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Meta-Analysis
. 2021 Jan-Dec;13(1):1-30.
doi: 10.1080/19490976.2021.1897210.

Maternal exposures and the infant gut microbiome: a systematic review with meta-analysis

Allison Grech  1   2 , Clare E Collins  3   4 , Andrew Holmes  2   5 , Ravin Lal  1   2 , Kerith Duncanson  3 , Rachael Taylor  3   4 , Adrienne Gordon  1   2
Affiliations
Meta-Analysis

Maternal exposures and the infant gut microbiome: a systematic review with meta-analysis

Allison Grech et al. Gut Microbes. 2021 Jan-Dec.

Abstract

Early life, including the establishment of the intestinal microbiome, represents a critical window of growth and development. Postnatal factors affecting the microbiome, including mode of delivery, feeding type, and antibiotic exposure have been widely investigated, but questions remain regarding the influence of exposures in utero on infant gut microbiome assembly. This systematic review aimed to synthesize evidence on exposures before birth, which affect the early intestinal microbiome. Five databases were searched in August 2019 for studies exploring pre-pregnancy or pregnancy 'exposure' data in relation to the infant microbiome. Of 1,441 publications identified, 76 were included. Factors reported influencing microbiome composition and diversity included maternal antibiotic and probiotic uses, dietary intake, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), diabetes, mood, and others. Eleven studies contributed to three meta-analyses quantifying associations between maternal intrapartum antibiotic exposure (IAP), BMI and GWG, and infant microbiome alpha diversity (Shannon Index). IAP, maternal overweight/obesity and excessive GWG were all associated with reduced diversity. Most studies were observational, few included early recruitment or longitudinal follow-up, and the timing, frequency, and methodologies related to stool sampling and analysis were variable. Standardization and collaboration are imperative to enhance understanding in this complex and rapidly evolving area.

Keywords: Pregnancy; child health; gut microbiome diversity; infant gut microbiome; systematic review; women’s health.

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Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flow diagram of the study selection process for the current review on maternal exposures during pregnancy and associations with the infant intestinal microbiome
Figure 2.
Figure 2.
Timeline of stool sample collection across included articles investigating the role of prenatal antibiotic exposure or intrapartum antibiotic prophylaxis (IAP) on infant microbiome composition and/or diversity. Abstracts are denoted with an asterisk (*). Filled diamonds (◆) represent the time at which maternal antibiotic exposure occurred. Filled circles (∙) represent approximate times at which infant samples were collected (timeline not to scale). Articles investigating the use of a single antibiotic are denoted in blue, multiple antibiotics in red, and antibiotic categories in orange. Articles for which the type of antibiotic used was not specified are indicated in green. Type of antibiotic and measures of dose, frequency or duration of use are indicated for each study, where possible
Figure 3.
Figure 3.
Maternal Intrapartum Antibiotic Prophylaxis (IAP) exposure in relation to infant intestinal microbiome diversity, as measured by the Shannon Index
Figure 4.
Figure 4.
Maternal pre-pregnancy obesity in relation to infant intestinal microbiome diversity, as measured by the Shannon Index
Figure 5.
Figure 5.
Maternal gestational weight gain (GWG) in relation to infant intestinal microbiome diversity, as measured by the Shannon Index
None
See this image and copyright information in PMC

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