Maternal bacteria to correct abnormal gut microbiota in babies born by C-section

Abstract

Introduction: There is evidence that caesarean section (CS) is associated with increased risk of childhood obesity, asthma, and coeliac disease. The gut microbiota of CS-born babies differs to those born vaginally, possibly due to reduced exposure to maternal vaginal bacteria during birth. Vaginal seeding is a currently unproven practice intended to reduce such differences, so that the gut microbiota of CS-born babies is similar to that of babies born vaginally. Our pilot study, which uses oral administration as a novel form of vaginal seeding, will assess the degree of maternal strain transfer and overall efficacy of the procedure for establishing normal gut microbiota development. Methods and analysis: Protocol for a single-blinded, randomized, placebo-controlled pilot study of a previously untested method of vaginal seeding (oral administration) in 30 CS-born babies. A sample of maternal vaginal bacteria is obtained prior to CS, and mixed with 5 ml sterile water to obtain a supernatant. Healthy babies are randomized at 1:1 to receive active treatment (3 ml supernatant) or placebo (3 ml sterile water). A reference group of 15 non-randomized vaginal-born babies are also being recruited. Babies’ stool samples will undergo whole metagenomic shotgun sequencing to identify potential differences in community structure between CS babies receiving active treatment compared to those receiving placebo at age 1 month (primary outcome). Secondary outcomes include differences in overall gut community between CS groups (24 hours, 3 months); similarity of CS-seeded and placebo gut profiles to vaginally-born babies (24 hours, 1 and 3 months); degree of maternal vaginal strain transfer in CS-born babies (24 hours, 1 and 3 months); anthropometry (1 and 3 months) and body composition (3 months). Ethics and dissemination: Ethics approval by the Northern A Health and Disability Ethics Committee (18/NTA/49). Results will be published in peer-reviewed journals and presented at international conferences. Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618000339257).

The views of pregnant women in New Zealand on vaginal seeding: a mixed-methods study

“…Based on currently available evidence, many of our participants were technically correct in their responses; it is currently unknown if vaginal seeding reduces the risk of any specific health conditions, while only one very small study suggests it may shift the microbiome of infants born by caesarean section to more closely reflect that of infants born vaginally [ 11 ]. Larger and long-term studies are currently ongoing to assess the impact of seeding, not only on the gut microbiome [ 12 – 15 ], but also on childhood obesity [ 13 , 14 ], allergic diseases [ 13 , 15 ], and asthma [ 15 ]. Notably, childhood obesity is a health condition that is particularly subject to stigma; in fact, healthcare professionals report not raising the topic for fear of damaging their relationships with families [ 32 ].…”

“…The interviews took place at the Liggins Institute Clinical Research Unit, just prior to women’s health screening tests for eligibility to further participate in the ECOBABe trial [ 12 ]. Interviews were audio-recorded and lasted up to 10 min, conducted by one of two researchers (ÉMB or CPG).…”

“…While promising, these results are far from conclusive. Our group is currently conducting the Early COlonisation with Bacteria After Birth (ECOBABe) study, assessing the effectiveness of vaginal seeding in establishing the gut microbiome in CS-born babies [ 12 ], whilst other trials are ongoing elsewhere [ 13 – 15 ].…”

Gut microbiota as risk factor causing obesity in children

“…и Bacteroides spp., и у них чаще обнаруживаются С. difficile [42]. В то же время хорошо известно, что бифидобактерии и бактероиды преобладают в ранней кишечной микробиоте детей, рожденных естественным путем [43]. Данные бактерии способствуют формированию иммунитета новорожденных.…”

Alterations in intestinal microbiota composition in cesarean section-born children and possibility of its correction

“…Вагинальный посев предполагает обеспечение контакта новорожденного с материнской вагинальной микробиотой сразу после рождения. Для этого может использоваться накожное нанесение марли, предва-рительно инкубированной во влагалище матери, или пероральное введение материнской микробиоты, полученной перед рождением ребенка [23,41,42]. Эффективность влагалищного посева еще недостаточно изучена, и высказываются опасения в отношении возможности ятрогенного инфицирования ребенка, поэтому применение данного метода требует исключения заражения ребенка инфекциями, передающимися интранатально (стрептококком группы В, вирусом простого герпеса и др.)…”