Cesarean Section, Microbiota and Risk of Respiratory Infection

Written by
Dr Fathalla Ali, PHD Paediatrics

6/1/2021​

Cesarean Section (CS) is one of the most common life-saving surgical procedure that is performed when some complications developed during pregnancy and labour. Despite that, it is a major operation that is associated with complications that may have implications for future pregnancies and long-term health effects. Mode of delivery is considered a significant determinant for the early acquisition and development of gut microbiota in infants.

In a recent prospective study, Reyman et al (2019), assessed the effect of delivery mode on gut microbiota, independent of antibiotic administration to mothers. Additionally, the team investigated the role of delivery mode-induced gut microbiota changes on health. In this study, the routine antibiotic administration to the mothers was postponed until after the cord clamping.

The effect was assessed in 120 infants and their mothers. 74 infants were vaginally delivered (VD), and 46 caesarean section delivered (CS). The 120 children had at least 5 fecal samples available from ten timepoints (2 hours postpartum, 1 day, 1 week, 2 weeks and 1,2,4,6,9 and 12 months of age). Also, a detailed questionnaire on the health status of infants were collected at each timepoint of sample collection. Results showed that:

  • The maximum effect of delivery mode on the early development of microbiota was observed at 1 week of age and continued until 2 months.
  • The VD infants showed more stable microbiota composition than the CS infants.
  • The microbiota composition of the VD infants was similar to that of their own mother.
  • The high abundance of health associated bacteria such as Bifidobacteria was associated with infants born by VD.
  • The lack of Bifidobacteria colonization among CS infants was not corrected by breastfeeding.
  • Breastfed CS infants had less gut Bifidobacterium than formula fed VD infants.
  • Bacteroides spp., which are considered to be important for regulators for intestinal immunity were also found more abundant in VD infants compared with CS infants.
  • The high abundance of potentially pathogenic and proinflammatory Bacteria such as Staphylococcus, Klebsiella & Enterococcus was associated with infants born by CS.
  • There was an association between gut microbiota composition at the age of 1 week and the number of Respiratory Infections (RI) events.
  • There was a trend toward more RI events and a higher need for antibiotic in the first year of life in CS infants compared with VD infants.
  • Bifidobacterium, Klebsiella & Enterococcus were found to be the most important bacteria associated with the RI events during the first year of life.
  • Bifidobacterium were associated with fewer RI events during the first year of life.
  • Klebsiella & Enterococcus, Veillonella were associated with higher RI events during the first year of life. These bacteria were associated with higher rate of CS delivery.

Keywords: Cesarean Section, Mode of delivery, Microbiota, Respiratory Infections, Bifidobacteria

Reference:

Reyman, M., van Houten, M.A., van Baarle, D. et al. Impact of delivery mode-associated gut microbiota dynamics on health in the first year of life. Nature Communications 10, 4997 (2019). Click here

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