WASHINGTON, June 16, 2023 (BSS/AFP) - Babies born by cesarean section don't
acquire the same healthy bacteria as those delivered vaginally, a setback to
the development of their immune system thought to increase their risk of
certain diseases later in life.

But a new study, published Thursday in the journal Cell Host & Microbe, finds
that exposing C-section babies to their mother's vaginal fluids after birth
successfully restores this microbial balance, and has neurodevelopment
benefits, too.

The study used rigorous methods but was small, involving just 68 infants.
 
Coauthor Jose Clemente of the Icahn School of Medicine at Mount Sinai told
AFP that if the findings are confirmed in bigger clinical trials, the
technique could be used as a low-cost way to ensure C-section newborns start
life on the same footing as vaginally delivered infants.

"If the results can be generalizable to a larger population, then ideally we
would like to see that this becomes a part of standard of care," he said.

It comes as C-section rates are on the rise globally, now accounting for
around one in every three births in the United States, though the World
Health Organization estimates only 10-15 percent are medically necessary.

Past research has shown infants born by C-section have vastly different gut
bacteria composition compared to those born vaginally.

The latter receive their early gut bacteria from their mother's birth canal,
while C-section babies receive theirs mainly from their mothers' skin, breast
milk and the environment.

These differences tend to disappear by around the age of one, but even so,
they can have certain lasting impacts, raising the risk for asthma, allergies
and diabetes.

- 'Vaginal seeding' -
In the new study, Clemente, an expert on the role of the microbiome in human
health, collaborated with colleagues at the Southern Medical University in
Guangzhou, China to test out a technique known as "vaginal seeding," or
smearing newborns with vaginal fluid.

Chinese colleagues, led by researcher Yan He, rubbed 32 newborns delivered by
C-section with a gauze soaked with their mother's vaginal fluids, and another
36 newborns with a gauze soaked with saline as a control.

The gauze was placed inside the mothers' vaginas about an hour before C-
section. Applying it to babies took about 30 seconds, starting with the mouth
and face and moving to the rest of the body.

Mothers were tested in advance to make sure they did not have sexually
transmitted diseases or group B streptococcus. No infants experienced severe
adverse events as a result of the experiment.

At six-weeks-old, the group exposed to vaginal fluid had gut bacteria that
was more "mature" and more characteristic of vaginally delivered babies than
the group given the saline placebo.

The team also looked at the babies' neurodevelopment at three months and six
months using a standard questionnaire to ask their mothers about milestones,
such as whether the babies were able to make simple sounds or had begun
rolling or getting in the crawl position.

The infants who received the vaginal seeding scored significantly higher at
both three and six months.

"We think this is partially because of how microbes are producing certain
chemical compounds that might impact brain function," said Clemente, an
expanding field of study that is backed by animal research.

Crucially, he stressed, the experiment was "triple blinded," meaning nobody
involved (mothers, healthcare providers or researchers) knew beforehand which
babies belonged to which group, in order to eliminate any temptation to make
the results match expectations.

Dorothy Bishop, a developmental neuropsychology expert at the University of
Oxford, who was not involved in the study, praised the "clever design," and
said the team had laid the groundwork for bigger trials by establishing the
safety and feasibility of the technique.

However, she stressed that they had not yet proven developmental benefit and
that the test scores from the placebo group "seem pretty average" rather than
suggesting impairment.

Next, Clemente is looking to expand the study with his Chinese collaborators
to move the procedure closer to clinical practice, while he has another
ongoing study assessing whether it reduces the risk of food allergies.

In the meantime, he says, families should not try to replicate the procedure
outside of clinical research settings.