Mode of Delivery – Effects on Gut Microbiota and Humoral Immunity

Abstract

Background: The rate of caesarean deliveries has increased 10-fold worldwide during the past decades. Objective: To evaluate differences in the establishment of gut microbiota in infants born by vaginal or caesarean delivery and its impact on mucosal immunity. Methods: Altogether, 165 consecutive children, prospectively followed from birth at our clinic in Turku, Finland, were gathered; 141 (85%) were born by vaginal delivery and 24 (15%) by caesarean section. Blood was drawn at physician visits for indirect evaluation of mucosal immunity by ELISPOT assay. Faecal samples were obtained for determination of the gut microbiota by fluorescence in situ hybridization of bacterial cells. Results: Infants delivered by caesarean section harboured fewer bifidobacteria at an early age and were shown to mount a stronger humoral immune response. At 1 month of age, the total gut bacterial cell counts per 1 g faeces were higher in vaginally delivered infants (9.9 × 10⁹, 95% CI 7.9 × 10⁹–1.2 × 10¹⁰) as compared to caesarean section delivered (3.1 × 10⁹, 95% CI 1.1 × 10⁹–8.6 × 10⁹) (p = 0.001). This distinction was mainly due to the greater number of bifidobacteria in vaginally delivered infants (1.9 × 10⁹, 95% CI 6.3 × 10⁸–5.6 × 10⁹ vs. 1.5 × 10⁶, 95% CI 4.1 × 10²–5.7 × 10⁹, respectively) (p = 0.001). During the first year of life, the total number of IgA-, IgG- and IgM-secreting cells was lower (p = 0.03, p = 0.02, p = 0.11, respectively) in infants born by vaginal delivery than in those born by caesarean section, possibly reflecting excessive antigen exposure across the vulnerable gut barrier. Conclusions: Our findings demonstrate that the mode of delivery may have, possibly via gut microbiota development, significant effects on immunological functions in the infant (http://www.clinicaltrials.gov/ct/gui/show/NCT00167700).

Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics

“…10,13,18 In the present study, we only observed a tendency towards an increased risk of overweight in boys delivered by CS. However, the adjustments for many covariates may have decreased the power to observe significant differences, as the ORs did not change with adjustments, but the CIs increased.…”

“…15 Furthermore, studies of rodents have found that the gut microbiota may have a role in energy harvesting, hence suggesting a link to development of obesity. [16][17][18] If so, the mother's pre-pregnancy body mass index (BMI) may also be expected to influence whether the child (if vaginally delivered) obtains an obesogenic microbiota. In addition to the described obesogenic features, the gastrointestinal microbiota has also been suggested of importance in relation to overall metabolism, hormonal regulation and immunisation.…”

“…In addition to the described obesogenic features, the gastrointestinal microbiota has also been suggested of importance in relation to overall metabolism, hormonal regulation and immunisation. 18,19 The aim of the present study therefore was to investigate whether factors presumably influencing the gut microbiotal transmission from mother to the newborn (that is, mode of delivery, early use of antibiotics and pre-pregnancy BMI) were associated with development of overweight later in childhood, while carefully taking into account several other factors possibly confounding the association, such as socioeconomic status, 20 smoking during pregnancy 21 and breastfeeding. 20,22 …”

Gut microbiota: a source of novel tools to reduce the risk of human disease?

“…In parallel, the mode of delivery has also been reported to affect immune development. More pronounced humoral immune responses have been detected in cesarean section-delivered infants as compared to vaginally delivered infants throughout the first year of life (49), whereas T helper 1-type immune responses are reportedly reduced in infants born by cesarean section during the first 2 y of life (50).…”

Gut–Liver Axis: Role of Inflammasomes

“…69 Interestingly, different gut microbial populations develop in infants born by caesarean section compared with those born by vaginal delivery. 73 The composition of GALT (gut associated lymphoid tissue) is affected by presence of microbial colonies in the gastrointestinal tract. There is steep rise in the number of intraepithelial lymphocytes immediately after exposure to luminal microorganisms.…”