Intervention strategies for cesarean section-induced alterations in the microbiota-gut-brain axis

Abstract

Microbial colonization of the gastrointestinal tract is an essential process that modulates host physiology and immunity. Recently, researchers have begun to understand how and when these microorganisms colonize the gut and the early-life factors that impact their natural ecological establishment. The vertical transmission of maternal microbes to the offspring is a critical factor for host immune and metabolic development. Increasing evidence also points to a role in the wiring of the gut-brain axis. This process may be altered by various factors such as mode of delivery, gestational age at birth, the use of antibiotics in early life, infant feeding, and hygiene practices. In fact, these early exposures that impact the intestinal microbiota have been associated with the development of diseases such as obesity, type 1 diabetes, asthma, allergies, and even neurodevelopmental disorders. The present review summarizes the impact of cesarean birth on the gut microbiome and the health status of the developing infant and discusses possible preventative and restorative strategies to compensate for early-life microbial perturbations.

Keywords: cesarean section; immunity; metabolism; microbiota; prebiotics; probiotics.

Figure 1

Cesarean section can alter colonization of the newborn intestine, which is a critical event influencing many developmental and physiological processes and, thereby, the functioning of the immune and neuroendocrine systems, with long-lasting effects on health. It is thought that an unhealthy microbiota can promote the increased translocation of pathogenic bacterial components from the intestinal mucosa to the systemic circulation, where they activate innate immunity characterized by production of proinflammatory cytokines, resulting in metabolic inflammation and abnormal gut function. Abbreviation: BBB, blood-brain barrier.

Figure 2

Schematic representation of the main strategic points of intervention to reverse the effects of cesarean section delivery. This can be done by improving the environment through different hygienic habits and health practices. Alternatively, the intervention could be focused on the mother herself by using probiotics and/or prebiotics and/or polyunsaturated fatty acids during pregnancy. Finally, the intervention could focus on the newborn with “seeding” approaches: breastfeeding instead of formula feeding or the use of infant formulas enriched and improved with probiotics/prebiotics. This figure summarizes the current modulating therapies to improve the composition of the microbiota and neurodevelopmental health of the infant.