Microbiota transplantation in restoring cesarean-related infant dysbiosis: a new frontier

ABSTRACT

C-section is crucial in reducing maternal and neonatal mortality when medically indicated, but one of its side effects could be the disruption of vertical transmission of maternal-infant microbiota during delivery, potentially leading to gut dysbiosis and increased disease risks in C-section infants. To address such dysbiosis, it seems reasonable to supplement “what is missing” during C-section procedure. This idea has prompted several clinical trials, including proof-of-concept, investigating interventions like vaginal microbial seeding, oral administration of maternal vaginal microbes and even oral administration of maternal fecal materials. Hereby, we have summarized these trials to help understand the current state of these researches, highlighting the predominantly pilot nature of most of these studies and emphasizing the need for well-designed studies with larger sample to guide evidence-based medicine in the future.

GRAPHICAL ABSTRACT

PUBLIC SUMMARY

• C-section is associated with gut dysbiosis in CS infants and increased disease risks from childhood to adulthood.

• Apart from using traditional probiotics to restore CS-related dysbiosis, a new research direction is to investigate the potential of mimicking natural inoculation process would alleviate infant gut dysbiosis.

• Several small-scale studies have shown that transplanting maternal vaginal or even fecal microbiota might restore CS-related infant dysbiosis. Controversy remains regarding the clinical applicability, safety, efficacy and mechanisms of these approaches.

KEYWORDS:

• Microbiota transplantation
• Vaginal microbial seeding
• Gut microbiota
• C-section
• Infant

Acknowledgments

We express our gratitude to the participants and their families who contributed to this study. We also extend our appreciation to the funding agencies whose support made this research possible. Specifically, we acknowledge the National Key R&D Program of China (2019YFA0802301 [to Y.H.]) and the National Natural Science Foundation of China (NSFC82022044 [to Y.H.] and NSFC82272391 [to Y.H.]). Their contributions were instrumental in advancing our research endeavors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Y.H and R.H.X provided direction and guidance throughout the preparation of this manuscript. S.N.L collected and interpreted studies and was a major contributor to the writing and editing of the manuscript. X.X.L reviewed and made significant revisions to the manuscript. L.P.Z collected studies. All authors read and approved the final manuscript.

Additional information

Funding

The work was supported by the National Key Research and Development Program of China [2019YFA0802301 [to Y.H.]]; National Natural Science Foundation of China [NSFC82022044, NSFC82272391].