Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:128

Article

van Nimwegen, Frederika A.¹  Penders, John^1,2  Stobberingh, Ellen E.²  Postma, Dirkje S.⁶  Koppelman, Gerard H.⁷  Kerkhof, Marjan⁸  Reijmerink, Naomi E.^6,9  Dompeling, Edward³  van den Brandt, Piet A.¹⁰  Ferreira, Isabel^4,5  Mommers, Monique¹  Thijs, Carel¹ 

[1] Maastricht Univ, Dept Epidemiol, CAPHRI Sch Publ Hlth & Primary Care, Med Ctr, NL-6200 MD Maastricht, Netherlands

[2] Maastricht Univ, Dept Med Microbiol, CAPHRI Sch Publ Hlth & Primary Care, Med Ctr, NL-6200 MD Maastricht, Netherlands

[3] Maastricht Univ, Dept Pediat Pulmonol, CAPHRI Sch Publ Hlth & Primary Care, Med Ctr, NL-6200 MD Maastricht, Netherlands

[4] Maastricht Univ, Dept Clin Epidemiol & Med Technol Assessment, CAPHRI Sch Publ Hlth & Primary Care, Med Ctr, NL-6200 MD Maastricht, Netherlands

[5] Maastricht Univ, Dept Internal Med, CAPHRI Sch Publ Hlth & Primary Care, Med Ctr, NL-6200 MD Maastricht, Netherlands

[6] Univ Groningen, Beatrix Childrens Hosp, Dept Pulmonol, NL-9700 AB Groningen, Netherlands

[7] Univ Groningen, Beatrix Childrens Hosp, Dept Pediat Pulmonol & Pediat Allergol, NL-9700 AB Groningen, Netherlands

[8] Univ Groningen, Univ Med Ctr Groningen, Dept Epidemiol, NL-9700 AB Groningen, Netherlands

[9] Univ Groningen, Univ Med Ctr Groningen, Beatrix Childrens Hosp, NL-9700 AB Groningen, Netherlands

[10] Maastricht Univ, Dept Epidemiol, Sch Oncol & Dev Biol GROW, Med Ctr, NL-6200 MD Maastricht, Netherlands

关键词: Mode of delivery;    cesarean section;    hospital delivery;    gastrointestinal microbiota composition;    wheeze;    eczema;    asthma;    atopy;    mediation analysis;    cohort study;    KOALA study;   

DOI  :  10.1016/j.jaci.2011.07.027

来源: Elsevier

【 摘 要 】

Background: Both gastrointestinal microbiota composition and cesarean section have been linked to atopic manifestations. However, results are inconsistent, and the hypothesized intermediate role of the microbiota in the association between birth mode and atopic manifestations has not been studied yet. Objectives: We sought to investigate the relationship between microbiota composition, mode and place of delivery, and atopic manifestations. Methods: The Child, Parent and Health: Lifestyle and Genetic Constitution Birth Cohort Study included data on birth characteristics, lifestyle factors, and atopic manifestations collected through repeated questionnaires from birth until age 7 years. Fecal samples were collected at age 1 month (n = 1176) to determine microbiota composition, and blood samples were collected at ages 1 (n = 921), 2 (n = 822), and 6 to 7 (n = 384) years to determine specific IgE levels. Results: Colonization by Clostridium difficile at age 1 month was associated with wheeze and eczema throughout the first 6 to 7 years of life and with asthma at age 6 to 7 years. Vaginal home delivery compared with vaginal hospital delivery was associated with a decreased risk of eczema, sensitization to food allergens, and asthma. After stratification for parental history of atopy, the decreased risk of sensitization to food allergens (adjusted odds ratio, 0.52; 95% CI, 0.35-0.77) and asthma (adjusted odds ratio, 0.47; 95% CI, 0.29-0.77) among vaginally home-born infants was only found for children with atopic parents. Mediation analysis showed that the effects of mode and place of delivery on atopic outcomes were mediated by C difficile colonization. Conclusion: Mode and place of delivery affect the gastrointestinal microbiota composition, which subsequently influences the risk of atopic manifestations. (J Allergy Clin Immunol 2011;128:948-55.)

【 授权许可】

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