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The Gut Microbiome in Pregnancy and Neonatal Health

Gut health is a valuable contributor to our health and well-being from a multitude of facades across different life stages. The conversations on its implications on pregnancy, neonatal, and postnatal maternal health highlight its transdisciplinary impacts.  Hormonal, inflammatory, and immune changes are typical qualities of pregnancies that are correlated with changes in the gut microbiome profile dissimilar to that of a healthy non-pregnant adult depending on the stages of pregnancy1,3,4.

Pre-Pregnancy Gut Health on Reproductive and Neonatal Outcomes

The gut microbiome in a non-pregnant individual can impact their reproductive health outcomes–women who struggle with infertility have presented gut dysbiosis profiles characterized by elevated Verrucomirobia and reduced Stenotrophomonas, Streptococcus, and Roseburia2. Although further investigation is required to specify predominant microbial species and shifts, the gut microbiome may also contribute to the development of polycystic ovary syndrome–which also impacts fertility2.

Pre-conception irritable bowel syndrome has different gut microbiome profiles that may affect neonatal, and pregnancy health compared to healthy individuals. It is characterized by reduced gut microbial diversity in the first trimester of pregnancy, lower populations of Bacteriodetes, and increased populations of Gammaproteobacteria.2. High pre-pregnancy BMI–which is associated with maternal obesity and excess pregnancy weight gain–are also correlated with reduced microbial diversity, but characterized with reduced populations of Bifidobacterium spp. And elevated populations of pro-inflammatory species such as E.Coli spp.2. Neonates are observed to carry similar microbial profiles to their mothers which may have developmental and health implications for their long-term health2.

Maternal Gut Health and Neonatal Health

In a healthy pregnancy, changes in the gut microbiome in latter stages of the third trimester include increased levels of Bifidobacterium associated with elevated maternal progesterone levels. Bifidobacterium is vital for neonates as it assists in the degradation of indigestible oligosaccharides found in human breast milk1,2. Sinha et al. (2023) contend that elevated levels of these beneficial bacteria in the maternal gut may facilitate its transfer to infants in childbirth to develop and support their gut microbiota and immune system in addition to assisting digestion of breast milk oligosaccharides1.  

Pregnancy Gut Microbiome Status and Pregnancy Health

Koren et al. (2012) found that the gut microbiome during the first trimester of pregnancy remains similar to that of a healthy non-pregnant adult. They conducted fecal analysis in healthy first- and third-trimester pregnant women and transplanted their feces to germ-free female mice. They found that the gut microbiome profiles were vastly different between the two trimesters and attributed third-trimester dysbiosis to the effects of normal pregnancy physiological changes; this form of dysbiosis may be associated with metabolic changes and diseases in non-pregnant individuals but is not harmful and can even be beneficial in contexts of normal pregnancies 1,2,3,4. Normal pregnancy physiological changes include marginally increased maternal blood glucose, reduced insulin sensitivity, and increased adiposity; these may help support the continuous supply of nutrients to the fetus and prepare for birth3. It is contended that these changes promote beneficial dysbiosis in later-stage pregnancies by mildly increasing proinflammatory cytokines and low-grade epithelial inflammation; elevated progesterone levels in this pregnancy stage may also be a contributing factor1,3,4. This form of dysbiosis is beneficial because it promotes the preferential growth of Bifidobacterium in the maternal microbiome, which is known to support fetal and maternal outcomes1,3,4.

Although marginal physiological changes and dysbiosis are normal and beneficial in healthy pregnancies, extreme weight fluctuations or insulin resistance, such as in maternal obesity and diabetes, can be harmful; it may lead to more severe dysbiosis, drastically increasing inflammation and, thus, increasing risks of pregnancy complications like restricted fetal growth and preeclampsia1,2,4,5. Species-specific characterization of detrimental levels of dysbiosis and its mechanisms in pregnancy complications warrants further research.

Dietary Interventions for a Healthy Pregnancy Gut

Currently, dietary interventions and preventative measures are recommended to support a healthy lifestyle to promote gut, pregnancy, and neonatal health with additional attention to managing weight and pregnancy complications. In addition to the food groups highlighted in the Australian Guide to Healthy Eating and dietary counseling, certain Lactobacillus and Bifidobacterium probiotic strains can have anti-inflammatory effects to promote intestinal integrity and improve gut health and metabolic management4. The fermentation of prebiotics, such as oats and bananas, produce byproducts like short-chain fatty acids (SCFA) that provide energy to and support the health of the gut microbiome; elevated serum SCFA levels (such as acetate, propionate, and butyrate) can contribute to improved maternal metabolic management4,5. Pregnant individuals may benefit from balanced diets that include soluble and fermentable fiber and pregnancy-safe probiotics, such as Lacticaseibacillus paracasei Shirota in Yakult, to promote a healthy gut microbiome and pregnancy while also addressing other common pregnancy conditions like constipation4. Research on changes in the gut microbiome during pregnancy and therapeutic probiotic interventions are limited and still require more investigation1,4.

  1. Sinha, T., Brushett, S., Prins, J., & Zhernakova, A. (2023). The maternal gut microbiome during pregnancy and its role in maternal and infant health. Current Opinion in Microbiology, 74, 102309. https://doi.org/10.1016/j.mib.2023.102309
  2. Turjeman, S., Collado, M. C., & Koren, O. (2021). The gut microbiome in pregnancy and pregnancy complications. Current Opinion in Endocrine and Metabolic Research, 18, 133–138. https://doi.org/10.1016/j.coemr.2021.03.004
  3. Koren, O., Goodrich, J. K., Cullender, T. C., Spor, A., Laitinen, K., Bäckhed, H. K., Gonzalez, A., Werner, J. J., Angenent, L. T., Knight, R., Bäckhed, F., Isolauri, E., Salminen, S., & Ley, R. E. (2012). Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell, 150(3), 470–480. https://doi.org/10.1016/j.cell.2012.07.008
  4. Edwards, S. M., Cunningham, S. A., Dunlop, A. L., & Corwin, E. J. (2017). The Maternal Gut Microbiome during Pregnancy. MCN. The American Journal of Maternal Child Nursing, 42(6), 310–317. https://doi.org/10.1097/NMC.0000000000000372
  5. Kunasegaran, T., Balasubramaniam, V. R. M. T., Arasoo, V. J. T., Palanisamy, U. D., & Ramadas, A. (2023). Diet Gut Microbiota Axis in Pregnancy: A Systematic Review of Recent Evidence. Current Nutrition Reports, 12(1), 203–214. https://doi.org/10.1007/s13668-023-00453-4