obstet Gynecol. 1989 Mar;160(3):529-34. doi: 10.1016/s0002-9378(89)80020-1. Am J Obstet Gynecol. 1989. PMID: 2648830 Review.