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Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy

Published:August 29, 2011DOI:https://doi.org/10.1016/j.jaci.2011.07.027

      Background

      Both gastrointestinal microbiota composition and cesarean section have been linked to atopic manifestations. However, results are inconsistent, and the hypothesized intermediate role of the microbiota in the association between birth mode and atopic manifestations has not been studied yet.

      Objectives

      We sought to investigate the relationship between microbiota composition, mode and place of delivery, and atopic manifestations.

      Methods

      The Child, Parent and Health: Lifestyle and Genetic Constitution Birth Cohort Study included data on birth characteristics, lifestyle factors, and atopic manifestations collected through repeated questionnaires from birth until age 7 years. Fecal samples were collected at age 1 month (n = 1176) to determine microbiota composition, and blood samples were collected at ages 1 (n = 921), 2 (n = 822), and 6 to 7 (n = 384) years to determine specific IgE levels.

      Results

      Colonization by Clostridium difficile at age 1 month was associated with wheeze and eczema throughout the first 6 to 7 years of life and with asthma at age 6 to 7 years. Vaginal home delivery compared with vaginal hospital delivery was associated with a decreased risk of eczema, sensitization to food allergens, and asthma. After stratification for parental history of atopy, the decreased risk of sensitization to food allergens (adjusted odds ratio, 0.52; 95% CI, 0.35-0.77) and asthma (adjusted odds ratio, 0.47; 95% CI, 0.29-0.77) among vaginally home-born infants was only found for children with atopic parents.
      Mediation analysis showed that the effects of mode and place of delivery on atopic outcomes were mediated by C difficile colonization.

      Conclusion

      Mode and place of delivery affect the gastrointestinal microbiota composition, which subsequently influences the risk of atopic manifestations.

      Key words

      Abbreviations used:

      aOR (Adjusted odds ratio), GM (Gastrointestinal microbiota), KOALA (Child, Parent and Health: Lifestyle and Genetic Constitution), OR (Odds ratio)
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      Linked Article

      • The mediating effect of microbial colonization on the effect of cesarean section delivery
        Journal of Allergy and Clinical ImmunologyVol. 129Issue 2
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          van Nimwegen et al1 report an intriguing set of results concerning the role of intestinal microbiota colonization in the relationship between mode and place of delivery on childhood risk of allergic disease. The possibility of cesarean section being a potential cause of asthma has received considerable attention,2,3 and although other hypotheses have been posed,4 the most often cited explanation for this association is reduced colonization with microbiota from the maternal gut and vagina.5 The authors observed that, of the measured microbiota, only colonization by Clostridium difficile was related to the risk of allergic disease.
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