Modification of the gut microbiome in an attempt to reduce the risk of child disease: Clinical data from prenatal interventions

Abstract

Abstract Current research interest in the modulation of the gut microbiome focuses both on characterizing specific probiotic strains, their growth factors, and microbial metabolites in terms of efficacy and safety for preventive purposes and on the optimal timing of such an intervention. Pregnancy, according to the current understanding, is an optimal target for interventions aiming to reduce the risk of disease in future generations: by promoting the health of the pregnant and lactating women today, the health of the next generation(s) may be successfully improved. The justification of the statement is twofold: the developmental origins of health and disease theory envisions that our health is determined by events experienced in utero and during early infancy, and the compositional development of the gut microbiome holds a key position on the maturation of the host defense systems. A shift in the gut microbiome composition, dysbiosis, early in life induces lasting alterations in the immune and metabolic phenotype as well as neural pathways with manifestations ranging from asthma, allergy, obesity, type 1 diabetes to neuropsychiatric disorders. Recent experimental and clinical studies have attracted scientific interest in repairing deviations in the gut microbiome, and the focus is moving toward the early colonizers, the microbial inoculum provided by the feto–maternal interface, along with microbial contact during delivery and through lactation. Clinical data on the efficacy and safety exist on specific probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Randomized clinical trials with prenatal probiotic intervention suggest clinical efficacy in reducing the risk of chronic disease such as atopic eczema in the child, but only in the context of appreciating the continuum from fetal life to early infancy and breastfeeding. Taken the theory and clinical evidence thus far together, the critical time-window for successful modifiers of the gut microbiome to exert a programming effect falls in the pregnancy, perinatal period, and early infancy.