C-Section Birth & Infant Gut Microbiota (PDF)

C-Section Birth and the Infant Gut Microbiota: Nutritional Strategies Healthy gut microbiota development after birth – why it is so important? A healthy gut microbiota development after birth contributes to healthy growth, immediate and long-term health1-5 Microbial signals to the host Relative abun...

C-Section Birth and the Infant Gut Microbiota: Nutritional Strategies Healthy gut microbiota development after birth – why it is so important? A healthy gut microbiota development after birth contributes to healthy growth, immediate and long-term health1-5 Microbial signals to the host Relative abundances Gut barrier function against pathogens Normal metabolic development Bone health Proper development of a baby’s immature immune system Clostridia Bifidobacteria Enterobacteria Bacteroides Normal functioning of the gut-brain-axis on a baby’s developing brain Age Vaginal birth and breastfeeding Weaning What is the impact of C-section birth on an infant’s gut development and health? C-section birth is a major disruptor of early gut microbiota development1 Vaginal birth C-section birth Exposure to microbes from the skin and the hospital environment Exposure to maternal gut microbes Infant gut is colonised by specific, beneficial maternal microbes (Bifidobacterium and Bacteroides species*) Lower abundance of beneficial bifidobacteria and almost total lack of Bacteroides species. Increased levels of pathogens. Relative abundances Microbiota dysbiosis: Relative abundances Healthy gut microbiota development: Clostridia Bifidobacteria Enterobacteria Bacteroides Enterobacteria Clostridia Bifidobacteria Bacteroides Age Vaginal birth and breastfeeding Age Weaning C-section birth Weaning *Several species of Bifidobacterium and Bacteroides can metabolise human milk oligosaccharides (HMOs), which very likely explains their success in colonising the infant gut1 Microbial dysbiosis in early life is associated with gastrointestinal infections and carries long-term health risks, including increased risk of chronic immune diseases, overweight, and may impact neurodevelopment1-4 What do we know about C-section rates? The global C-section rate is higher than recommended and continues to rise6 3 in 10 births (29%) via C-section 2 in 10 births (21%) via C-section When medically necessary, a C-section is an effective means of saving maternal and infant lives7 WHO recommends a maximum C-section rate of 10% to 15%7 2030 2018 Can nutritional interventions balance a disruptive gut microbiota after C-section in early life? HMOs, certain prebiotics and probiotics help shift gut microbiota in babies born by C-section closer to that of vaginally born and breastfed infants8-10 HMOs Prebiotics HMOs Definition Definition A group of diverse and complex oligosaccharides in breast milk, supporting gut microbiota and immune health in four major ways11,12 A substrate selectively utilised by host microorganisms, conferring a demonstrated health benefit13 A clinical study shows: Altered glycan expression Differential gene expression Promote the growth of beneficial bacteria, such as Bifidobacterium species Strengthen gut barrier function Probiotics T cell Th1 Feeding bovine milk-derived oligosaccharides can change gut microbiota of C-section born infants towards the composition observed in vaginally born and breastfed infants9 Th2 Definition Prevent pathogen adhesion in the gut Symbol Key: Pathogen Educate the developing immune system Glycan on cell surface Beneficial bacteria Live microorganisms when administered in adequate amounts confer a health benefit on the host14 Efficacy of a probiotic is strain specific14 Adapted from Bode, 2012.12 A clinical study shows: Feeding a blend of 5 HMOs (2’FL, DFL, LNT, 3’SL, 6’SL) can8: 6’SL 2’FL shift the gut microbiota of C-section born infants closer to breastfed and 5 HMOs DFL 3’SL vaginally born infants by increasing beneficial LNT Bifidobacterium Several clinical studies show: Bifidobacterium lactis helps support a healthy gut microbiota and immune system in formula-fed infants born by C-section15-17 Lactobacillus reuteri helps shift overall gut microbiota profile and taxa abundance in C-section born infants towards that of vaginally born infants18,19 C-section birth is a major disruptor of an infant’s early gut microbiota development, which can have a negative impact on their health status. Early nutritional interventions with HMOs, certain probiotics and prebiotics can help correct microbial dysbiosis and shift gut microbiota closer to that of vaginally born and breastfed infants. C-section, caesarean section; DFL, difucosyllactose; FL, fucosyllactose; HMO, human milk oligosaccharide; LNT, lacto-N-tetraose; SL, sialyllactose. References 1. Korpela K. Ann Nutr Metab. 2021;30:1-9; 2. Dogra SK, et al. Microorganisms. 2021,7;9(10):2110; 3. Ihekweazu FD, et al. Am J Med Sci. 2018;356(5):413-423; 4. Di Profio E, et al. Nutrients.2022;14: 3198; 5. Yan Q, et al. Front Cell Infect Microbiol. 2022;12:821429; 6. Betran AP, et al. BMJ Glob Health. 2021; 6(6): e005671; 7. WHO Statement on Caesarean Section Rate, WHO 2015. WHO_RHR_15.02_eng.pdf. Viewed November 2022; 8. Bosheva M, et al. Front Nutr. 2022;9:920362; 9. Estorninos E, et al. Am J Clin Nutr. 2022;115:142–153; 10. Martin-Pelaez S, et al. Nutrients. 2022;14(2):341.; 9. 10; 11. Bode L. Glycobiology. 2012;22(9):1147-62; 12. Walsh C, et al. J Funct Foods. 2020;72:104074; 13. Gibson GR, et al. Nat Rev Gastroenterol Hepatol. 2017; 14(8) :491-502; 14. Hill C, et al. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-14; 15. Yuniaty T, et al. Paediatr Indones. 2013;53:89-98; 16. Holscher HD, et al. JPEN J Parenter Enteral Nutr. 2012;36(1 Suppl):106S-17S; 17. Baglatzi L, et al. Clin Med Insights Pediatr. 2016;10:11-19; 18. Garcia-Rodenas CL, et al. J Pediatr Gastroenterol Nutr. 2016;63(6):681-687; 19. Alliet P, et al. Nutr J. 2022;21(1):11.