Cesarean Delivery Affecting Newborn, Gastrointestinal Microbiome, Host Microbial Interactions, Intestinal Microbiome, Microbiota, Obesity, Childhood
Conditions
Brief summary
Neonates delivered by scheduled Cesarean Section will be randomized to receive vaginal seeding (exposing the infant to Mother's vaginal flora) or sham. Infants will be followed for three years to examine health outcomes including microbiome development, immune development, metabolic outcomes, and any adverse events.
Detailed description
Cesarean section (CS) delivery is a common surgical procedure intended to increase the chances of successful delivery and to protect the health of the mother and baby. Yet this intervention is overused and has been associated with higher risk of immune and metabolic disorders in the offspring. It is hypothesized that these associations are due to CS-delivered newborns not receiving the full inoculum of maternal microbes at birth. While restoring labor is not possible, restoring the microbes that colonize infants during birth through exposure to vaginal flora, is feasible, and has been shown in a small pilot study, to normalize the microbiota of the intestine, skin and mouth during the first month of life. The investigators hypothesize that the restoration of the vaginal microbiota to the infant at birth will restore the infant microbiome and decrease the risk of obesity and other immune-mediated diseases linked with CS. The investigators aim to test this hypothesis in a randomized controlled trial by first examining the effect of vaginal seeding, in CS-delivered newborns, on the gut microbiota composition, structure and function (Phase I of study; first 50 infants) and then on the BMI z score and other immune-mediated outcomes (Phase II of study; 600 infants). Methods: CS-delivered neonates will be randomized to either an experimental arm with exposure to the maternal vaginal microbiota at birth, or a control arm with no exposure. Feces, skin, saliva, breast milk, and vaginal swabs will be collected for microbiome analysis. The investigators will obtain clinical information from in-person visits, surveys and the electronic health record. Implications: this randomized controlled clinical study will provide evidence of whether the vaginal seeding procedure can safely transfer microbes from mom-to-baby, and whether these microbes are beneficial for the metabolic and immune health of the child.
Interventions
BIOLOGICALVaginal Seeding
A gauze containing the Mother's vaginal flora will be swabbed over the face and body of the neonate shortly after cesarean delivery.
OTHERNo Vaginal Seeding
A gauze carrying sterile saline will be swabbed over the face and body of the neonate shortly after cesarean delivery.
Sponsors
Johns Hopkins University
Rutgers University
Inova Health Care Services
National Institute of Allergy and Infectious Diseases (NIAID)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
0 Days to 50 Years
Healthy volunteers
Yes
Inclusion criteria
for Mother: * Scheduled for cesarean delivery at ≥ 37 weeks * Pregnant with single fetus, in good general health, age 18 years or older * Negative maternal testing for infections transmitted through vaginal and/or other body fluids performed as standard of care tests in early pregnancy * Negative testing for Group B strep at 35-37 weeks gestation * Vaginal pH ≤ 4.5 indicative of Lactobacillus-dominated vaginal microbiota * No maternal or fetal complications that may inhibit the ability to perform microbiome restoration per protocol * English or Spanish speaking * Negative maternal testing for Gonorrhea, Chlamydia, Hepatitis B, Hepatitis C, Syphilis, and HIV at 35 weeks gestation or later * Women aged 18-29 years must have a normal Pap test within 3 years * Women aged 30-65 years must have a normal Pap test and an HPV test (co-testing) within 5 years or FDA-approved primary hrHPV testing alone within 5 years or a normal Pap test alone within 3 years * Negative maternal testing for SARS-CoV-2 for the delivery admission performed as standard of care test at the Inova Health System. Inclusion Criteria for Infant: * Infant condition after delivery requires no more than standard neonatal resuscitation\* or is otherwise medically unable to receive the full VMT procedure \[\*\] Standard neonatal resuscitation may include: tactile stimulation, bulb suction, oxygen without positive pressure, or drying
Exclusion criteria
for Mother: * Delivery at a hospital other than Inova Health System * Cesarean delivery scheduled for active infection that would have interfered with vaginal delivery such as genital herpetic lesions * Rupture of membranes prior to scheduled cesarean delivery * Bacterial vaginosis within 30 days of cesarean delivery * Symptomatic urinary tract infection within 30 days of cesarean delivery * Antibiotic therapy within 30 days of cesarean delivery (exclusive of medication use for prophylaxis at the time of surgery) * Symptoms on admission suggesting Chorioamnionitis, e.g. maternal fever, fundal tenderness * Symptoms on delivery admission of possible vaginal infection such as genital herpetic lesions * History of genital HSV * History positive testing for Group B strep infection * History of a child with a diagnosis of Group B strep sepsis * Pregnancy a result of donor egg or surrogacy * Preexisting history of Type I or Type II Diabetes * Maternal history of documented genital HPV infection, positive HPV testing or genital warts on physician examination * Positive maternal testing for SARS-CoV-2 within 30 days of delivery or symptoms on admission suggesting potential Covid-19 infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adiposity | 2 years | E.g. Body mass index z-score |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adverse events | 3 years | Monitoring for adverse events |
| Intestinal microbiota | 3 years | Intestinal microbiota development over the first three years of life |
| Immune and inflammatory regulation | 3 years | E.g. Monitoring for immune and inflammatory mediated conditions |
Countries
United States
Contacts
Primary ContactSuchitra Hourigan, MD
Backup ContactShira Levy
Outcome results
None listed