The impact of antibiotics on a newborn's microbiota

When baby is born, his mum has prepared the best microbial starter pack for him to be colonized with on his way out (if you'd like to read more about this, follow here).

However, in some cases when infections can occur during or after birth (especially after C-sections and in pre-term births), baby may be administered vital antibiotics to combat opportunistic infections. It has been estimated that 1.4 million of babies die at birth because of invasive infections; therefore, we can all agree that there are no questions over whether antibiotics are essential or not, they just ARE!!

But what happens to the first microbial colonies of baby when under attack by antibiotics.

A study looking at the microbiota of pre-term babies who received antibiotics showed that these babies had in their gut an unusual amount of a family species called enterobacteriaceae.

It might not mean anything on its own, but because our microbes have established a balance between themselves, if you tip that balance, their carefully attributed functions are all messed up and it can take up to two years to re-establish a  correct balance between the species.

Today we are recognizing the effects of a tipped balance on our health. Unfortunately, consequences linked to the administration of antibiotics to babies are, for example, an increased risk of developing auto-immune diseases such as inflammatory bowel disease (Crohn's, colitis), Type I diabetes, and allergies.

Unfortunately, there is as yet no alternatives to antibiotics that are as effective in delicate situations such as to ensure baby's survival.

Recently, some scientists have found a way to combat bacterial infections using a different mechanism of action. Although it will take years before we can see the alternatives being applied to clinical practice, I'm hopeful that the incidence of some of these diseases will decrease thanks to, once again, progress in our understanding as to how nature works.

Do you know children with allergies that you think may be linked to having been given antibiotics at birth?

Don't hesitate to share your stories in the comments below, I'd love to read them.

See you next Monday!

The vaginal swab technique for C-section babies

Although it may sound really gross, this is a revolutionising yet simple technique that has been devised to help C-section babies get the best microbial starter pack from their mums (find out what this pack is here).

Indeed, while C-section is an essential tool for mothers and babies for who natural birth may put them at risk, those little bundles of joy are missing some vital ingredients they would have encountered on a natural way out: mum's vaginal microbes.

However, in many countries, it is possible to simply choose when to have your baby. It may seem the next logical step in our 'civilised' and sterile way of living but what about those friendly microbes? More and more scientists are realising that these first microbes baby encounters on his way out determine the level of risk of developing many diseases (coming soon).

When the wife of one of those experts in microbiota gave birth by emergency C-section, he didn't take any chance and applied the vaginal swab technique to his own baby. I recently read that one year on, their baby was very healthy and had not shown any of the signs C-section babies are most at risk such as allergies and eczema.

How to do a vaginal swab?

From Dominguez-Bello et al, 2016.*

The technique consists in keeping a sterile wipe inside the mum's vagina up until the last minute. When baby is out through mummy's tummy, the wipe is applied on baby's mouth, face, and then the rest of his body as if he had been pushed out through mum's vagina with maximum contact in the mouth, then face, then body.

A super recent study* examined how efficient this technique is. Their results showed that gut, oral, and skin bacterial communities of these swabbed newborns were enriched in vaginal bacteria during the first 30 days of life, similar to vaginal birth babies' and, most importantly, completely different from unswabbed C-section babies' - thereby demonstrating the effectiveness of the technique.

Would you ask for a vaginal swab if your baby needs to be born by C-section?

Let me know your thoughts in the comments section, I'd love to read them.

*The study I'm referring to is: Dominguez-Bello MG, et al. Nat Med 2016; doi:10.1038/nm.4039. 

What is the risk of GBS infection during water birth?

I would like to share with you Part II of the question I was asking myself: Is water birth bad for baby?
If you'd like to catch up on the first part, please follow here.

When researching for answers, I came accross an article saying that it was bad; however, many professionals disagreed.
Interestingly one of them brought forward this article focused on the risk of GBS infection during water birth:

GBS stands for Group B Streptococcus and can be worrying for pregnant women who are found to have some in their gut (mums are called GBS carriers). In fact, up to 41% of women are carriers and 1 in 2 children born from these mothers will themselves be colonized by GBS. Out of all these children, it was estimated that 1% could develop complications that sometimes can be life-threatening (1 in 10).

This US paper stated that there was a 300% lower rate of early onset GBS infection when babies were born in water (and without using antibiotic prophylaxis) compared with babies born on dry land (both hospitals) - when looking at uncomplicated pregnancy (what are GBS' pregnancy complications?).

In the UK, pregnant women are not routinely screened for GBS (NHS)

The article concluded that if there is a risk of early onset GBS, the risk may be lowered by encouraging the mother to give birth in a warm water pool without antibiotics (effect of antibiotics at birth coming soon).

Another 2007 study showed that GBS-carrier mums who gave birth in the water - as opposed to laboured in the water and got out before the big push - contaminated the water pool with their GBS much more, nevertheless there were fewer of their children colonized by GBS!

In conclusion, for now we can say that water birth has not been shown to influence baby's gut early microbiota and it may even have a protective effect for babies at risk of GBS infection.

Do you know if you are a GBS carrier?

If you'd like to share your thoughts or stories, please don't hesitate to leave me a comment, I'd love to read them.

See you next Monday!

Scientific articles on GBS here and here

Is water birth bad for baby's microbiota?

Ever since I read my first book on microbiota, I've been wondering if a baby born in a water birth pool still gets his mummy's best microbial starter pack!

Previous articles here on MBAI have covered how important it is for babies to be colonized by mum's vaginal and rectal microbes on their way out of their cozy womb where they were virtually germ-free (although this is now debatable). This early bug population is indeed essential in immunity development as well as a digestive help. And knowing that a lot of research data shows the link between increased disease risk and C-section due to baby being colonized by skin rather than vaginal bugs, I started to wonder about water birth!

Water birth (photo borrowed from here)

So, what happens when babies are born in a 'wet' environment? Here are the natural questions one could ask oneself:

• How is the water treated? Does it kill or affect in any way mum's vaginal and rectal environments?
• How is the pool treated? If it's a mild treatment to avoid the above, is it strong anti-microbial to kill off previous mums' inhabitants (pathogenic or not)?
• When baby travels the birth canal, does he meet enough of mum's essential microbes to be colonized, or are they diluted?
• When baby is taken out of the pool, is he patted dry more vigorously, cleaning off his microbes?

I don't know the definite answers to these questions. I couldn't find any scientific articles on the outcome but I found that:
- In terms of anti-microbial treatment, off-gas chlorine is usually used and can then be eliminated by adding Vitamin C powder to the water. Filtered water is also used as well as ozonated water!
- Baby's vernix is also thick enough not to be affected by any treatment!
- We can imagine that as baby passes through the birth canal, he will have swallowed copious amount of microbes already and will be colonized as if he had been born on 'dry' grounds!

I could however find a couple of blog posts asking the same question but speculating that yes water birth does have a negative influence on baby's microbiota.
(Note: It was also suggested that water pool should be used during labour only to ease the pain but to give birth on 'dry' grounds so the issues raised above are not too much of a worry!)

Needless to say, following each of these articles (here and here) were comments of diverse opinions:

A gastroenterology-focused naturopath and nutrigenomic specialist 'wrote' that she herself analyzed the microbiota of many infants and that there was no difference between babies born on 'dry' land and babies born in water pool. Many midwives also refuted the claim.

Have you given birth to your child in a water pool? Or at home?

If you'd like to share your thoughts or stories, please don't hesitate to leave me a comment, I'd love to read them.

See you next Monday!