Maternal breastmilk, infant gut microbiome and the impact on preterm infant health

Abstract

Aim This narrative review summarises the benefits of maternal breastmilk to both the infant and the mother, specifically the benefits that relate to modification of the infant microbiome, and how this might vary in the preterm infant. Methods We used PubMed to primarily identify papers, reviews, case series and editorials published in English until May 2020. Based on this, we report on the components of breastmilk, their associated hypothesised benefits and the implications for clinical practice. Results Breastmilk is recommended as the exclusive diet for newborn infants because it has numerous nutritional and immunological benefits. Additionally, exposure to the maternal breastmilk microbiome may confer a lasting effect on gut health. In the preterm infant, breastmilk is associated with a significant reduction in necrotising enterocolitis, an inflammatory gastrointestinal disease and reduction in other key morbidities, together with improved neurodevelopmental outcomes. Conclusion These impacts have long‐term benefits for the child (and the mother) even after weaning. This benefit is likely due, in part, to modification of the infant gut microbiome by breastmilk microbes and bioactive components, and provide potential areas for research and novel therapies in preterm and other high‐risk infants.

Use of omic technologies in early life gastrointestinal health and disease: from bench to bedside

“…Mothers' own breast milk significantly influences the development of the microbiome and is known to be the single most important factor for reducing disease in preterm infants, but babies receiving breast milk can still develop the disease, suggesting potentially important alterations in breast milk composition [85]. For instance, alterations in concentrations of complex sugars present in breast milk, termed human milk oligosaccharides (HMOs), have been reported in mothers of infants who develop NEC compared to control infants.…”

Untangling human milk oligosaccharides and infant gut microbiome

“…Human milk is a complex biofluid, which not only provides nourishment to the new-born, but also helps the immature body cope with foreign environmental stimuli and the microorganisms it first encounters ( Ballard and Morrow, 2013 ). The microbial shaping effect is driven through various mechanisms, including by directly providing potential colonizers from the breast milk microbiome, immune factors (e.g., secretory IgA, antimicrobial peptides, and proteins), and human milk oligosaccharides (HMOs) ( Granger et al., 2021 ). Defining a healthy infant gut microbiome is challenging, but microbial communities rich in Bifidobacterium spp.…”

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“…Longer breastfeeding is associated with a reduced risk of obesity and type 2 diabetes [ 18 ], and increased intelligence quotient scores, which translate into increased productivity at school and work in later life [ 19 ]. Breastfeeding is also linked to beneficial effects for infants’ gut microbiota [ 20 , 21 ].…”