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Inchingolo F, Inchingolo AD, Palumbo I, Trilli I, Guglielmo M, Mancini A, Palermo A, Inchingolo AM, Dipalma G. The Impact of Cesarean Section Delivery on Intestinal Microbiota: Mechanisms, Consequences, and Perspectives-A Systematic Review. Int J Mol Sci 2024; 25:1055. [PMID: 38256127 PMCID: PMC10816971 DOI: 10.3390/ijms25021055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
The relationship between cesarean section (CS) delivery and intestinal microbiota is increasingly studied. CS-born infants display distinct gut microbial compositions due to the absence of maternal birth canal microorganisms. These alterations potentially link to long-term health implications like immune-related disorders and allergies. This correlation underscores the intricate connection between birth mode and the establishment of diverse intestinal microbiota. A systematic literature review was conducted on the PubMed, Scopus, and Web of Science databases by analyzing the articles and examining the intricate interactions between CS delivery and the infant's intestinal microbiota. The analysis, based on a wide-ranging selection of studies, elucidates the multifaceted dynamics involved in CS-associated shifts in the establishment of fetal microbiota. We also explore the potential ramifications of these microbial changes on neonatal health and development, providing a comprehensive overview for clinicians and researchers. By synthesizing current findings, this review contributes to a deeper understanding of the interplay between delivery mode and early microbial colonization, paving the way for informed clinical decisions and future investigations in the field of perinatal medicine.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
| | - Irene Palumbo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
| | - Irma Trilli
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
| | - Mariafrancesca Guglielmo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (I.P.); (I.T.); (M.G.); (A.M.); (A.M.I.); (G.D.)
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Tremblay A, Bronner S, Binda S. Review and Perspectives on Bifidobacterium lactis for Infants' and Children's Health. Microorganisms 2023; 11:2501. [PMID: 37894159 PMCID: PMC10609373 DOI: 10.3390/microorganisms11102501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
The influence of microbiota dysbiosis in early life is increasingly recognized as a risk factor for the development of several chronic diseases later in life, including an increased risk of asthma, eczema, allergies, obesity, and neurodevelopmental disorders. The question whether the potential lifelong consequences of early life dysbiosis could be mitigated by restoring microbiota composition remains unresolved. However, the current evidence base suggests that protecting the normal development of the microbiome during this critical developmental window could represent a valuable public health strategy to curb the incidence of chronic and lifestyle-related diseases. Probiotic Bifidobacteria are likely candidates for this purpose in newborns and infants considering the natural dominance of this genus on microbiota composition in early life. Moreover, the most frequently reported microbiota composition alteration in association with newborn and infant diseases, including necrotizing enterocolitis and diarrhea, is a reduction in Bifidobacteria levels. Several studies have assessed the effects of B. animalis subsp. lactis strains in newborns and infants, but recent expert opinions recommend analyzing their efficacy at the strain-specific level. Hence, using the B94 strain as an example, this review summarizes the clinical evidence available in infants and children in various indications, discussing the safety and potential modes of actions while providing perspectives on the concept of "non-infant-type" probiotics for infants' health.
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Affiliation(s)
- Annie Tremblay
- Rosell Institute for Microbiome and Probiotics, 6100 Royalmount Avenue, Montreal, QC H4P 2R2, Canada; (A.T.); (S.B.)
| | - Stéphane Bronner
- Rosell Institute for Microbiome and Probiotics, 6100 Royalmount Avenue, Montreal, QC H4P 2R2, Canada; (A.T.); (S.B.)
| | - Sylvie Binda
- Rosell Institute for Microbiome and Probiotics, 6100 Royalmount Avenue, Montreal, QC H4P 2R2, Canada; (A.T.); (S.B.)
- Lallemand Health Solutions, 19 Rue des Briquetiers, BP 59, 31702 Toulouse, France
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Nakandalage R, Guan LL, Malmuthuge N. Microbial Interventions to Improve Neonatal Gut Health. Microorganisms 2023; 11:1328. [PMID: 37317302 DOI: 10.3390/microorganisms11051328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023] Open
Abstract
The diverse pioneer microbial community colonizing the mammalian gastrointestinal tract is critical for the developing immune system. Gut microbial communities of neonates can be affected by various internal and external factors, resulting in microbial dysbiosis. Microbial dysbiosis during early life affects gut homeostasis by changing metabolic, physiological, and immunological status, which increases susceptibility to neonatal infections and long-term pathologies. Early life is crucial for the establishment of microbiota and the development of the host immune system. Therefore, it provides a window of opportunity to reverse microbial dysbiosis with a positive impact on host health. Recent attempts to use microbial interventions during early life have successfully reversed dysbiotic gut microbial communities in neonates. However, interventions with persistent effects on microbiota and host health are still limited. This review will critically discuss microbial interventions, modulatory mechanisms, their limitations, and gaps in knowledge to understand their roles in improving neonatal gut health.
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Affiliation(s)
- Ranga Nakandalage
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5, Canada
- Lethbridge Research and Development Center, Agriculture Agri-Food Canada, Lethbridge, AB T1J 4B1, Canada
| | - Le Luo Guan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Nilusha Malmuthuge
- Lethbridge Research and Development Center, Agriculture Agri-Food Canada, Lethbridge, AB T1J 4B1, Canada
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Liu Y, Li HT, Zhou SJ, Zhou HH, Xiong Y, Yang J, Zhou YB, Chen DJ, Liu JM. Effects of vaginal seeding on gut microbiota, body mass index, and allergy risks in infants born through cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5:100793. [PMID: 36334724 DOI: 10.1016/j.ajogmf.2022.100793] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Vaginal seeding-exposure of neonates to maternal vaginal fluids-has been proposed to improve the microbiota of infants born through cesarean delivery, but its impacts on the infants' subsequent health outcomes remain unclear. OBJECTIVE This study aimed to examine the impacts of vaginal seeding on gut microbiota, growth, and allergy risks in infants born through cesarean delivery. STUDY DESIGN This randomized controlled trial was conducted at Liuyang Maternal and Child Health Care Hospital in Hunan, China. We estimated that a minimum sample size of 106 was needed by assuming a standardized effect size of 0.6 for the primary outcomes, with a statistical power of 80%, a 2-sided type I error of 0.05, and an expected loss to follow-up rate of 15%. Finally, 120 singleton term pregnant women scheduled for cesarean delivery were enrolled from November 2018 to September 2019. Infant follow-up was completed in September 2021. The participants were randomized in a 1:1 ratio to the vaginal seeding group (n=60; infants were swabbed immediately after birth using gauze preincubated in maternal vagina) or the control group (n=60; routine standard care). The first set of primary outcomes was infant body mass index and body mass index z-scores at 6, 12, 18, and 24 months of age. The other primary outcome was the total allergy risk score at 18 months for 20 common allergens (each scored from 0-6 points). Characteristics of gut microbiota, overweight/obesity, and allergic diseases and symptoms were included as secondary outcomes. The main analyses were performed according to the modified intention-to-treat principle. RESULTS Of 120 infants, 117 were included in the analyses. Infant body mass index and body mass index z-scores did not significantly differ between the 2 groups at any of the 4 time points, with the largest difference in point estimates occurring at 6 months: the mean (standard deviation) body mass index was 17.5 (1.4) kg/m2 and 17.8 (1.8) kg/m2 in the vaginal seeding and control groups, respectively (mean difference, -0.31 kg/m2 [95% confidence interval, -0.91 to 0.28]; P=.30), and body mass index z-score was 0.2 (1.0) and 0.4 (1.1), respectively (mean difference, -0.20 [95% confidence interval, -0.58 to 0.18]; P=.31). The median total allergy risk score was 1.5 (interquartile range, 0.0-4.0) in the vaginal seeding group and 2.0 (interquartile range, 1.0-3.0) in the control group (median difference, 0.00 [95% confidence interval, -1.00 to 1.00]; P=.48). For infants from the vaginal seeding group, the relative abundance of genera Lactobacillus and Bacteroides in the gut microbiota was slightly yet nonsignificantly elevated at birth and 6 months, and the risk of overweight/obesity was lower at 6 months (0/57 vs 6/59; relative risk, 0.03 [95% confidence interval, 0.00-0.57]; P=.03) though not at subsequent time points. Other secondary outcomes did not differ between groups. No adverse events related to the intervention were reported. CONCLUSION For infants born through cesarean delivery, vaginal seeding has no significant impacts on the gut microbiota, growth, or allergy risks during the first 2 years of life.
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Affiliation(s)
- Yang Liu
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu); Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)
| | - Hong-Tian Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu); Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu); Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Haidian District, Beijing, China (Drs H Li and J Liu).
| | - Shu-Jin Zhou
- Liuyang Maternal and Child Health Care Hospital, Changsha, Hunan, China (Drs S Zhou, H Zhou, and Y Xiong)
| | - Hui-Huang Zhou
- Liuyang Maternal and Child Health Care Hospital, Changsha, Hunan, China (Drs S Zhou, H Zhou, and Y Xiong)
| | - Ying Xiong
- Liuyang Maternal and Child Health Care Hospital, Changsha, Hunan, China (Drs S Zhou, H Zhou, and Y Xiong)
| | - Jing Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian District, Beijing, China (Dr J Yang)
| | - Yu-Bo Zhou
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu); Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)
| | - Dun-Jin Chen
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (Dr D Chen)
| | - Jian-Meng Liu
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu); Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu); Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Haidian District, Beijing, China (Drs H Li and J Liu).
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Blanco-Rojo R, Maldonado J, Schaubeck M, Özen M, López-Huertas E, Olivares M. Beneficial Effects of Limosilactobacillus fermentum CECT 5716 Administration to Infants Delivered by Cesarean Section. Front Pediatr 2022; 10:906924. [PMID: 35874592 PMCID: PMC9301023 DOI: 10.3389/fped.2022.906924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Cesarean section (CS) disrupts the natural microbiota colonization process in infants, which might compromise immune system maturation, leading to a higher risk of infections. We evaluated the effect of the probiotic Limosilactobacillus (L.) fermentum CECT 5716 on the incidence of gastrointestinal and respiratory infections in the CS infant subgroups (n = 173) of three randomized clinical trials in which this probiotic strain was demonstrated to be safe and effective for preventing infections. Therefore, the data for the CS infants were extracted to obtain the incidence rate ratio (IRR) and 95% CI for gastrointestinal and respiratory infections for each study and were then combined to obtain a pooled IRR and 95% CI using the generic inverse variance method. There was a significant reduction of 73% in the incidence of gastrointestinal infections in CS infants receiving L. fermentum CECT 5716 compared with those receiving the control formula [n = 173, IRR: 0.27 (0.13, 0.53), p = 0.0002]. Regarding respiratory infections, although pooled results showed a reduction of 14% in the probiotic group, the difference was not statistically significant [n = 173, IRR (95% CI): 0.86 (0.67, 1.11), p = 0.25]. In conclusion, the administration of L. fermentum CECT 5716 to CS-born infants protects them from gastrointestinal infections by reducing the risk by up to 73% in this population.
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Affiliation(s)
- Ruth Blanco-Rojo
- Research and Development Department, Biosearch Life, a Kerry Company, Granada, Spain
| | - José Maldonado
- Pediatric Unit, University Hospital Virgen de las Nieves, Granada, Spain.,Department of Pediatric, University of Granada, Granada, Spain.,Biosanitary Research Institute (IBS), Granada, Spain
| | | | - Metehan Özen
- Department of Pediatrics, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Eduardo López-Huertas
- Estación Experimental Zaidín, Consejo Superior Investigaciones Científicas, Granada, Spain
| | - Mónica Olivares
- Research and Development Department, Biosearch Life, a Kerry Company, Granada, Spain
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