A team of researchers in Milan, Italy, is investigating the potential impacts of prenatal antibiotic (ABX) treatment on breast milk composition and the resulting effects on babies’ gut microbial health and immune system functionality. Published in the journal Pediatric Research, the study protocol aims to confirm whether the antibiotic-induced gut microbial and immune alterations observed in murine models also occur in human neonates.
Previous studies have shown that ABX treatment can disrupt gut microbiota composition, reduce immunoglobulin A (IgA) levels, and impair gut immune defenses in animals. The new study seeks to determine whether maternal antibiotic use during pregnancy can weaken the immune function of breast milk, leaving infants more vulnerable to infections.
The researchers aim to recruit two cohorts of women—one exposed to at least seven consecutive days of ABX treatment during pregnancy and the other with no ABX exposure—and follow them for one year. The study will examine the impact of antibiotic use on breast milk IgA, gut microbiota, and neonatal fecal microbiota using advanced genomic techniques such as shotgun sequencing. The findings will provide vital information to help mothers and clinicians better understand the potential health implications of prenatal antibiotic treatment.
Newborns rely heavily on breast milk for gut protection, particularly IgA, which is essential in preventing infections. Research indicates that any reduction in maternal IgA could leave babies susceptible to gastrointestinal infections. The relationship between microbiota and the immune system is complex and bidirectional. Microbiota composition influences immune function, and in turn, components like secretory IgA (sIgA) play a role in shaping the microbiota.
Recent studies have suggested that mothers’ breast milk components shape and seed their infants’ microbiota while preventing harmful bacterial translocation into the gut. However, ABX treatments are known to alter gut microbiota and impair immune function, and studies have shown that antibiotics administered during neonatal periods can lead to short- and long-term adverse health effects, including atopy, obesity, and necrotizing enterocolitis (NEC).
Despite these findings, it remains unclear whether ABX treatment in pregnant or breastfeeding women can adversely affect their babies’ health by disrupting the entero-mammary pathway, which is responsible for transferring immune components like IgA into breast milk.
The proposed study will recruit 41 mother-infant pairs for each cohort: one group of women who received ABX during the final stages of pregnancy and a control group who had no antibiotic exposure. The researchers will investigate various factors, including breast milk IgA levels, microbiota composition, and neonatal fecal microbiota.
To assess the microbial communities, the study will employ shotgun metagenomics, a high-resolution technique that provides detailed insights into bacterial changes in both breast milk and infant feces. Investigative methods will include enzyme-linked immunosorbent assays (ELISAs) to quantify breast milk IgA, magnetic-activated cell sorting (MACS) for separating IgA-coated microbiota, and genomic sequencing on the Illumina HiSeq 2500 platform for bacterial characterization.
The researchers will also conduct follow-up assessments at multiple time points—shortly after delivery, one month after birth, three months after birth, and between 8-12 months of age, once solid foods have been introduced. Neurodevelopmental outcomes will also be assessed using the Ages and Stages Questionnaire (ASQ-3) at the final follow-up.
The proposed research aims to fill knowledge gaps about the potential effects of prenatal antibiotic exposure on breast milk immunity, microbial composition, and infant health. By focusing on the interplay between maternal ABX treatment, IgA levels, and neonatal gut microbial development, this study could provide valuable insights for clinicians and mothers considering antibiotic treatment during pregnancy.
Additionally, the study will contribute to the understanding of how prolonged antibiotic use before delivery might alter the functionality of the entero-mammary pathway, ultimately impacting neonatal immunity and health. The findings could lead to new clinical guidelines and help inform decisions about ABX use in pregnant women.
This study represents an important step in understanding the potential risks associated with prenatal antibiotic treatment and its implications for both maternal and neonatal health. By examining the impact of antibiotics on breast milk immunity and gut microbial health, the research aims to provide evidence that will guide clinicians and mothers in making informed choices about antibiotic treatment during pregnancy, while also improving overall neonatal health outcomes.
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