Influence of timing of maternal antibiotic administration during caesarean section on infant microbial colonisation: a randomised controlled trial

Abstract

ObjectiveRevised guidelines for caesarean section (CS) advise maternal antibiotic administration prior to skin incision instead of after umbilical cord clamping, unintentionally exposing the infant to antibiotics antenatally. We aimed to investigate if timing of intrapartum antibiotics contributes to the impairment of microbiota colonisation in CS born infants.DesignIn this randomised controlled trial, women delivering via CS received antibiotics prior to skin incision (n=20) or after umbilical cord clamping (n=20). A third control group of vaginally delivering women (n=23) was included. Faecal microbiota was determined from all infants at 1, 7 and 28 days after birth and at 3 years by 16S rRNA gene sequencing and whole-metagenome shotgun sequencing.ResultsCompared with vaginally born infants, profound differences were found in microbial diversity and composition in both CS groups in the first month of life. A decreased abundance in species belonging to the genera Bacteroides and Bifidobacterium was found with a concurrent increase in members belonging to the phylum Proteobacteria. These differences could not be observed at 3 years of age. No statistically significant differences were observed in taxonomic and functional composition of the microbiome between both CS groups at any of the time points.ConclusionWe confirmed that microbiome colonisation is strongly affected by CS delivery. Our findings suggest that maternal antibiotic administration prior to CS does not result in a second hit on the compromised microbiome. Future, larger studies should confirm that antenatal antibiotic exposure in CS born infants does not aggravate colonisation impairment and impact long-term health.

Maternal antibiotic exposure during pregnancy and risk of IBD in offspring: a population-based cohort study

“…In this analysis, we uncover further nuances. Safety of one to two courses of antibiotics towards offspring IBD risk is consistent with data on lack of microbiome disruption 1. For further courses, benefits should be weighed against risks.…”

“…We read with interest the randomised controlled trial by Dierikx et al that demonstrated the lack of long-term impact of antenatal antibiotics on offspring gut microbiome 1. Antibiotics in early life are implicated in IBD risk, potentially mediated by gut microbiome perturbations and altered host–microbe interactions 2 3.…”

Development of gut microbiota during the first 2 years of life

“…We cannot ascertain use or timing of peripartal antibiotic prophylaxis in our maternal cohort, but a randomized control trial including 20 children in each arm with up to 3 years of follow-up failed to show any effect of different timing of antibiotic treatment, although both groups differed compared with a third group of vaginally delivered children. These findings indicate that there are other more important factors that explain the association of caesarean section with the child’s gut microbiota 48 .…”

What is the relationship between mode of birth, antibiotics, and childhood health?

“…We know that caesarean section has a profound effect on the gut microbiota, and it may be that a single dose of prophylactic antibiotics does not have further significant impact on what is already a dysbiosis. This is supported by two small recent randomised controlled trials that did not find marked differences in microbial colonisation in babies exposed to cefuroxime administered before skin incision compared with babies with caesarean birth whose mothers received antibiotics after cord clamping 45…”