Secrets of
Baby Guts from Science Friday Podcast, w/Dr Chana Palmer,
Program Director, Canary Foundation, San Jose, CA
Vaginal
birth and Caesarean: Differences in babies' bacteria
[9/18/19] By James Gallagher, Health and science correspondent,
BBC News
Babies born by Caesarean section have dramatically different gut
bacteria to those born vaginally, according to the largest study
in the field.
The UK scientists say these early encounters with microbes may act
as a "thermostat" for the immune system.
And they may help explain why Caesarean babies are more likely to
have some health problems later in life.
The researchers stress women should not swab babies with their
vaginal fluids - known as "vaginal seeding". . . .
"What surprised me and scared me was the amount of healthcare bugs
showing up in these children," Dr Trevor Lawley, from the Wellcome
Sanger Institute, told the BBC.
"It could be 30% of their total microbiome.
The method of birth had the biggest impact on the babies'
microbiomes, but antibiotics and whether or not mothers breastfed
their babies, also altered the fledgling relationship between our
microbial and human halves.
Previous research in this field has led to a trend for "vaginal
seeding" in which mothers rub vaginal fluid on the face and mouth
of their babies after a Caesarean.
However, the study showed that even vaginally-born babies were
getting no more vaginal bacteria than Caesarean babies.
Instead, the bacteria passed from mother to baby were coming from
contact with the mother's faeces during labour.
The researchers said vaginal seeding risked exposing babies to
dangerous Group B strep.
New
Research in Babies Microbiomes - Babies May Not Be Born Sterile
But With Their Own Bacteria! - Evidence is now showing that
babies are born with the bacteria that colonise the mother’s
digestive system in the womb. Originally the first bacterial flora
to colonise an infant was thought to be obtained by the mother’s
vagina or the environment the infant was born into.
The
Healthy Birth: Dyad or Triad? Exploring Birth and the Microbiome
[4/28/15] by Sharon Muza
In a normal, healthy birth, a baby is born sterile. Nature
intended that the baby pick up normal skin bacteria from the
mother, since the mother and baby both typically will already have
immunity to those germs, or they will be benign germs. If
the baby is colonized with germs from other non-family members or
from non-family household items, such as sheets or blankets,
problems could result. As Michel Odent, MD, says, "The first
germs on the baby's skin will rule the kingdom."
Many of the probiotics that are especially helpful to newborns have lost their usefulness to adults, so it's especially easy for them to be wiped out by a course or two of antibiotics. If this happens, the mom doesn't have them to pass along to the baby, which is how problems can arise.
A couple of weeks ago, I was looking in the refrigerated supplements section at Whole Foods, and they had two new probiotics formulas "for babies", but I assume they would be helpful to a pregnant woman to help colonize her gut with these newborn-supportive probiotics.
Does anyone have specialized knowledge about what and when would
be especially helpful for a pregnant woman to take during
pregnancy to support her newborn at birth?
Babies' bacteria depend on type of delivery - The way babies are delivered exposes them to different bacteria that could affect their future health, a study finds. Vaginal births appear more advantageous than C-sections [6/25/10] By Jessie Schiewe, Los Angeles Times
Microbes
Colonize
a Baby’s Gut with Distinction
Of
microbes
and men - Bacteria disappearing from our bodies may harm
human health [Boston Globe, 2/25/08]
► The composition of the gut microbiota changes dramatically
during pregnancy
► Third trimester stool is associated with greater inflammation
and energy content
► Third trimester microbiota induce pregnancy-like metabolism in
germ-free mice
► Gut microbiota impacts metabolism in pregnancy similarly to
metabolic syndrome
Baby’s
First
Bacteria Depend on Birth Route - C-section newborns may
harbor fewer helpful microbes than infants born vaginally [6/22/10]
Why
We
Develop Food Allergies - Author Per Brandtzaeg explains how
oral tolerance is established in the first months of life and the
factors that influence this process, including the role of
breastfeeding and the advantage of vaginal delivery for
inoculating babies with healthy bacteria.
Recovery
of
potential pathogens and interfering bacteria in the nasopharynx
of otitis media-prone children and their smoking and nonsmoking
parents.
Brook I, Gober AE.
Arch Otolaryngol Head Neck Surg. 2005 Jun;131(6):509-12.
CONCLUSIONS: A high recovery rate of potential pathogens and a
low number of interfering organisms were observed in OMP children.
Earache-prone kids tend to carry more bacteria - [6/20/05, Reuters] - Children who suffer frequent ear infections -- otitis media -- often harbor high numbers of the bacteria that cause the infections, and a low number of organisms that inhibit growth of the disease-causing bugs, a small study indicates.
Drs. Brook and Gober conclude that otitis-media-prone children exhibit "a high recovery rate of potential pathogens and a low number of interfering organisms." They comment that "therapeutic colonization" of the nose and throat of parents with harmless interfering organisms might be worth looking into, as way of reducing the number of disease-causing bacteria and thereby the number of ear infections in their children.
See also: Bathing Baby
See also: Umbilical Cord
Care
Typically, babies are sterile until they come into contact with the extrauterine world, i.e. beyond the cervix.
Sometimes babies are born with some blood or mucous in their hair or in a few spots, and some parents may choose to do some spot washing. If there is white, creamy vernix on the baby's skin, this can be rubbed in or left to be absorbed, as it will protect the baby's skin.
The reason that hospital personnel are so eager to bathe newborns is that the baby is assumed to be a source of germs in the same way that the birth canal is a source of germs. They are concerned that they might be exposed to some of these germs if the baby isn't thoroughly scrubbed with disinfectants shortly after birth. However, they can easily wear gloves to handle the baby, and this actually protects the baby from *their* germs. So it's very reasonable to decline the ritual bathing of the newborn. Hospital personnel then may put a note on your baby's bassinet to remind them to wear gloves when handling your baby; just watch them to make sure that they *change* their gloves before handling your newborn so they don't contaminate your baby with germs from other babies or the hospital environment.
Does
bathing
newborns remove potentially harmful pathogens from the skin?
Medves JM, O'Brien B.
Birth. 2001 Sep;28(3):161-5.
"The findings did not support the efficacy of bathing with soap
and water to reduce skin colonization of bacterial pathogens"
In Dec., 2010, one of my supplements sources (Metagenics) had a little note that B. infantis strain has recently been reclassified as B. lactis. I think they may be wrong.
The best information I can find about this is a Sept., 2010, abstract. This seems to say that B. infantis and B. longum are both subspecies of B. longum and that B. lactis is a subspecies of B. animalis.
Genomic
insights into bifidobacteria.
Lee JH, O'Sullivan DJ.
Microbiol Mol Biol Rev. 2010 Sep;74(3):378-416.
Since the discovery in 1899 of bifidobacteria as numerically
dominant microbes in the feces of breast-fed infants, there have
been numerous studies addressing their role in modulating gut
microflora as well as their other potential health benefits.
Because of this, they are frequently incorporated into foods as
probiotic cultures. An understanding of their full interactions
with intestinal microbes and the host is needed to scientifically
validate any health benefits they may afford. Recently, the genome
sequences of nine strains representing four species of
Bifidobacterium became available. A comparative genome
analysis of these genomes reveals a likely efficient capacity to
adapt to their habitats, with B. longum subsp. infantis
exhibiting more genomic potential to utilize human milk
oligosaccharides, consistent with its habitat in the infant gut.
Conversely, B. longum subsp. longum exhibits a higher genomic
potential for utilization of plant-derived complex carbohydrates
and polyols, consistent with its habitat in an adult gut. An
intriguing observation is the loss of much of this genome
potential when strains are adapted to pure culture environments,
as highlighted by the genomes of B. animalis subsp. lactis
strains, which exhibit the least potential for a gut habitat and
are believed to have evolved from the B. animalis species during
adaptation to dairy fermentation environments.
This is confirmed by a bit
from Wikipedia on the new name for b. infantis
In 2002, three previously distinct species of Bifidobacterium, B.
infantis, B. longum, and B. suis, were unified into a single
species named B. longum with the biotypes infantis, longum, and
suis respectively.[6] This occurred as the three species had
extensive DNA similarity including a 16s rRNA gene sequence
similarity greater than 97%.[7] In addition, the three original
species were phenotypically difficult to distinguish due to
different carbohydrate fermentation patterns among strains of the
same species.[1] As probiotic activity varies among strains of B.
longum, there exists an interest in the exact classification of
new strains, although this is made difficult by the high gene
similarity between the three biotypes.[8] Currently, strain
identification is done through polymerase chain reaction (PCR) on
the subtly different 16s rRNA gene sequences.[8]
The effects
of selected probiotic strains on the development of eczema (the
PandA study).
Niers L, Martín R, Rijkers G, Sengers F, Timmerman H, van
Uden N, Smidt H, Kimpen J, Hoekstra M.
Allergy. 2009 Sep;64(9):1349-58
METHODS: In a double-blind, randomized, placebo-controlled trial,
a mixture of probiotic bacteria selected by in-vitro experiments
(Bifidobacterium bifidum, Bifidobacterium lactis, and Lactococcus
lactis; Ecologic Panda) was prenatally administered to mothers of
high-risk children (i.e. positive family history of allergic
disease) and to their offspring for the first 12 months of life.
RESULTS: Parental-reported eczema during the first 3 months of
life was significantly lower in the intervention group compared
with placebo, 6/50 vs 15/52 (P = 0.035). After 3 months, the
incidence of eczema was similar in both groups. Cumulative
incidence of parental-reported eczema at 1 and 2 years was 23/50
(intervention) vs 31/48 (placebo) and 27 (intervention) vs 34
(placebo), respectively. The number needed to treat was 5.9 at age
3 and 12 months and 6.7 at age 2 years. The intervention group was
significantly more frequently colonized with higher numbers of Lc.
lactis. Furthermore, at age 3 months, in vitro production of IL-5
(146 pg/ml vs 72 pg/ml; P = 0.04) was decreased in the
probiotic-group compared with the placebo-group. CONCLUSIONS: This
particular combination of probiotic bacteria shows a preventive
effect on the incidence of eczema in high-risk children, which
seems to be sustained during the first 2 years of life. In
addition to previous studies, the preventive effect appears to be
established within the first 3 months of life.
Factors
influencing
the composition of the intestinal microbiota in early infancy.
Penders J, Thijs C, Vink C, Stelma FF, Snijders B, Kummeling I,
van den Brandt PA, Stobberingh EE.
Pediatrics. 2006 Aug;118(2):511-21.
CONCLUSIONS: . . . Term infants who were born vaginally at
home and were breastfed exclusively seemed to have the most
"beneficial" gut microbiota (highest numbers of bifidobacteria and
lowest numbers of C difficile and E coli).
Here's an interesting study about the significance of the germs that colonize the baby's digestive tract:
Friendly
Microbes
Control Intestinal Genes, Study Finds - "One of our
findings is that microbes are able to regulate intestinal genes
involved in breaking down foods into simpler units that can be
absorbed," explains Gordon. "This raises the question of whether
there are variations in the types of intestinal microbes between
individual humans, and how such differences affect our nutritional
status, our health and our predisposition to certain diseases."
According to Gordon, answering this question might shed light on
human diseases such as inflammatory bowel disease, irritable bowel
syndrome and other disorders. Understanding the regulation of
intestinal barrier functions might even reveal how some microbes
affect our susceptibilities to food and other allergies.
[Hooper LV, Wong MH, Thelin A, Hansson L, Falk PG, Gordon JI.
Molecular analysis of commensal host-microbial relationships in
the intestine. Science, Feb. 2, 2001. ]
From The first hour following birth by Michel Odent, MD [4th September 2002]
"Perspective six. The bacteriological point of view
"At birth, a baby is germ-free. An hour later there are millions
of germs covering her mucous membranes. To be born is to enter the
world of microbes. The question is - which germs will be the first
to colonize the baby's body? Bacteriologists know that the winners
of the race will be the rulers of the territory. The germ
environment of the mother is already familiar and friendly from
the perspective of the newborn because mother and baby share the
same antibodies (IgG). In other words, from a bacteriological
point of view, the newborn human baby urgently needs to be in
contact with only one person - her mother. If we add that early
consumption of colostrum will help establish an ideal gut flora,
there is no doubt that, from a bacteriological point of view, the
hour following birth is a critical period with life long
consequences. Our gut flora can be presented as an aspect of our
personality that cannot be easily modified later on in life."
According to Gordon, answering this question might shed light on
human diseases such as inflammatory bowel disease, irritable bowel
syndrome and other disorders.
I'd like to add necrotizing enterocolitis, on an individual
level, which as I understand it is when a portion of the
intestines actually rots and must be surgically removed. It
is a condition which is linked to withholding breastmilk to use
substitutions, and was more common when all babies went to the
nursery for 24 hour periods and were fed sugar water or
formula. The babies' intestines were therefore not colonized
with the beneficial bacteria within the mother's milk which helps
to protect against this condition. Of course there are other
predisposing factors, "including perinatal hypotension, hypoxia,
or sepsis, as well as umbilical catheters, exchange transfusions,
and the feeding of cow milk and hypertonic solutions" (Williams
Obstetrics, 21st ed, p 1073). Another potential tool in
breastfeeding education. Help prevent needless
gastrointestinal surgery for your newborn baby.
Hacking
Your
Body's Bacteria for Better Health
Infant
Probiotic
Formulation - L. Acidophilus, B. Bifidum and B. Infantis
(250 billion cfu per gram. $165 per 100 gram; $100 per 50 gram.)
This is expensive stuff, but if your baby is having ongoing health
problems, this is a good place to start.
Friendly
Help for Your Baby's Health - It is not only adults who
benefit from these friendly bacteria. Breast-fed babies generally
have a lower incidence of colic and other digestive disturbances
than bottle-fed babies, and this has been attributed to friendly
microorganisms in the digestive system whose growth is encouraged
by mother's milk.
Natren produces a probiotic product designed specifically for
infants. Life
Start is made with Bifidobacterium infantis - the beneficial
bacteria which is most prominent in infants. This can be
beneficial for newborn thrush, newborn diarhea or diaper rash.
Origin of
digestive flora in new born babies - more than 99% of the
intestinal flora of a healthy breast-fed infant should be made up
of Bifidobacterium infantis (B. infantis). BioFlora
makes a product called Infantiflora, containing B. infantis.
Long-term
consumption
of infant formulas containing live probiotic bacteria: tolerance
and safety.
Saavedra JM, Abi-Hanna A, Moore N, Yolken RH.
Am J Clin Nutr. 2004 Feb;79(2):261-7.
Long-term consumption of formulas supplemented with B. lactis and
S. thermophilus was well tolerated and safe and resulted in
adequate growth, reduced reporting of colic or irritability, and a
lower frequency of antibiotic use. [Ed. It's possible that they
missed the mark on this study and should have been studying
Bifidobacterium infantis (B. infantis), the bacteria most
naturally found in an infant's gut.]
Improving
health
with bacteria in diet - `PROBIOTICS' RESEARCH AT UCSF HOLDS
PROMISE [9/20/06]
By Kendra Marr, Mercury News
Researchers at the University of California-San Francisco are
seeking volunteers for a study in which newborns will be fed live
bacteria in hopes it will keep them asthma-free.
Clinical
Trial for Asthma and Eczema - The Impact of Perinatal Daily
Supplement of a Probiotic (Lactobacillus Rhamnosus GG), Given to
Mothers, on Immunological Development, Atopic Sensitisation and
Allergic Disease in Their Off-Spring
Another
Clinical
Trial for Asthma and Eczema - Influence of Probiotics on
Prevention of Atopy, Atopic Disease and Immunological Responses
See also: Laundry Issues
since delicate newborn skin may react to dry cleaning fluid or
even ordinary household laundry products.
See also: Eczema
In a recent
study, Kukkonen and her colleagues gave a probiotic
containing four strains of gut bacteria to 461 infants labeled as
high risk for developing allergic disorders. After two years, the
children were 25 percent less likely than those given a placebo to
develop eczema, a type of allergic skin inflammation. The study
was published in the January issue of Journal of Allergy and
Clinical Immunology. [from Hacking
Your
Body's Bacteria for Better Health ]
Clinical
Trial for Asthma and Eczema - The Impact of Perinatal Daily
Supplement of a Probiotic (Lactobacillus Rhamnosus GG), Given to
Mothers, on Immunological Development, Atopic Sensitisation and
Allergic Disease in Their Off-Spring
Another
Clinical
Trial for Asthma and Eczema - Influence of Probiotics on
Prevention of Atopy, Atopic Disease and Immunological Responses
Effects
of
probiotics on atopic dermatitis: a randomised controlled trial.
Weston S, Halbert A, Richmond P, Prescott SL.
Arch Dis Child. 2005 Sep;90(9):892-7.
CONCLUSION: Supplementation with probiotic L fermentum
VRI-003 PCC is beneficial in improving the extent and severity of
AD in young children with moderate or severe disease.
WedMD
- A new study shows children of women who took supplements of Lactobacillus
rhamnosus
GG (Lactobacillus GG) around the time of childbirth were
half as likely to develop atopic eczema by age 4 than those who
did not.
Probiotics
and
prevention of atopic disease: 4-year follow-up of a randomised
placebo-controlled trial.
Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E.
Lancet. 2003 May 31;361(9372):1869-71.
Perinatal administration of the probiotic Lactobacillus
rhamnosus strain GG (ATCC 53103), reduces incidence of
atopic eczema in at-risk children during the first 2 years of life
(infancy). We have therefore assessed persistence of the potential
to prevent atopic eczema at 4 years. Atopic disease was diagnosed
on the basis of a questionnaire and a clinical examination. 14 of
53 children receiving lactobacillus had developed atopic eczema,
compared with 25 of 54 receiving placebo (relative risk 0.57, 95%
CI 0.33-0.97). Skin prick test reactivity was the same in both
groups: ten of 50 children previously given lactobacillus compared
with nine of 50 given placebo tested positive. Our results suggest
that the preventive effect of lactobacillus GG on atopic eczema
extends beyond infancy.
Gut
Bacteria from Breastfeeding Linked to Improved Infant Response
to Vaccine - [READ
THE FULL ARTICLE FROM THE USDA] Infants with the highest
Bifidobacterium levels when they were vaccinated before 15 weeks
of age had responses to tuberculosis, polio (oral), tetanus, and
hepatitis B vaccines that were from 42 percent to 107 percent
higher than infants with the lowest Bifidobacterium levels. And
the higher response lasted until the infants were about two years
old, when the study ended. [Ed: Note that some studies show that
these benefits are lifelong.]
Could mode of delivery influence the neonatal immune response? -
Cesarean section may increase the risk of diarrhea and allergy in
susceptible babies, German researchers suggest.
Caesarean
Birth
May Raise Allergy Risk in Babies
Wed Oct 20, 2004 07:08 PM ET
LONDON (Reuters) - Being born by Caesarean section may increase a baby's risk of suffering from food allergies and diarrhea in the first year of life, German doctors said on Thursday.
"The researchers suspect that in babies born by Caesarean section
the colonisation of natural bacteria in the gut which promotes
health and plays an important role in the immune system response
is delayed or altered by a Caesarean birth."
Child's Cavity Risk Linked to Cesarean Delivery
Mode
of
Delivery and Other Maternal Factors Influence the Acquisition of
Streptococcus mutans in Infants.
Li Y, Caufield PW, Dasanayake AP, Wiener HW, Vermund SH.
J Dent Res. 2005 Sep;84(9):806-11.
"[T]hose delivered by Caesarean section acquired S. mutans 11.7
mos earlier than did vaginally delivered infants (p = 0.038)."
Caesarean
section
and gastrointestinal symptoms, atopic dermatitis, and
sensitisation during the first year of life.
Laubereau B, Filipiak-Pittroff B, von Berg A, Grubl A, Reinhardt
D, Wichmann HE, Koletzko S; GINI Study Group.
Arch Dis Child. 2004 Nov;89(11):993-7.
"Caesarean delivery might be a risk factor for diarrhoea and
sensitisation in infants with family history of allergy. Further
research in this area seems warranted as choosing caesarean
section becomes increasingly popular."
Mode
of
delivery and risk of allergic rhinitis and asthma.
Bager P, Melbye M, Rostgaard K, Stabell Benn C, Westergaard T.
J Allergy Clin Immunol 2003 Jan;111(1):51-6
"People who were born by cesarean section are 33% more likely to
develop asthma than people who were delivered spontaneously."
Given that many of the risks of seeding are the same as for
skin-to-skin contact after the birth, I'm thinking that ACOG is
opposed to the idea because it may carry some liability if the OB
is party to the seeding, whereas parental skin-to-skin contact is
done on the parents' initiative. I understand that their protocols
for a c-section are different from protocols for a vaginal birth
in some key differences. For example, if a mom with GBS is
laboring with the expectation that the baby will be born
vaginally, then they make sure that the appropriate antibiotics
are given at the appropriate interval. If it becomes clear that
the baby is not going to come out vaginally, but the c-section is
delayed for some reason, it's possible that the mom is no longer
current on the IV antibiotics for GBS. So then exposing the baby
to vaginal secretions could become a serious risk to the baby.
I do understand that conscientious parents are very motivated to
minimize the harm to the baby from a c-section, and helping them
to get the microbiome that nature intended seems like one way of
doing that. It might be helpful to parents to convey that we now
believe that gut bacteria is transported to the baby through
breastmilk via the lympathic system.
Maybe the answer is to have a commercial preparation of ideally
beneficial skin and gut flora with which to seed the baby.
BigPharma might be motivated to fund the research if it has
commercial potential.
There are already some commercial formulas of beneficial vaginal
flora, such as Jarrow's Fem-Dophilus. And Natren's LifeStart
formula is meant to provide baby with the flora necessary to
digest human milk. We need studies to determine if they're safe to
rub on baby's skin or to give orally right at birth.
Dental Microbial Colonization
Child's Cavity Risk Linked to Cesarean Delivery