Shaping of the human immune system begins in utero, and continues to develop and mature during the first 36 months postpartum.7 While it is not yet fully known how the maternal microbiome and prepartum probiotic supplementation influence the infant immune system, it is known that microbes play an immense role in its development. Further, there appears to be a limited window of opportunity during which the innate immune response can be shaped.8
A growing body of evidence suggests that cesarean delivery and perinatal antibiotic use are risk factors for eczema and allergies, due to microbial dysbiosis in the infant. Conversely, studies have suggested that maternal supplementation with probiotics has been associated with modulated immune responses, and reduced incidence of allergies and eczema.8 This highlights the importance of the microbiota in immune development.7, 8
There are two main ways by which the maternal gut microbiota affects the infant’s immunity:
Next, we take a closer look at the evidence on how these two natural processes may affect infant immunity.
The infant microbiota is influenced by prenatal external factors, such as maternal stress,11 suggesting the importance of balancing the maternal microbiota during pregnancy.11 Further evidence suggests that manipulation of the maternal microbiota during pregnancy may play a key role in the health of the infant.12, 13
In randomized, blinded and controlled studies, maternal probiotic supplementation has been shown to support a healthy gut and immune system in infants. Mothers with a family history of atopic disease were supplemented with Lactobacillus rhamnosus, LGG® (hereafter referred to by use of the trademark LGG®) during pregnancy and breastfeeding (or given infant formula with the LGG® strain if not breastfeeding). After the intervention the newborns of mothers receiving the LGG® strain had a 50% lower incidence of atopic eczema compared to placebo-treated mothers.1 This effect was sustained in follow-up studies when the infants were 4,1, 2 and 7 years old.1, 3 Similarly, pre- and postnatal maternal supplementation with the LGG® strain, Bifidobacterium, BB-12® (hereafter referred to by use of the trademark BB-12®) and Lactobacillus acidophilus, LA-5® has been associated with a reduced incidence of atopic dermatitis in breastfed infants.4
Breastfeeding in the postnatal period can also impact infant immune development via the maternal microbiota. Selected gut bacteria and metabolites from the maternal gut can access the mammary glands.9, 14 This is further supported by mice models as probiotic bacteria given to the dams have been found in mammary tissue and milk.15 Maternal supplementation with probiotics has been associated with changes to breastmilk.5, 16 In some studies, consumption of the LGG® strain during pregnancy and breastfeeding has been associated with increases in breast milk concentration of TGFβ2, and with a reduced incidence of atopic eczema in the infant.16 TGFβ2 is an important factor for breastmilk-induced immune tolerance,17 since exposure to TGFβ2 stimulates immune maturation in the immature gut.18, 19 The same effect of an increased concentration of TGFβ2 in breastmilk was likewise observed following maternal supplementation with the LGG® and BB-12® strains.5
The maternal gut microbiota changes dramatically between trimesters 1 and 3, with a reduced species richness, and an increased abundance of bifidobacteria.20, 21 Progesterone is thought to be an inducer of this natural change in the gut microbiota during late pregnancy.21 These changes in the mother’s microbiome may impact immune development of the infant.
Modulation of the maternal microbiota may directly impact the infant microbiota during vaginal birth. Specific bifidobacterial strains have been identified in mother-infant pairs following vaginal delivery but not in mother-infant pairs following cesarean delivery. This suggests that an important transmission from the mother to infant occurs in the birth canal.22 In support of this, an investigation of maternal seeding demonstrated that specific bacterial species (essential for the infant microbiome) were nearly always shared between mother and vaginally born infants.23 These persist for at least one year.23 When mothers consumed LGG® in the weeks leading up to birth, their newborns had increased bifidobacterial diversity,6 possibly due to the bifidogenic effect of lactobacilli.24, 25, 26, 27 Therefore, maternal probiotic supplementation can help early colonization of the vaginally born infant.6, 22, 23
These observations emphasize the prenatal and postnatal interactions between maternal gut microbes and the infant immune system. This suggest an important role for maternal probiotic supplementation during pregnancy and breastfeeding in order to direct the infant’s immune system towards tolerance.
BB-12®, LA-5® and LGG® are registered trademarks of Chr. Hansen A/S.
The article is provided for informational purposes regarding probiotics and is not meant to suggest that any substance referenced in the article is intended to diagnose, cure, mitigate, treat, or prevent any disease.
The probiotic strain Bifidobacterium, BB-12® is the world’s most documented probiotic bifidobacterium. It has been extensively studied and has been associated with improved outcomes across various health areas.
BB-12® is a trademark of Chr. Hansen A/S
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