Medicalised deliveries: the hidden triple threat to infant health

Jan Knol is a Professor at Wageningen University and a microbiologist who has been working at Danone Nutricia Research for the last 25 years to improve knowledge about the infant microbiome.

A such, he is spreading the word about the long-term health burdens we are placing on infants when they are born via medical intervention.

“Babies are born virtually sterile, in terms of their gut colonisation, and you can imagine going from sterile to having a microbiome of one kilo is a huge and sensitive process," he tells NutraIngredients.

“It’s amazing how quickly the gut has to become effective at absorbing nutrients to support the rate of growth of the body, the brain and the immune system."

With the sensitivity of this colonisation process in mind, Knol discusses the many modern day burdens to the microbiome which can set many babies' health on the backfoot right from birth.

The main impactors he notes are C-section deliveries, use of antibiotics, sterile environments, and reduced gestational age. Not only are these all common but in many situations they are layered on top of one another.

“As we have changed methods of delivery and we have invented antibiotics, although these save many lives, these can really hit the microbiome hard.

“In some areas of the world antibiotics are given out very freely - we have seen many situations where healthy infants are prescribed antibiotics."

He notes that many babies are delivered before their due date and if its gut microbiome has not developed to the stage it should have by the time he or she is born, then this will impact the gut's ability to colonise.

During natural birth, Bifidobacterium​ is transmitted from the mother to the infant and it is an early coloniser of the infant gut. The transmission of Bifidobacterium​ during natural birth and breastfeeding highlights the role of the maternal microbiome in establishing Bifidobacterium​ as a paramount early coloniser of the infant gut.

But Knol says rates of C-section have almost doubled since 2000, with 3 in 10 babies now born this way in Europe. 

He adds: “C-section delivery is a big impactor and in some parts of the world the rate of C-section deliveries could be up to 90% and very much considered the norm.”

Knol explains there are a number of external factors causing health professionals to prefer this route.

“There are many systems where the doctors want a 9-5 job and they want C-sections as they can be planned. For some hospitals, there is a financial incentive to doing C-section deliveries. And at the same time there’s a big lack of awareness as to the negative implications of this method, especially among surgeons.”

In the case of C-section deliveries, Knol says babies are dealt with a ‘triple burden’ to their microbiome as not only will they be delivered unnaturally, but their delivery will be planned to take place before their due date to ensure the mother doesn’t go into labour naturally, plus they will often receive antibiotics as a result of the intervention as it opens the baby and mother to infection.

The bifido-factor

Thankfully, breast milk is effective at counteracting the microbial issues caused by these burdens. 

Discussing how the infant's gut colonises from a sterile state, Knol notes the species of note are those that colonise well when fed by human milk oligosacharides (HMOs) - substrate sugars the baby can’t digest but feed the bacteria in the gut.

“Bifidobacteria​ are specific to the human gut because they like HMOs. They produce acids, metabolites, and cross feed other bacteria so they play a key role in the early life microbiome and the transition to the mature microbiome.”

Research has revealed the microbiome of C-section babies are lower in the health promoting metabolites that feed on HMOS, such as bifidobacteria​, strict anaerobes, and bacteroides.

As a result, C-section babies are at higher risk of allergies and immune related diseases.

“This is also the time that the gut is trained to drive the development of the immune system by learning what’s nutrients and what are pathogens. As a result, we are seeing more and more evidence that C-section born infants have a high risk of immune balance, inflammation, obesity, and allergies in later life.”

To support babies who can't be breastfed, Danone Nutricia researchers have conducted studies​ showing that feeding a baby formula supplemented with bifidobacteria​ and prebiotics can help to colonise the microbiome of the infant so that it is more similar to that of a vaginally delivered infant.

This nutritional intervention has also been linked to lower incidence of eczema and atopic dermatitis in infants. 

Looking to the future, Knol says he can see healthcare systems moving away from medicalised births as people become more aware of the impact on microbiome health.

“As papers are coming out with big cohort studies showing all the immune disorders and diseases, such as diabetes, that are increased by these interventions, I’m sure we will see some change.”

Asked if he can see microbiome testing becoming a common protocol in the future, Knol noted that the Danone Nutricia researchers in Singapore are currently conducting regular infant microbiome tests, either directly with the mothers or via health care professionals, in order to collect more data to help improve infant nutrition in the future.