Gut Microbiota in the Infants' First 1000 Days: History
Please note this is an old version of this entry, which may differ significantly from the current revision.

The first 1000 days after birth represent a critical window for gut microbiome development, which is essential for immune system maturation and overall health. The gut microbiome undergoes major changes during this period due to shifts in diet and environment. Disruptions to the microbiota early in life can have lasting health effects, including increased risks of inflammatory disorders, autoimmune diseases, neurological disorders, and obesity. Maternal and environmental factors during pregnancy and infancy shape the infant gut microbiota.

  • microbiota
  • colonization
  • children
  • breastfeeding

1. Introduction

The first 1000 days of a child represent a critical window for the maturation of the immune system and the establishment of gut microbiota [1]. This simultaneous development has caught the attention of immunology researchers, making it an area of study that is both intriguing and captivating. The human being lives in harmony with microbiota, which is made up of not only bacteria but also viruses and fungi [2]. These microorganisms are present throughout the human body in different sites such as the skin, mouth, nasopharynx, and intestine [2][3]. Identifying the bacterial composition of the prenatal meconium has been challenging due to the potential of microbiological contamination [4][5][6]. It is widely documented that the process of microbial colonization starts quickly after birth, as evidenced by numerous studies [7][8]. During the initial 1000 days after birth, breastfeeding influences the intestinal microbiome, which is dominated by Bifidobacterium [1]. This group of bifidobacteria includes Bifidobacterium bifidum, Bifidobacterium breve, and Bifidobacterium longum spp. [9][10]. The microbiome undergoes significant transformations during two crucial developmental phases early in life: from birth until weaning, and then during the transition from weaning into early adulthood. These modifications are driven by the diversification of the diet, resulting in considerable changes to the microbial composition [11]. The variance in microbiome configurations depends on the infant’s genetics plus the infant’s environmental properties, including humidity, pH, nutrients, and oxygenation [2].

2. First Gut Microbiota of Infants

Delivery plays a crucial role in establishing the initial colonization of the infant’s gut microbiota. The skin, mouth, and intestine of newborns who were delivered vaginally contain Lactobacillus, which is one of the most abundant microorganisms of the maternal vaginal flora [12]. After birth, the first microorganisms of the infant’s body come from the mother’s microbiota found in the vaginal area, feces, breast milk, mouth, and skin, as well as the surrounding environment [13][14][15]. During the initial years of life, the microbial population that inhabits the gastrointestinal tract includes facultative anaerobic bacteria. However, in the weeks to come, these early colonizers are gradually displaced by conventional anaerobic bacteria that eventually come to dominate the intestinal microbiota [16]. Immediately after birth, the newborn’s intestinal microbiota is firstly overpopulated by the presence of Enterobacteriaceae and Staphylococcus [17], but later it is replaced by Bifidobacterium and some lactic acid bacteria [18]. This Bifidobacterium-dominated microbiota, also known as “Bifidus flora”, remains until the introduction of complementary food [19][20]. As the infant approaches weaning, the relative abundance of Bacteroides gradually increases, leading to the competitive exclusion of Bifidobacterium within the intestinal microbiota. After weaning, the Bifidus flora is replaced by adult-type microorganisms, which mainly include bacteria such as Bacteroides, Prevotella, Ruminococcus, Clostridium, and Veillonella [19]. By three years of age, the gut microbiota becomes similar to that of an adult [21]. The gut microbiota’s functions also change significantly before and after the introduction of solid foods. In the first year of life, the early microbiota is enriched with bacteria that can utilize lactate. Solid food promotes the growth of bacteria that can use a wider variety of carbohydrates, synthesize vitamins, and degrade xenobiotics [19][21][22]. By this period, the infant’s gut has been exposed to a variety of environmental factors such as breastfeeding, type of delivery and exposure to antibiotics, which can have a significant impact on the further development of the infant’s intestinal flora [23][24][25].

3. Factors Influencing the Intestinal Microbiota during the First 1000 Days after Birth

3.1. Maternal Factors

In infants with normal gestational age, microbiota develops more quickly towards that of an adult when compared to preterm infants [26]. Premature infants are characterized by lower diversity of the intestinal microbiota compared to full-term infants [27]. The type of birth, especially vaginal delivery, determines in newborns microbial species from the vaginal area of the mother and perianal regions, including Lactobacillus, Prevotella, or Sneathia spp. [28], while infants who are delivered through caesarian section have limited exposure to these bacteria [29]. The maternal vaginal microbiota is an important contributing factor. When women are pregnant, microbial variety within the vaginal microbiota decreases; on the other hand, the abundance of Lactobacillus spp. increases, potentially strengthening their defensive function [30][31]. Besides vaginal bacteria, uterine and placental bacteria may confer potential benefits to both the developing fetus and the newborn. Specifically, these microbes may foster tolerance towards microorganisms that promote postnatal well-being, including those affiliated with the Lactobacillus genus [32].
However, some studies suggest that dysbiosis that occurs at the time of pregnancy leads to an increased risk of premature birth [33]. A relation between microbiota and preterm births was observed [34]. The study found that women who delivered prematurely exhibited significantly different vaginal microbiota compared with women who gave birth to full-term infants. Explicitly, women who gave birth preterm had decreased levels of Lactobacillus. These findings suggest that the composition of the vaginal microbiota may be a useful indicator of the risk of preterm birth. Another possible factor is maternal health status; this includes obesity, gestational diabetes, and inflammation, which can participate in the instability of the constituents and composition of the infant’s intestinal microbiota, as observed by the analysis of the newborn meconium. Additionally, maternal inflammation during pregnancy has been associated with an increased risk of gut dysbiosis in the infants [35][36][37]. It was observed that maternal diet could influence the microbiota, as a high-fat diet in mothers affects the initial colonization of bacteria [38]. When the mother consumed a high-fat diet, the meconium microbiome of the neonate was significantly depleted in Bacteroides, and this depletion continued until the infant was 6 weeks old [38].
The neonatal gut microbiota is significantly influenced by a maternal high-fat diet and not just by maternal obesity [39][40][41]. Microbiota in maternal milk may come from the mother’s gut microbiota [42][43]. Therefore, if the mother’s gut microbiota is imbalanced due to an unhealthy diet, this could potentially be transferred to the milk and affect the infant’s gut microbiome during breastfeeding [40]. However, there is currently limited research on the long-term effects of maternal lifestyle and health during pregnancy and breastfeeding on the infant’s gut microbiota.
Exposure to antibiotics during pregnancy has a significant impact on the microbiome, leading to a reduction in microbial load and changes in composition, as well as long-term effects on the development of the infant gut microbiome [44]. Another study has shown that antibiotics can have an impact on the microbiome of breast milk, with high levels of Bifidobacterium found in breast milk from mothers who did not receive antibiotics intrapartum [45]. Furthermore, antibiotic use during lactation can result in a decrease in the microbial community of breast milk, including lactobacilli and bifidobacteria, and is associated with lower bacterial diversity in breast milk [46][47].

3.2. Environmental Factors

It is widely recognized that the mode of delivery plays a crucial role in determining the initial bacterial colonization of infants [28]. Children born via caesarian section have a risk for the development of specific diseases such as obesity, allergy, asthma, and atopy possibly due to altered immune development [48][49]. Infants born vaginally are colonized by bacteria that are normally located in the maternal vagina [28]. On the other hand, infants born via caesarian section are colonized by bacteria that are similar to those present on the maternal skin and in the oral cavity [29][31]. Furthermore, extensive studies that have monitored the composition of microbiota in infants from birth until 2 years of age suggested a correlation between delivery by caesarian section and delayed colonization of the Bacteroidetes phylum, as well as lower overall microbial diversity up to 2 years of age [50]. Moreover, at 7 years of age, differences were observed between the microbiotas of infants born via caesarian section and those born vaginally [51]. The microbial distinctions observed in children delivered via caesarian section encompass heightened colonization rates of C. difficile and other clostridia, alongside diminished levels of lactobacilli, bifidobacteria, bacteroides, and E. coli [51]. The bacterial microbiota is influenced by gestational age [52]. Premature neonates are often subjected to heightened antibiotic exposure and frequently experience prolonged hospital stays, mechanical ventilation, and parenteral nutrition. Such conditions have the potential to induce enduring modifications to the typical colonization and developmental mechanisms of the gut microbiota [2][53]. Adopting a Mediterranean-style diet, supplementing with probiotics and prebiotics, and breastfeeding are all crucial for maintaining a diverse gut microbiota. These practices also provide newborns with essential nutrients and can help reduce the risk of developing allergies [54].
Breastfeeding can be considered among the most crucial factors in the normal development of infant microbiota. The type of nutrition, whether through breastfeeding or formula, significantly affects the composition of gut microbiota in the first days after birth. Human milk is rich in nutrients such as fats, proteins, and carbohydrates, and contains immunoglobulins and endocannabinoids. Constituents of breast milk are responsible for selecting the types of bacteria that colonize the gastrointestinal tract. For instance, immune regulatory cytokines like TGF-β and IL-10 in breast milk facilitate the host immune system’s tolerance to intestinal bacteria and enhance the production of IL-10 in infants [55][56]. The oligosaccharides in human milk (HMO), particularly galactooligosaccharide (GOS), are incompletely broken down in the small intestine and instead primarily fermented in the colon by Bifidobacterium, generating short-chain fatty acids [57][58]. Research by Matsuki et al. [17] has shown that the growth of Bifidobacterium in infants’ guts leads to a decrease in the number of HMOs present in feces, with a concurrent increase in acetic acid and lactic acid. These results imply that HMOs have a beneficial impact on the development of a Bifidobacterium-dominated gut microbiota [17]. It is recommended to encourage mothers to breastfeed their infants, according to a cross-sectional study involving 1008 mothers with children aged 9 to 14 months, in which factors influencing the duration of breastfeeding were investigated [59]. The study findings revealed that perinatal education and mother-baby-friendly hospitals were associated with extended breastfeeding duration. Notably, the conventional teaching of pregnant mothers and proactive engagement in perinatal education emerged as crucial factors in promoting the duration of breastfeeding. The formula-fed infants show an abundance of Bacteroides, Clostridium coccoides, and Lactobacillus [60]. Other studies found that the fecal analysis from formula-fed infants is most likely to contain staphylococci, Escherichia coli, and clostridia [61][62]. However, in recent times, milk formula has undergone enhancements, including the addition of certain oligosaccharides, to enable the development of a microbiota rich in Bifidobacterium in infants [63].
Administering antibiotics during the early stages after birth can have a significant impact on the development of gut microbiota. It causes a shift in the composition of gut microbiota towards a higher proportion of Proteobacteria and a lower proportion of Actinobacteria populations [64][65]. This also results in reduced overall diversity of the infant’s microbiota and a selection of drug-resistant bacteria [66][67]. In a study by Tanaka et al. [64], the impact of early postnatal exposure to antibiotics on the development of intestinal bacteria was observed in 26 infants. Among these infants, five were given antibiotics orally for the first four days after birth, while three received antibiotics intravenously before delivery. The study discovered that the infants who were exposed to antibiotics had fewer types of bacteria, with reduced colonization of Bifidobacterium and abnormal colonization of Enterococcus during the first week. Additionally, an overgrowth of enterococci and a lack of growth of Bifidobacterium were observed in the antibiotic-exposed group. One month later, the antibiotic-exposed group had a higher population of Enterobacteriaceae compared with the control group. These findings suggest that exposure to antibiotics at an early stage of life can significantly impact the development of neonatal intestinal microbiota [64]. Solid foods represent another influencing factor for the composition of gut microbiota in infants. When solid foods containing indigestible carbohydrates are introduced into an infant’s diet, their gut quickly acquires a functional gene pool that is largely dominated by carbohydrate metabolism genes, similar to that of an adult [21]. Factors affecting the infant’s gut microbiota during the first 1000 days after birth are described in Table 1.
Table 1. Summary of the factors affecting the infant’s intestinal microbiota during the first 1000 days after birth.
Category Factor Description
Maternal Gestational Age Full-term infants develop microbiota more quickly than preterm infants, who have lower intestinal microbiota diversity [26][27].
Maternal Mode of Delivery Vaginal delivery exposes newborns to maternal vaginal and perianal microbes, while caesarian section limits this exposure [28][29].
Maternal Maternal Vaginal Microbiota Microbial variety in the vaginal microbiota decreases during pregnancy, potentially impacting the infant’s microbiome [30][31]. Dysbiosis may increase the risk of premature birth [34].
Maternal Maternal Health Status Obesity, gestational diabetes, and inflammation can impact the infant’s intestinal microbiota and increase the risk of gut dysbiosis [35][36][37].
Maternal Maternal Diet A high-fat diet can impact the initial colonization of bacteria in offspring, regardless of the mother’s obesity status [38][39][40].
Maternal Antibiotic Exposure During Pregnancy Antibiotics during pregnancy can reduce microbial load and alter the composition of the infant’s gut microbiome. They can also impact the breast milk microbiome [45][46][47].
Environmental Gestational Age Premature infants exposed to high levels of antibiotics and long hospital stays have altered gut microbiota development [2][52][53].
Environmental Feeding Method Breastfeeding significantly impacts the formation of the gut microbiota, promoting the growth of Bifidobacterium [55][56]. Formula feeding results in a different gut microbiota composition, but recent improvements aim to encourage Bifidobacterium growth [60][61][62].
Environmental Antibiotic Exposure Early exposure to antibiotics leads to altered gut microbiota composition, reduced overall diversity, and a selection for drug-resistant bacteria [63][64][65][66][67].
Environmental Introduction of Solid Foods The introduction of solid foods containing indigestible carbohydrates affects the infant’s gut microbiota, leading to a functional gene pool similar to that of an adult [21][22][29].

This entry is adapted from the peer-reviewed paper 10.3390/nu15163647

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