The maternal microbiome may have important health implications not only for the mother but also for the developing fetus. It can influence fetal immune health, metabolism, brain health, inflammation, physical growth, and overall development. Supporting the maternal microbiome could be beneficial for the developing fetus.
Maintaining a healthy gut microbiome may help manage pregnancy-associated challenges, like insulin resistance and gestational diabetes. This article will review the functions of the maternal gut microbiome, the physiology of pregnancy, and suggestions to support a healthy pregnancy.
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Understanding the Maternal Microbiome
The maternal microbiome includes normal indwelling microorganisms that may influence maternal health and the health of the fetus. Microbiomes are found in the oral cavity, vaginal canal, and gastrointestinal tract.
Oral Microbiome
The oral microbiome is a community of microbes consisting mostly of bacteria but also of viruses, protozoa, and fungi.
It plays several important roles in the body:
- Food digestion
- Early nutrient extraction
- Immune support
- Metabolic regulation
- Barrier function from pathogens
- Detoxification of toxins
Vaginal Microbiome
The vaginal microbiome is dominated by Lactobacillus. These microorganisms are important in both the non-pregnant and pregnant states to support fetal health.
The vaginal microbiome has the following broad functions:
- Maintain optimal vaginal pH
- Support vaginal and cervical health
Gut Microbiome
The gut microbiome is the overall collection of the gut microbiota, the individual living organisms that inhabit the gut, including bacteria, viruses, fungi, and other yeasts. Important bacteria include Bacteroides, Firmicutes, and Actinobacteria species.
The gut microbiome plays a key role in these functions in maternal health:
- Food digestion
- Nutrient absorption
- Immune modulation
- Metabolism regulation
- Neurotransmitter signaling
- Inflammation regulation
Impact of the Maternal Microbiome on Fetal Health
The maternal microbiome may have an impact on fetal health.
Vertical Transmission:
Microbes from the maternal microbiome can be transmitted to the fetus during pregnancy and childbirth through various routes. During pregnancy, the presence of gut microbes in amniotic fluid suggests that a suboptimal maternal gut microbiome may be associated with intrauterine infections.
Microbes from the gut and vaginal microbiomes can cross the placenta or be swallowed by the fetus, potentially influencing fetal colonization. During vaginal delivery, the neonate is exposed to maternal vaginal and fecal microbes, which may initiate the colonization of the neonatal gut.
Contact with maternal skin flora and microbes in breast milk after delivery continues to form the neonatal microbiome. This initial microbiome colonization is important for the development of the neonatal immune system and metabolism.
Developmental Outcomes:
Current evidence suggests a strong association between maternal microbiome composition and current and future fetal health. The composition of the maternal microbiome has been linked to key developmental outcomes for the fetus. It may influence the maturation of the fetal immune system and its ongoing function.
An adequately diverse maternal microbiome has been associated with a decreased risk of allergies in the fetus. The maternal microbiome may also influence fetal metabolic programming.
Factors Affecting the Maternal Microbiome
Several factors can affect the maternal microbiome.
Diet and Nutrition:
Maternal diet can significantly impact microbiome composition. The pregnancy state mimics physiologic changes consistent with metabolic syndrome in the non-pregnant state. With pre-pregnancy obesity or in the event of excessive gestational weight gain, these metabolic and inflammatory changes may be amplified, including the increased prevalence of pathogenic gut bacteria. Together, these changes may increase the risk of gestational challenges.
In contrast, consuming a diverse, nutrient-dense, anti-inflammatory diet high in prebiotic and probiotic foods may help maintain a healthy gut microbiome that can perform its beneficial functions. In addition, identifying and avoiding food sensitivities and intolerances may promote lower levels of inflammation, gut eubiosis, and better overall health.
Lifestyle Factors:
Through the brain-gut axis, both sleep quality and stress levels have reciprocal associations with the microbiome. While good sleep quality and reduction of chronic stress may support a healthy microbiome with optimal diversity of beneficial bacteria, poor sleep quality and ongoing chronic stress may promote gut dysbiosis and associated challenges, including the following:
- Poor immune function
- Upregulated inflammation
- Poor nutrient absorption
- Metabolic dysregulation
- Impaired neurotransmitter signaling
Exercise may also impact the maternal gut microbiome. Consistent evidence suggests the beneficial effects of regular exercise on optimal gut microbiota diversity and function.
Use of Antibiotics and Medications:
Antibiotics and other medications can significantly impact the maternal microbiome during pregnancy, potentially affecting maternal and fetal health outcomes. Antibiotics may disrupt the various microbiomes, leading to dysbiosis, poor immune function, altered metabolism, and increased inflammation.
Other medications, like proton pump inhibitors (PPIs) and nonsteroidal anti-inflammatory drugs (NSAIDs), may affect the maternal microbiome. PPIs, which are common agents used to manage gastroesophageal reflux disease, can alter gastric pH, affecting the composition of gut microbiota. NSAIDs used to manage pain and inflammation can disrupt the gut barrier, potentially leading to increased intestinal permeability and inflammation.
How to Support the Maternal Microbiome
The following suggestions may help support the maternal microbiome:
Probiotics and Prebiotics:
Enhancing the health of the gut microbiome with prebiotics and probiotics may be beneficial both in pregnant and non-pregnant states. Supplementation with a probiotic consisting of Lactobacillus and Bifidobacterium may support glucose metabolism, help manage the incidence of gestational diabetes mellitus, and mitigate adverse proinflammatory sequelae.
Prebiotic supplementation, such as with dietary fiber and fermentable carbohydrates, has been shown to support functional immune-fighting B and T cells in the placenta and the fetus, persisting in the fetus after delivery and potentially supporting immune function.
Dietary Suggestions:
Specific anti-inflammatory dietary strategies may support a healthy gut microbiome during pregnancy.
Increase Dietary Fiber Intake
Consider consuming a variety of fiber-rich foods, such as the following:
- Fruits
- Vegetables
- Whole grains
- Legumes
- Nuts
- Seeds
Complex carbohydrates can be a great source of energy during pregnancy. Fruits may help satisfy cravings for sweets, and vegetables provide valuable micronutrients.
Include Fermented Foods
Fermented foods are good sources of probiotics, which may help maintain a healthy, balanced maternal gut microbiome. Focus on naturally fermented options that are not pasteurized for maximum benefit, but do discuss safety with your healthcare provider. Consider these probiotic-rich food sources in pregnancy:
- Greek yogurt
- Sauerkraut
- Pickles
- Kimchi
Kombucha is also high in probiotics, but it can contain some fermentable alcohol, so it should be consumed with caution in pregnancy.
Reduce Processed Foods
Processed foods may negatively impact the diversity of the gut microbiome and promote inflammation, weight gain, and other negative metabolic outcomes. Consider minimizing processed foods like these:
- Added sugars in snacks and drinks
- High fructose corn syrup
- Trans fats
- Refined carbohydrates
- Processed meats
Instead, choose whole, real, nutrient-dense foods that can effectively nourish the mother and the baby.
Drink Plenty of Water
Staying hydrated offers benefits beyond the maternal microbiome in pregnancy. Optimal hydration may improve maternal circulation and blood flow to the fetus. It may encourage optimal fetus growth and development, help manage premature uterine contractions, and alleviate many common pregnancy discomforts, like constipation, cramps, fatigue, and skin concerns.
Monitoring and Personalization:
While microbiome assessments may not be necessary for all pregnant patients, they can be helpful in cases of maternal malabsorption, nutrient deficiencies, gastrointestinal disturbances, or increased illness susceptibility. Microbiomes vary significantly between individuals, so tailored interventions may be necessary to address specific microbial imbalances.
Utilizing a personalized approach allows for custom dietary suggestions, supplementation with probiotics and prebiotics, and additional lifestyle modifications to support optimal maternal and fetal health.
Challenges and Considerations in Clinical Practice
There are certain challenges and considerations that should be considered in clinical practice:
Ethical and Safety Considerations:
Manipulating the maternal microbiome during pregnancy raises ethical and safety concerns due to potential maternal and fetal health risks. While some suggestions, like probiotic supplementation, have supporting evidence in pregnancy, safety data is limited because randomized controlled trials are not typically performed on pregnant patients.
Health practitioners should consider ethical considerations like proper informed consent, minimizing risks to the mother and the fetus, and ensuring prescribed treatments are evidence-based.
Interdisciplinary Collaboration:
Interdisciplinary collaboration among obstetricians, nutritionists, and other specialists may help support maternal microbiome health to improve maternal and fetal health outcomes. Obstetricians provide medical expertise on pregnancy-related issues. Nutrition experts can offer dietary guidance tailored to support a healthy microbiome. Additional maternal-fetal medicine specialists can provide guidance in complex cases.
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Key Takeaways
Understanding the maternal microbiomes and the important roles they play is necessary for the best possible prenatal care.
- Maintaining good oral hygiene
- Consuming a healthy diet
- Getting adequate probiotics
- Consuming healthy prebiotics
- Maintaining vaginal health and hygiene
A personalized approach for each patient may help deliver optimal health outcomes.
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