Childbirth and consequent atopic disease: emerging evidence on epigenetic effects based on the hygiene and EPIIC hypotheses

Abstract

Background: In most high and middle income countries across the world, at least 1:4 women give birth by cesarean
section. Rates of labour induction and augmentation are rising steeply; and in some countries up to 50 % of laboring
women and newborns are given antibiotics. Governments and international agencies are increasingly concerned about
the clinical, economic and psychosocial effects of these interventions.

Discussion: There is emerging evidence that certain intrapartum and early neonatal interventions might affect the
neonatal immune response in the longer term, and perhaps trans-generationally. Two theories lead the debate in this
area. Those aligned with the hygiene (or ‘Old Friends’) hypothesis have examined the effect of gut microbiome colonization
secondary to mode of birth and intrapartum/neonatal pharmacological interventions on immune response and epigenetic
phenomena. Those working with the EPIIC (Epigenetic Impact of Childbirth) hypothesis are concerned with the effects of
eustress and dys-stress on the epigenome, secondary to mode of birth and labour interventions.

Summary: This paper examines the current and emerging findings relating to childbirth and atopic/autoimmune
disease from the perspective of both theories, and proposes an alliance of research effort. This is likely to accelerate
the discovery of important findings arising from both approaches, and to maximize the timely understanding of the
longer-term consequences of childbirth practices.