Investigation of the impact of birth by cesarean section on fetal and maternal metabolism

Shokry, Engy; Marchioro, Linda; Uhl, Olaf; García-Bermúdez, Mercedes; García-Santos, José Antonio; Segura, María Teresa; Campoy, Cristina; Koletzko, Berthold

doi:10.1007/s00404-019-05213-w

Cited by 13 publications

(10 citation statements)

References 47 publications

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“…The strongest relationships with the cord blood metabolome were events that were in close temporal proximity to the sample being collected (delivery mode) or of fundamental biological importance (sex and birth order). While sex imprinting on the metabolome of infants has been frequently described [32,33], as has the difference in delivery mode [34][35][36], we were surprised to find that birth order (i.e. first born or having older siblings) was also reflected in the metabolome.…”

Section: Discussionmentioning

confidence: 73%

Umbilical cord blood metabolome differs in relation to delivery mode, birth order and sex, maternal diet and possibly future allergy development in rural children

et al. 2021

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Allergy is one of the most common diseases among young children yet all factors that affect development of allergy remain unclear. In a small cohort of 65 children living in the same rural area of south-west Sweden, we have previously found that maternal factors, including prenatal diet, affect childhood allergy risk, suggesting that in utero conditions may be important for allergy development. Here, we studied if metabolites in the umbilical cord blood of newborns may be related to development of childhood allergy, accounting for key perinatal factors such as mode of delivery, birth order and sex. Available umbilical cord blood plasma samples from 44 of the participants were analysed using gas chromatography-mass spectrometry metabolomics; allergy was diagnosed by specialised paediatricians at ages 18 months, 3 years and 8 years and included eczema, asthma, food allergy and allergic rhinoconjunctivitis. Nineteen cord blood metabolites were related to future allergy diagnosis though there was no clear pattern of up- or downregulation of metabolic pathways. In contrast, perinatal factors birth order, sex and mode of delivery affected several energy and biosynthetic pathways, including glutamate and aspartic acid—histidine metabolism (p = 0.004) and the tricarboxylic acid cycle (p = 0.006) for birth order; branched chain amino acid metabolism (p = 0.0009) and vitamin B6 metabolism (p = 0.01) for sex; and glyoxylate and dicarboxylic acid metabolism (p = 0.005) for mode of delivery. Maternal diet was also related to some of the metabolites associated with allergy. In conclusion, the cord blood metabolome includes individual metabolites that reflect lifestyle, microbial and other factors that may be associated with future allergy diagnosis, and also reflects temporally close events/factors. Larger studies are required to confirm these associations, and perinatal factors such as birth order or siblings must be considered in future cord-blood metabolome studies.

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Section: Discussionmentioning

confidence: 73%

Umbilical cord blood metabolome differs in relation to delivery mode, birth order and sex, maternal diet and possibly future allergy development in rural children

et al. 2021

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“…The transfer of bacteria from the pregnant mother to the foetus is universal in the animal kingdom. Bacterial translocation from the intestine to the maternal blood stream and from there to other organ systems is increased during pregnancy [27] . Multiple recent studies employing meconium as a proxy for in utero bacterial communities suggest that bacterial transmission from the mother to the foetus is a regular occurrence during human pregnancies [ 15 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Is the delivery mode a critical factor for the microbial communities in the meconium?

et al. 2019

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Background: Mothers are the primary source of bacteria for newborns, but it is unclear whether motherto-newborn transmission occurs prior to, during or after birth. Similarly, the effect of the delivery mode on neonatal microorganisms has been the focus of controversy. Methods: Healthy maternal and neonatal pairs that underwent vaginal birth and caesarean section were enrolled in this study. Meconium, placenta, membrane and amniotic fluid samples for newborns and vaginal, rectal and oral samples for mothers were collected. All samples were amplified and sequenced by a 16S rRNA gene primer set targeting bacteria and archaea. Findings: A total of 550 samples from 36 mother-neonate pairs with vaginal births and 42 motherneonate pairs with caesarean sections were included in this study. The negative controls showed that the data analysis in this study was not affected by contamination. There was a high diversity of microbial communities in the pregnancy environment of the foetus. Meconium samples could be divided into three distinct types that were not influenced by the delivery method. Interpretation: The distribution patterns of bacterial communities in the meconium, placenta, and foetal membranes were highly similar and had nothing to do with the mode of delivery. For approximately half of the placental microorganisms, the same sequence could be found in the vaginal, rectal, and oral samples of the mother.

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“…Most prominently, we and others have demonstrated alterations of the infant gut microbiome in C-section delivered children (primarily a depletion of Bacteroides taxa), 7 – 10 which may relate to obesity later in life. 11 Delivery via C-section may also cause immune dysregulation, 12 altered metabolism, 13 or epigenetic alterations in the offspring, 14 independent of (or dependent on) gut microbiota.…”

Section: Introductionmentioning

confidence: 99%

Association between cesarean delivery types and obesity in preadolescence

et al. 2020

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Background/Objectives: The association between mode of delivery and childhood obesity remains inconclusive. Because few studies have separated C-section types (planned or unplanned C-section), our objective was to assess how these subtypes relate to pre-adolescent obesity. Subjects/Methods: The study consisted of 570 maternal-child pairs drawn from the WHEALS birth cohort based in Detroit, Michigan. Children were followed-up at 10 years of age where a variety of anthropometric measurements were collected. Obesity was defined based on BMI percentile (≥95th percentile), as well as through gaussian finite mixture modeling on the anthropometric measurements. Risk ratios (RRs) and 95% confidence intervals (CIs) for obesity comparing planned and unplanned C-sections to vaginal deliveries were computed, which utilized inverse probability weights to account for loss to follow-up and multiple imputation for covariate missingness. Mediation models were fit to examine the mediation role of breastfeeding. Results: After adjusting for marital status, maternal race, prenatal tobacco smoke exposure, maternal age, maternal BMI, any hypertensive disorders during pregnancy, gestational diabetes, prenatal antibiotic use, child sex, parity, and birthweight z-score, children born via planned C-section had 1.77 times higher risk of obesity (≥95th percentile), relative to those delivered vaginally ((95% CI)=(1.16,2.72); p=0.009). No association was found comparing unplanned C-section to vaginal delivery (RR (95% CI)=0.75 (0.45, 1.23); p=0.25). Results were similar but slightly stronger when obesity was defined by anthropometric class (RR (95% CI)=2.78 (1.47, 5.26); p=0.002). Breastfeeding did not mediate the association between mode of delivery and obesity. Conclusions: These findings indicate that children delivered via planned C-section—but not unplanned C-section—have a higher risk of pre-adolescent obesity, suggesting that partial labor or membrane rupture (typically experienced during unplanned C-section delivery) may offer protection. Additional research is needed to understand the biological mechanisms behind this effect, including whether microbiological differences fully or partially account for the association.

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Investigation of the impact of birth by cesarean section on fetal and maternal metabolism

Cited by 13 publications

References 47 publications

Umbilical cord blood metabolome differs in relation to delivery mode, birth order and sex, maternal diet and possibly future allergy development in rural children

Umbilical cord blood metabolome differs in relation to delivery mode, birth order and sex, maternal diet and possibly future allergy development in rural children

Is the delivery mode a critical factor for the microbial communities in the meconium?

Association between cesarean delivery types and obesity in preadolescence

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