It is a well-known fact that caesarean section (c-section) birth is related to an increased risk of both immune and metabolic diseases later in life, possibly through aberrant gut microbiota composition and/or functional diversity. However, little is known about the effect of targeting gut microbiota with prebiotics and probiotics in c-section-born infants.

A new randomized, double-blind, controlled multicentre study, led by Dr. Voranush Chongsrisawat from the King Chulalongkorn Memorial Hospital at the Faculty of Medicine at Chulalongkorn University in Bangkok (Thailand), has found that supplementation with galacto- and fructo-oligosaccharides and Bifidobacterium breve M-16V in c-section-delivered infants helps emulate the gut physiological environment observed in vaginally-born infants.

The researchers studied the effect of short-chain galacto-oligosaccharides (scGOS), long-chain fructo-oligosaccharides (lcFOS) and B. breve M-16V on the gut microbiota of c-section-born infants. With this aim, infants were randomized to receive a standard nonhydrolyzed cow’s milk-based formula (control formula; n = 50), or the same formula supplemented with 0.8 g/100 mL scGOS/lcFOS (prebiotic formula; n = 51) or the identical prebiotic formula additionally supplemented with B. breve M-16V at a dose of 7.5 x 108 colony forming units/100 mL (synbiotic formula; n = 52) from birth (1-3 days at the latest) until 16 weeks of age. All infants included were mixed-fed and received the study product corresponding to each experimental group in addition to breastfeeding. A reference group of 30 non-randomized infants born vaginally was also included.

Synbiotic supplementation led to a higher proportion of bifidobacteria-total faecal bifidobacteria was the primary outcome- from day 3/5 until week 8, and a reduction of Enterobacteriaceae from day 3/5 until week 12, compared to controls. These results show that supplementation with scGOS/lcFOS and B. breve M-16V may compensate for the delayed Bifidobacterium colonization in c-section-delivered infants. Besides this, the synbiotic was also able to decrease faecal pH (acidification of the gut) from day 3/5 until week 4, which could be explained by the increased faecal acetate levels. The authors hypothesized that the reduced abundance of Enterobacteriaceae in the synbiotic formula group was likely due to the increase of acetate induced by the synbiotic. Both the reduction of Enterobacteriaceae and the increase of acetate have been previously reported as markers of a healthy gut ecosystem.

At the end of the study, the proportion of subjects with detectable infant type Bifidobacterium species was comparable across all the intervention groups. In the synbiotic group, B. breve M-16V was detected 6 weeks post-intervention in 38.7% of the infants.

In conclusion, this study demonstrates that gut microbiota manipulation early in life in c-section-born infants may help emulate the gut physiological environment observed in vaginally-delivered infants.



Chua MC, Ben-Amor K, Lay C, et al. Effect of synbiotic on the gut microbiota of cesarean delivered infants: a randomized, double-blind, multicenter study. J Pediatr Gastroenterol Nutr. 2017; 65(1):102-6. doi: 10.1097/MPG.0000000000001623.