C-section: a risk factor for dysbiosis?

Several maternal or environmental factors can promote the appearance of a dysbiosis such as taking antibiotics, but also the mode of delivery^1-5. This gut microbiota’s imbalance can have a significant impact on infants’ short- and long-term health^1,2.6,7.

CHARACTERISTICS AND CONSEQUENCES OF DYSBIOSIS

Dysbiosis is an unbalanced composition of the gut microbiota⁷.
There are three types of dysbiosis that are not mutually exclusive and can occur simultaneously. They’re reflected in^7:

Early dysbiosis, occurring in the first months after birth, increases in the short term the risk of respiratory infections, other infections (cystitis, sepsis…) or even infant colic^1,8. But an altered microbiota can also lead to long-term conditions such as increased risk of celiac disease, type 1 diabetes, obesity, atopy and asthma, or allergies and allergic rhinitis^1,2,9,10.

WHY DOES C-SECTION INFLUENCE THE BALANCE OF THE INFANTS’ GUT MICROBIOTA?

C-section is an essential procedure for some deliveries and its recommended rate by WHO is 5-15% of births¹¹. In some countries, this percentage is much higher, but overall, it tends to increase by about 4.4% per year¹². In West and Central Africa, caesarean birth rates are low (4.1%), while they are higher in North Africa (29.6%)¹³.

Infants born vaginally have a gut microbiota colonized by the mother’s fecal and vaginal bacteria, which are a majority of Bifidobacteria and Bacteroides. However, infants born by c-section do not benefit from them, because they are mostly exposed to bacteria from the hospital environment^1,5,6. The composition of their gut microbiota is then dominated by the genus Clostridium (Clostridium difficile in particular) in the first three months^1,14,16.

**Fig 1: Composition of the gut microbiota and development associated with the mode of delivery.**
**Adapted from Shao** **et al. (2019)**¹⁶

REBALANCE THE INFANT’S GUT MICROBIOTA

Nutrition, including breastfeeding, plays an essential role in the rebalancing of the gut microbiota^1,17. The beneficial bacteria and the prebiotic HMOs* present in breast milk work in synergy to restore the balance of the gut microbiota and support the baby’s immune system¹⁷. For non-breastfed infants, there are infant formulas that contain a combination of prebiotics scGOS/lcFOS** (9:1) and probiotics Bifidobacterium breve. This combination restores the microbial balance and promotes the development of a healthy immune system^18,19.

To learn more about the effects of synbiotic-containing infant formulas on the gut microbiota of infants born by c-section, read the article on the clinical study of Chua et al. 2017.

References

*HMOs = Human Milk Oligosaccharides

**scGOS/lcFOS = short-chain galacto-oligosaccharides, long-chain fructo-oligosaccharides

Munyaka, et al. “External influence of earlychildhood establishment of gutmicrobiota and subsequenthealth” Frontiers in pediatrics 2 (2014): 109.
Tanaka et al., Development of the gut microbiota in infancy and its impact on health in later life. Allergology International. 66 (2017) 515-522
Bischoff, Stephan C. “‘Gut health’: a new objective in medicine?” BMC medicine1 (2011): 24.
https://www.inserm.fr/information-en-sante/dossiers-information/microbiote-intestinal-flore-intestinale 05/09/2019
Penders, John, et al. “Factors influencing the composition of the intestinal microbiota in early infancy.” Pediatrics2 (2006): 511-521
Fujimura, Kei E., et al. “Role of the gut microbiota in defining human health.” Expert review of anti-infective therapy4 (2010): 435-454.
Petersen, et al. “Defining dysbiosis and its influence on host immunity and disease.” Cellular microbiology7 (2014): 1024-1033
De Weerth, Carolina, Susana Fuentes, and Willem M. de Vos. “Crying in infants: on the possible role of intestinal microbiota in the development of colic.” Gut Microbes5 (2013): 416-421
Girbovan, Anamaria, et al. “Dysbiosis a risk factor for celiac disease.” Medical microbiology and immunology2 (2017): 83-91.
Butel, M-J., A-J. Waligora-Dupriet, and S. Wydau-Dematteis. “The developing gut microbiota and its consequences for health.” Journal of developmental origins of health and disease 9.6 (2018): 590-597
Organisation Mondiale de la Santé, «Déclaration de l’OMS sur les taux de césarienne », 2015 ; 8 ; https://apps.who.int/iris/bitstream/handle/10665/161443/WHO_RHR_15.02_fre.pdf;jsessionid=8E57A0E97438BD9294176466A686FF88?sequence=1 [consulted October, 1st 2020]
Harrison MS, Goldenberg RL. Cesarean section in sub-Saharan Africa. Matern Health Neonatal Perinatal. 2016;2:6
Boerma T et al, Global epidemiology of use of and disparities in caesarean, Lancet 2018
Rutayisire E, Huang K, Liu Y, Tao F. The mode of delivery affects the diversity and colonization pattern of the gut microbiota during the first year of infants’ life: a systematic review. BMC Gastroenterol. 2016;16(1):86. Published 2016 Jul 30. doi:10.1186/s12876-016-0498-0
Dominguez-Bello, Maria G., et al. “Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns.” Proceedings of the National Academy of Sciences26 (2010): 11971-11975.
Shao, Yan et al. “Stunted microbiota and opportunisticpathogen colonization in caesarean-section birth.” Nature vol. 574,7776 (2019): 117-121.
Scholtens, Petra AMJ, et al. “The early settlers: intestinal microbiology in early life.” Annual review of food science and technology 3 (2012): 425-447
Chua M, et al. Effect of Synbiotic on the Gut Microbiota of Cesarean Delivered Infants: A Randomized, Double-blind, Multicenter Study JPGN, 2017;65:102–106.
Wopereis H, et al. The first thousand days – intestinal microbiology of early life: establishing a symbiosis, Pediatr Allergy Immunol, 2014; 25;428-38.

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Clinical study: the effects of a synbiotic combination on the gut microbiota of caesarean-born infants