Skip to main content
  • Meeting abstract
  • Open access
  • Published:

Mode of delivery and gut microbiota

In 1985 the World Health Organization (WHO) stated: "There is no justification for any region to have Caesarean Section (CS) rates higher than 10-15%"[1]. During the last decades the percentage of births managed by CS has increased beyond the recommended level, especially in high income areas such as Italy, Germany, France, United Kingdom, and North America [2, 3].

Emerging evidences indicate that the early composition of neonatal gut microbiota is responsible for shaping of immune response since there is a complex interaction between the intestinal microbiome and the immune system (Gut-Associated Lymphoid Tissue) and this cross-talk is involved in maintaining normal immune homeostasis [4]. The microbiome promotes human health, but can also drive disease. The potential disadvantages of caesarean delivery include altered bacterial profile known as dysbiosis of the gut microbiota which in turn leads to immune dysfunction and increased tendency for immune-mediated diseases such as allergies [5, 6] and autoimmunity [7].

Upon delivery, the neonate is exposed to a wide variety of microbes, many of which are provided by the mother during and after the passage through the birth canal, a heavily colonized ecosystem. The neonatal colonization pattern is further influenced by several post-natal environmental factors such as the place and mode of delivery, the level of affluence, the number of siblings, the use of antibiotics and infant feeding.

The reduced microbial exposure and delayed colonization occurring in caesarean born infants have been associated with the development of allergic disease. CS delivered infants, deprived of contact with the maternal vaginal microbiota, experience a deficiency of strict anaerobes such as Bacteroides, E. coli, and bifidobacteria and a higher presence of facultative anaerobes such as Clostridium species, compared with vaginally born infants [8].

It is debated whether a low total diversity of the gut microbiota during infancy is more important than an altered prevalence of particular bacterial species (Clostridia) for the increasing incidence of allergic disease [5, 6]. Recently Bisgaard et al. demonstrated that reduced diversity of intestinal microbiota during infancy is associated with increased risk of allergic disease during childhood [9].

The concept of probiotics has attracted increasing attention in recent years since several clinical studies have been published suggesting that probiotics may convert a dysbiosis to a symbiosis in infants with inadequate intestinal colonization (premature delivery, delivery by CS and excessive use of perinatal antibiotics) [1015]. Clinical evidences suggest that probiotics could substantially affect metabolic and immunomodulatory functions [16].


  1. World Health Organization: Appropriate technology for birth. Lancet. 1985, 2: 436-7.

    Google Scholar 

  2. MacDorman MF, Menacker F, Declercq E: Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008, 35: 293-307. 10.1016/j.clp.2008.03.007.

    Article  PubMed  Google Scholar 

  3. Zizza A, Tinelli A, Malvasi A, Barbone E, Stark M, De Donno A, Guido M: Caesarean section in the world: a new ecological approach. J Prev Med Hyg. 2011, 52: 161-73.

    CAS  PubMed  Google Scholar 

  4. Chung H, Kasper DL: Microbiota-stimulated immune mechanisms to maintain gut homeostasis. Curr Opin Immunol. 2010, 22: 455-460. 10.1016/j.coi.2010.06.008.

    Article  CAS  PubMed  Google Scholar 

  5. van Nimwegen FA, Penders J, Stobberingh EE, Postma DS, Koppelman GH: Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. J Allergy Clin Immunol. 2011, 128: 948-955. 10.1016/j.jaci.2011.07.027.

    Article  PubMed  Google Scholar 

  6. Penders J, Thijs C, van den Brandt PA, Kummeling I, Snijders B, Stelma F, Adams H, van Ree R, Stobberingh EE: Gut microbiota composition and development of atopic manifestations in infancy: the KOALA Birth Cohort Study. Gut. 2007, 56: 661-667. 10.1136/gut.2006.100164.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, Goldacre MJ: Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia. 2008, 51: 726-735. 10.1007/s00125-008-0941-z.

    Article  CAS  PubMed  Google Scholar 

  8. Adlerberth I, Wold AE: Establishment of the gut microbiota in Western infants. Acta Paediatrica. 2009, 98: 229-238. 10.1111/j.1651-2227.2008.01060.x.

    Article  CAS  PubMed  Google Scholar 

  9. Bisgaard H, Li N, Bonnelykke K, Chawes BL, Skov T, Paludan-Müller G, Stokholm J, Smith B, Krogfelt KA: Reduced diversity of the intestinal microbiota during infancy is associated with increased risk of allergic disease at school age. J Allergy Clin Immunol. 2011, 128: 646-652. 10.1016/j.jaci.2011.04.060.

    Article  PubMed  Google Scholar 

  10. Prescott SL, Björkstén B: Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol. 2007, 120: 255-62. 10.1016/j.jaci.2007.04.027.

    Article  CAS  PubMed  Google Scholar 

  11. Pfefferle PI, Prescott SL, Kopp M: Microbial influence on tolerance and opportunities for intervention with prebiotics/probiotics and bacterial lysates. J Allergy Clin Immunol. 2013, 131: 1453-63. 10.1016/j.jaci.2013.03.020.

    Article  PubMed  Google Scholar 

  12. Hardy H, Harris J, Lyon E, Beal J, Foey AD: Probiotics, prebiotics and immunomodulation of gut mucosal defences: homeostasis and immunopathology. Nutrients. 2013, 29: 1869-1912. 10.3390/nu5061869.

    Article  Google Scholar 

  13. Weng M, Walker WA: The role of gut microbiota in programming the immune phenotype. J Dev Orig Health Dis. 2013, 4: 203-214. 10.1017/S2040174412000712.

    Article  CAS  PubMed  Google Scholar 

  14. Bezirtzoglou E, Stavropoulou E: Immunology and probiotic impact of the newborn and young children intestinal microflora. Anaerobe. 2011, 17: 369-374. 10.1016/j.anaerobe.2011.03.010.

    Article  PubMed  Google Scholar 

  15. Kuitunen M, Kukkonen K, Juntunen-Backman K, Korpela R, Poussa T, Tuure T, Haahtela T, Savilahti E: Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. J Allergy Clin Immunol. 2009, 123: 335-341. 10.1016/j.jaci.2008.11.019.

    Article  PubMed  Google Scholar 

  16. Walker WA: Initial intestinal colonization in the human infant and immune homeostasis. Ann Nutr Metab. 2013, 63 (Suppl 2): 8-15.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miniello, V.L., Colasanto, A., Diaferio, L. et al. Mode of delivery and gut microbiota. Ital J Pediatr 40 (Suppl 2), A17 (2014).

Download citation

  • Published:

  • DOI: