Epigenetics

What is the issue?

Human Genome Project (Olden et al. 2011).

Epigenetics (Clark et al. 2013).

Prenatal development (Wright et al. 2013). There is more than enough research evidence to justify having nurses counsel patients about epigenetic remodeling processes and the subsequent potential health consequences that can occur during prenatal and infant periods.

How doese it involve genetic or genomic health?

DNA methylation (Tollefsbol 2014). Increase in methylation of CpGs affects prenatal and postnatal gene expression (Wright et al. 2013).

Impact on Care or Health

Perinatal stress (Dahlen et al. 2013). Prenatal tobacco exposure (Wright et al. 2013). Birth via cesarean section (Clark et al. 2013). Fetal exposure to famine (Wright et al. 2013). Prenatal stress (Portha et al. 2014). Physiologic labor and birth (Clark et al. 2013).

Background
EPIIC (Epigenetic Impact of Childbirth) (Clark 2013).

Nursing evidence-based practice (Wright et al. 2013).

Current state of the science.

Epigenetics evidence-based care (Clark et al. 2013). What research has been conducted? Natural experiments Longitudinal birth cohorts Longitudinal twin studies Prenatal cohorts In vitro fertilization conception cohorts What is known/unknown? Limited knowledge about epigenome. More research. More rigor in research studies. (Mill & Heijmans 2013)

Ethical, legal, and social implications.

Environmental challenges. Impacts on health across multiple generations. Legal and financial implications are complicated. (Wright et al. 2013)

Salient to nursing practice. Role of the nurse.

The issue salient to nursing practice is how to use an individuals available epigenomic data for use in clinical practice, serving as the basis for personalized strategies in the prevention, prediction, and treatment of disease.

The role of the nurse is to extend their knowledge beyond genetics and embrace epigenetics in their investigation of complex disease prevention, screening, diagnosis, and treatment.

Nursing competencies
Identify patients who may benefit.

Family history.
Educate patients. Promote disease prevention practices: Prenatal and postnatal development. Transgenerational risk factors Keep current on latest research.

Interpret data for patients.

(American Nurses Association 2008)

References
Clark, A. E., Adamian, M., & Taylor, J. Y. (2013). An Overview of Epigenetics in Nursing. Genomics, 48(4), 649659. doi:10.1016/j.cnur.2013.08.004 Consensus Panel (2008). Essentials of genetic and genomic nursing: competencies, curricula guidelines and outcome indicators. 2nd edition. Silver Spring, MD: American Nurses Association. Dahlen, H. G., Kennedy, H. P., Anderson, C. M., Bell, A. F., Clark, A., Foureur, M., Downe, S. (2013). The EPIIC hypothesis: Intrapartum effects on the neonatal epigenome and consequent health outcomes. Medical Hypotheses, 80(5), 656662. doi:10.1016/j.mehy.2013.01.017 Feinberg, A. P. (2007). Phenotypic plasticity and the epigenetics of human disease. Nature, 447(7143), 433440. doi:10.1038/nature05919

Consensus Panel (2008). Essentials of genetic and genomic nursing: competencies, curricula guidelines and outcome indicators. 2nd edition. Silver Spring, MD: American Nurses Association.
Mill, J., & Heijmans, B. T. (2013). From promises to practical strategies in epigenetic epidemiology. Nature Reviews Genetics, 14(8), 585594. Olden, K., Freudenberg, N., Dowd, J., & Shields, A. E. (2011). Discovering how environmental exposures alter genes could lead to new treatments for chronic illnesses. Health Affairs, 30(5), 833 841.

Portha, B., Fournier, A., Ah Kioon, M. D., Mezger, V., & Movassat, J. (2014). Early environmental factors, alteration of epigenetic marks and metabolic disease susceptibility. Biochimie, 97(0), 1 15. doi:10.1016/j.biochi.2013.10.003
Tollefsbol, T. (2014). Dietary Epigenetics in Cancer and Aging. In V. Zappia, S. Panico, G. L. Russo, A. Budillon, & F. Della Ragione (Eds.), Advances in Nutrition and Cancer (Vol. 159, pp. 257 267). Springer Berlin Heidelberg. Retrieved from http://dx.doi.org/10.1007/978-3-642-38007-5_15 Wright, M. L., Ralph, J. L., Ohm, J. E., & Anderson, C. M. (2013). DNA methylation in complex disease: Applications in nursing research, practice, and policy. Council for the Advancement of Nursing Science, 61(4), 235241.e4. doi:10.1016/j.outlook.2013.04.010