Cesarean section changes neonatal gut colonization

Jakob Stokholm; Jonathan Thorsen; Bo L Chawes; Susanne Schjørring; Karen A Krogfelt; Klaus Bønnelykke; Hans Bisgaard

doi:10.1016/j.jaci.2016.01.028

Cesarean section changes neonatal gut colonization

J Allergy Clin Immunol. 2016 Sep;138(3):881-889.e2. doi: 10.1016/j.jaci.2016.01.028. Epub 2016 Apr 1.

Authors

Jakob Stokholm¹, Jonathan Thorsen², Bo L Chawes², Susanne Schjørring³, Karen A Krogfelt³, Klaus Bønnelykke², Hans Bisgaard⁴

Affiliations

¹ COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Naestved Hospital, Naestved, Denmark.
² COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
³ Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
⁴ COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: bisgaard@copsac.com.

PMID: 27045582
DOI: 10.1016/j.jaci.2016.01.028

Abstract

Background: Delivery by means of cesarean section has been associated with increased risk of childhood immune-mediated diseases, suggesting a role of early bacterial colonization patterns for immune maturation.

Objective: We sought to describe the influence of delivery method on gut and airway colonization patterns in the first year of life in the Copenhagen Prospective Studies on Asthma in Childhood2010 (COPSAC2010) birth cohort.

Methods: Seven hundred children from the COPSAC2010 birth cohort participated in this analysis. Fecal samples were collected at age 1 week, 1 month, and 1 year, and hypopharyngeal aspirates were collected at age 1 week, 1 month, and 3 months and cultured for bacteria. Detailed information on delivery method, intrapartum antibiotics, and lifestyle factors was obtained by personal interviews.

Results: Seventy-eight percent of the children were born by means of natural delivery, 12% by means of emergency cesarean section, and 9% by means of elective cesarean section. Birth by means of cesarean section was significantly associated with colonization of the intestinal tract by Citrobacter freundii, Clostridium species, Enterobacter cloacae, Enterococcus faecalis, Klebsiella oxytoca, Klebsiella pneumoniae, and Staphylococcus aureus at age 1 week, whereas colonization by Escherichia coli was associated with natural birth. At age 1 month, these differences were less prominent, and at age 1 year, they were not apparent, which was confirmed by means of multivariate data-driven partial least squares analyses. The initial airway microbiota was unaffected by birth method.

Conclusion: Delivery by means of cesarean section was associated with early colonization patterns of the neonatal gut but not of the airways. The differences normalized within the first year of life. We speculate that microbial derangements, as indicated in our study, can demonstrate a possible link between delivery by means of cesarean section and immune-mediated disease.

Keywords: Cesarean section; bacteria; microbiota; parturition immune diseases.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bacteria / isolation & purification
Cohort Studies
Delivery, Obstetric / methods*
Denmark
Feces / microbiology*
Female
Humans
Infant
Infant, Newborn
Intestines / microbiology
Male
Microbiota*
Pregnancy
Trachea / microbiology*