2023-08-05 06:52:00
by Clemens Haug
As of August 05, 2023, 06:52
Before a cesarean section, mothers are given antibiotics to protect the surgical wound. But this damages the microbiome of the children and has long-term consequences. A study shows how the problem could be avoided.
For a long time, the caesarean section was considered a miracle cure in modern obstetric medicine. It has significantly reduced maternal and infant mortality and provided a safe escape from severe complications at the end of pregnancy. But in the meantime, there has also been criticism: Individual studies have found a possible connection between a birth by caesarean section and an increased risk of developing asthma later in life or developing atopic dermatitis, the skin disease colloquially known as neurodermatitis. The risk of becoming very overweight later on could also be increased. However, there are also studies that show the opposite.
The fact that the results are so different could be because it is probably not the cesarean section in and of itself that poses a problem, but its effects on the community of bacteria in the gut and on the newborn’s skin, called the microbiome. And this is where medical research only started a few years ago to understand how important the microbiome is and how easily it can be disrupted.
One such potential disruption in a caesarean section is antibiotics, which current recommendations are for mothers to take half an hour before the operation to minimize the risk of infection of the surgical site. A study by researchers from the university hospitals in Lübeck and Würzburg now shows that a small change in the time at which antibiotics are administered is sufficient to prevent the risks for the mother from increasing but to damage the child’s microbiome significantly less.
Natural childbirth: The maternal body prepares the right microbiome
In a natural, i.e., vaginal birth, the microbiome is transferred from the mother to the child when it is pushed through the birth canal. The composition of these bacteria is not random. “At the end of pregnancy, the microbiome in the mother’s body changes in such a way that the child is optimally prepared for its first contact with foreign microorganisms outside the womb after birth,” says Christoph Haertel, pediatrician and director of the children’s clinic at the University Hospital of Würzburg.
In the case of a caesarean section, however, this contact with the prepared microbiome in the birth canal is missing. That is why many doctors now advise natural childbirth if there are no major risks against it. Often, however, a caesarean section is not a voluntary choice, but medically necessary. The good news: In this case, too, doctors and mothers can do a lot to ensure that the children get a healthy microbiome.
Good bacteria: why a healthy microbiome is important for babies
Bacteria in the intestine are responsible, among other things, for the production of important messenger substances that regulate inflammation.
Because the mothers also transmit part of their bacterial communities when cuddling with their baby and by giving him their breast milk. In particular, bifidobacteria and lactobacilli, which settle in the children’s intestines, are transmitted. Researchers assume that there they work, on the one hand, by colonizing tissue that would otherwise be occupied by dangerous germs.
On the other hand, the good bacteria are involved in the production of important substances, including tryptophan, a messenger substance that controls the body’s immune reactions and regulates inflammation. A disrupted tryptophan metabolism caused by a damaged microbiome would be a possible explanation of why autoimmune problems such as neurodermatitis occur.
“Vaginal Seeding” – Artificial transmission of the microbiome is partially possible
Outside of Germany, doctors and obstetricians are experimenting with so-called “vaginal seeding”. A sterile swab is inserted into the vagina of a mother just before the birth to pick up bacteria. After the caesarean section, the babies are then dabbed with the secretion. Initial observational studies show that the microbiome of these children is very similar to that of children born naturally.
However, the medical specialist societies in Germany do not yet have a clear opinion on this approach. There is still hardly any data on how seeding affects the risks associated with caesarean sections, such as asthma and the like. There is also a risk that harmful germs or viruses could be unintentionally transmitted to the baby during the smear test.
Preventive administration of antibiotics: Children are also affected by the placenta
But the problem with a caesarean section is not only the lack of contact with the birth canal. As described, the microbiome can also be transmitted through skin contact and breast milk. However, this only works if the bacteria have not been completely destroyed. And here the preventive use of antibiotics, which has been customary up to now, plays a central role, as Christoph Härtel’s team has now been able to show with a study.
The doctors won a total of 40 pregnant women for the study who gave birth to their children by caesarean section. The women were randomly divided into two groups. 21 received antibiotics 30 minutes before delivery as previously recommended. According to the researchers, this time was sufficient for the medication to reach the child in the pregnant woman’s belly. After the birth, the doctors working with Haertel determined: “We were able to detect antibiotics in the blood of all these children.”
Later administration of antibiotics: no difference in mothers, but large differences in children
The second group of 19 women, on the other hand, only received the antibiotic after the children had cut their umbilical cords. Other studies had previously shown that the step could make sense. “There is data from Switzerland that the number of possible wound infections in a caesarean section does not differ if you only give the antibiotics after the child has cut its umbilicus,” says Härtel. He and his team have now been able to confirm this result.
The rate of wound infection was similar in both maternal groups. But the microbiome of the children differed significantly. Among other things, those who had not come into contact with the antibiotics had significantly more clostridia. These bacteria, some researchers suggest, are linked to a lower risk of asthma. These differences were still visible a year after birth.
Antibiotics and caesarean section: Larger study must confirm results
The study group of 40 mothers was still too small to change the guidelines. Therefore, the study should now be repeated with more participants. If the experiment is successful, a comparatively small change would be enough to achieve a major benefit for the children’s microbiome.
This topic in the program: MDR CULTURE – The Radio | March 31, 0021 | 3:59 p.m]
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