Vaginal seeding or vaginal microbial transfer from the mother to the caesarean-born neonate: a commentary regarding clinical management

September 1, 2017 at 8:22 am

BJOG: An International Journal of Obstetrics & Gynaecology

Commentary

T Haahr, J Glavind, P Axelsson, M Bistrup Fischer, J Bjurström, G Andrésdóttir, D Teilmann-Jørgensen, U Bonde, N Olsén Sørensen, M Møller, J Fuglsang, PG Ovesen, JP Petersen, J Stokholm, TD Clausen

Recent evidence suggests caesarean delivery (CD) to be a risk factor for inflammatory and metabolic diseases such as asthma, allergies and other chronic immune disorders in the child.[1]

One hypothetical pathogenesis of these associations has been proposed to be a disruption of the neonatal colonization (NC) after CD.[2]

To further support this hypothesis, it has been observed that the effect of CD on NC differed according to the type of CD, i.e. planned or emergency,[3] and that the risk of asthma in children born by CD was mitigated by rupture of membranes, though still increased compared with children delivered vaginally.[4]

Such interruption of NC has been speculated to hamper adequate immune development and set the stage for later disease.[5] Although this hypothesis was recently questioned by Chu et al.,[6] several publications have pointed out the mode of delivery as an important independent factor that impacts NC, especially in the first months of life.[3, 7, 8]

Thus, Dominguez-Bello and colleagues came up with the novel idea to transfer vaginal microbes from the mother to the caesarean-born neonate in an attempt to modulate NC, i.e. vaginal seeding (VS).[9] In their pilot study, it was concluded that the NC of caesarean-born neonates partially could be restored with VS based on data from four neonates.

Since then, several publications have discussed these findings which underscore the need to further investigate the balance between benefits and risks associated with VS and its potential use in the clinic.[10-12]

Nevertheless, many patients have already adopted the concept of this new birth trend; thus, obstetricians, midwives and other healthcare professionals frequently encounter couples who are concerned regarding disrupted NC after CD, and are querying the potential impact of VS….

FULL TEXT

http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14792/full

PDF

http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14792/epdf

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Entry filed under: Bacterias, Epidemiología, Health Care-Associated Infections, Infecciones nosocomiales, Metodos diagnosticos, REPORTS, Sepsis, Update.

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