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Effects of vaginal seeding on gut microbiota, body mass index, and allergy risks in infants born through cesarean delivery: a randomized clinical trial

  • Yang Liu
    Affiliations
    Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)

    Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)
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  • Hong-tian Li
    Correspondence
    Corresponding authors: Jian-meng Liu, PhD., Hong-tian Li, PhD.
    Affiliations
    Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)

    Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)

    Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Haidian District, Beijing, China (Drs H Li and J Liu)
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  • Shu-jin Zhou
    Affiliations
    Liuyang Maternal and Child Health Care Hospital, Changsha, Hunan, China (Drs S Zhou, H Zhou, and Y Xiong)
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  • Hui-huang Zhou
    Affiliations
    Liuyang Maternal and Child Health Care Hospital, Changsha, Hunan, China (Drs S Zhou, H Zhou, and Y Xiong)
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  • Ying Xiong
    Affiliations
    Liuyang Maternal and Child Health Care Hospital, Changsha, Hunan, China (Drs S Zhou, H Zhou, and Y Xiong)
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  • Jing Yang
    Affiliations
    Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian District, Beijing, China (Dr J Yang)
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  • Yu-bo Zhou
    Affiliations
    Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)

    Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)
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  • Dun-jin Chen
    Affiliations
    Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (Dr D Chen)
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  • Jian-meng Liu
    Correspondence
    Corresponding authors: Jian-meng Liu, PhD., Hong-tian Li, PhD.
    Affiliations
    Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)

    Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center; Haidian District, Beijing, China (Drs Y Liu, H Li, Y Zhou, and J Liu)

    Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Haidian District, Beijing, China (Drs H Li and J Liu)
    Search for articles by this author
Published:November 02, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100793

      BACKGROUND

      Vaginal seeding—exposure of neonates to maternal vaginal fluids—has been proposed to improve the microbiota of infants born through cesarean delivery, but its impacts on the infants' subsequent health outcomes remain unclear.

      OBJECTIVE

      This study aimed to examine the impacts of vaginal seeding on gut microbiota, growth, and allergy risks in infants born through cesarean delivery.

      STUDY DESIGN

      This randomized controlled trial was conducted at Liuyang Maternal and Child Health Care Hospital in Hunan, China. We estimated that a minimum sample size of 106 was needed by assuming a standardized effect size of 0.6 for the primary outcomes, with a statistical power of 80%, a 2-sided type I error of 0.05, and an expected loss to follow-up rate of 15%. Finally, 120 singleton term pregnant women scheduled for cesarean delivery were enrolled from November 2018 to September 2019. Infant follow-up was completed in September 2021. The participants were randomized in a 1:1 ratio to the vaginal seeding group (n=60; infants were swabbed immediately after birth using gauze preincubated in maternal vagina) or the control group (n=60; routine standard care). The first set of primary outcomes was infant body mass index and body mass index z-scores at 6, 12, 18, and 24 months of age. The other primary outcome was the total allergy risk score at 18 months for 20 common allergens (each scored from 0–6 points). Characteristics of gut microbiota, overweight/obesity, and allergic diseases and symptoms were included as secondary outcomes. The main analyses were performed according to the modified intention-to-treat principle.

      RESULTS

      Of 120 infants, 117 were included in the analyses. Infant body mass index and body mass index z-scores did not significantly differ between the 2 groups at any of the 4 time points, with the largest difference in point estimates occurring at 6 months: the mean (standard deviation) body mass index was 17.5 (1.4) kg/m2 and 17.8 (1.8) kg/m2 in the vaginal seeding and control groups, respectively (mean difference, −0.31 kg/m2 [95% confidence interval, −0.91 to 0.28]; P=.30), and body mass index z-score was 0.2 (1.0) and 0.4 (1.1), respectively (mean difference, −0.20 [95% confidence interval, −0.58 to 0.18]; P=.31). The median total allergy risk score was 1.5 (interquartile range, 0.0–4.0) in the vaginal seeding group and 2.0 (interquartile range, 1.0–3.0) in the control group (median difference, 0.00 [95% confidence interval, −1.00 to 1.00]; P=.48). For infants from the vaginal seeding group, the relative abundance of genera Lactobacillus and Bacteroides in the gut microbiota was slightly yet nonsignificantly elevated at birth and 6 months, and the risk of overweight/obesity was lower at 6 months (0/57 vs 6/59; relative risk, 0.03 [95% confidence interval, 0.00–0.57]; P=.03) though not at subsequent time points. Other secondary outcomes did not differ between groups. No adverse events related to the intervention were reported.

      CONCLUSION

      For infants born through cesarean delivery, vaginal seeding has no significant impacts on the gut microbiota, growth, or allergy risks during the first 2 years of life.

      Keywords

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