Research Underway Looking at Microbiome Seeding of the Newborn

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The topic of seeding the cesarean born newborn's microbiome with bacteria harvested from the birthing person's vagina has been under consideration for the past few years. Anne Estes, Ph.D. covered this topic on Science & Sensibility before: Seeding the Newborn's Microbiome - Can We Do It? Should We Be Doing It?. Yesterday on NPR's Morning Edition, information was shared on a study being conducted that aims to determine if there are benefits to a newborn being exposed to their parent's vaginal flora. I hope that this study will be sufficiently powered to answer this question. Previous studies that I have seen to date are too small to determine outcomes confidently.

The study in progress, Vaginal Microbiome Seeding and Health Outcomes in Cesarean-delivered Neonates, will randomize newborns born by scheduled cesarean to either be swabbed with a gauze containing secretions obtained from the birthing person's vagina or a placebo gauze saturated with sterile water. The newborn will be swabbed over the face and body with the gauze. They will be followed for three years to determine any health outcomes, including microbiome development, immune development, metabolic outcomes, and any adverse events. This is the first study allowed by the U.S. Food and Drug Administration.

Researchers hypothesize that those infants who receive the vaginal microbiota soaked gauze swab will have a restored infant microbiome and a reduced risk of obesity and immune-mediated diseases, that have been linked to cesarean birth.  The research is being conducted in two stages - 1) the effects of vaginal seeding on the gut microbiota composition, structure and function will be examined and then 2) a BMI z score and immune-mediated outcomes will be documented to explore the impact of seeding on child obesity.  Results will help provide evidence of whether the "vaginal seeding" procedure can safely transfer microbes from birthing parent to baby, and whether these microbes are beneficial for the metabolic and immune health of the child.

Based on the research currently published to date, the American College of Obstetricians and Gynecologists does not support microbiome seeding.  They have released a committee opinion on this topic in November 2017.

There is an ongoing similar study being conducted at the Icahn School of Medicine at Mount Sinai in New York City that examines the differences between those newborns who are born by planned cesarean and those born through a spontaneous vaginal birth.  The babies born during a planned cesarean will be either swabbed with a gauze containing vaginal secretions or a sterile placebo, so they are comparing three categories of exposure.

In my childbirth classes, families are constantly asking about the benefits (and risks) of exposing their cesarean born baby to the birthing parent's microbiome through vaginal secretions.  I am encouraged that I may have some published study results to share with them in the next year or so. Currently, I share what little has been published and advise them to speak with their health care provider.  There are definitely some situations where seeding would be contraindicated. (Active sexually transmitted infections (STI) or GBS positive status.)  Having some outcomes on the books will help me to share more information about what researchers have found. Do you have families discussing this topic as well?  What information are you sharing when they ask?

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