recent studies have shown that receiving antibiotics during labor alters the microbiota of the newborn, even if they are administered only an hour before birth. Reading about these studies made Neve, pregnant with her third child, feel uneasy. She knew that GBS could potentially be very serious and she understood the need for antibiotics during labor, but she wondered if anything could be done to prevent testing positive for GBS. Her second child has asthma and although it’s impossible to know whether his exposure to antibiotics during birth is to blame, she’s left wondering if it contributed. More importantly, Neve wanted to do whatever she could to decrease the risk of her new baby developing asthma, too. She hoped to help by testing negative for GBS, but how could she do something about that?
It turned out that she might actually have some say in the matter. GBS are bacteria that will expand in numbers only if they’re given the chance. Normally other members of the microbiota keep them in check, usually our bacteria superstars, the Lactobacilli in the gut and the vagina. In fact, if you grow Lactobacilli and GBS together in the lab, the Lactobacilli make it very hard for GBS to multiply; they beat them easily. Furthermore, a small number of studies suggest that applying probiotics directly to the vagina increases Lactobacilli and decreases the number of GBS. This finding was shown in healthy nonpregnant women and remains to be supported in bigger studies, but given how safe it is to administer probiotics to pregnant women, Neve was open to trying this approach and her midwife supported this prophylactic treatment.
Neve ended up testing negative for GBS at her 36-week visit, and she is expecting to have an antibiotic-free birth very soon. However, it’s important to mention that it remains to be proven in a randomized clinical trial that the prophylactic use of vaginal probiotics prevents or reduces the chance of a GBS-positive test during pregnancy. The use of vaginal probiotic suppositories, as with any treatments during pregnancy, should always be discussed with a health practitioner.
Can Bacteria Influence Us Before Birth?
So far we have discussed different ways to take care of the maternal microbiota during pregnancy in order to prepare the best kind of microbes that a mother can give to her baby at birth. This is when babies get soaked in microbes, during their trip down the vaginal canal. But very recent research shows that microbes may pay a visit to babies even before birth. For many years it has been widely accepted that humans are germ-free immediately before birth and that the presence of bacteria in utero is considered infectious and dangerous. Often this is true—bacteria growing in the placenta or the amniotic fluid can be a sign of infection and a cause of premature birth or even stillbirth. But what we’re just now beginning to learn is that there may be very low numbers of bacteria that commonly reach the baby in the uterus without causing any harm. We still don’t know how they get there and, more importantly, what they do, but in two separate studies bacteria were detected in the amniotic fluid and placentas of healthy babies. Although some scientists (including us) remain skeptical about these findings, the authors of these studies speculate that these bacteria are involved in immune stimulation of the fetus. Additional studies are needed before we can explain why this occurs, or if it even does.
Another more likely exposure to microbes before birth may occur in the form of bacterial metabolites, which are very small substances produced by the enormous amount of bacteria in our guts. Bacterial metabolites are known to travel in the bloodstream at all times, and are involved in biochemical reactions in just about every human organ, influencing many aspects of our metabolism. Thus, even if very few bacteria actually reach the fetus during pregnancy, the metabolites may reach the growing baby through the bloodstream and potentially affect fetal growth and development. Much-awaited studies are under way to explore the impact these microbes might have in human development before birth.
Dos and Don’ts
♦Do— eat for your microbes, not just your cravings. Make vegetables, fruits, and fiber staples of your diet, along with the other food groups, and reduce sugary foods. A varied diet is a healthy diet for you, your baby, and your microbiota.
♦Do— add daily probiotics, yogurt, or kefir (a fermented milk drink) to your diet. Increasing the growth of beneficial bacteria in your vagina will promote their passage to the newborn, where they carry out very important functions.
♦Do— prevent infections if possible. Not only will you avoid feeling awful while pregnant, but it also reduces the chances of having to take antibiotics. Wash your hands often, avoid being in close contact with sick people, and follow the current recommendations of foods that pregnant women should avoid. If antibiotics are necessary, start or continue taking probiotics.
♦Don’t– sweat the small stuff, and do try to control stress as much as possible. Severe stress is associated with a number of disorders in children and also with alterations to the microbiome. If stress is becoming a big part of your life, reach out for help through your health practitioner. Even if your stress is moderate, incorporating exercise, yoga, or meditation into your routine can help keep the edge off.
♦Do— consider vaginal probiotic suppositories in your third trimester in order to reduce the chances of testing positive for GBS. A negative GBS test will make an antibiotic-free birth more likely.
CARE FOR A SPOONFUL OF SOIL?
Perhaps the most bizarre of pregnancy cravings is the urge to eat dirt—a form of pica, a term used to describe an intense craving for nonfoods. Some suggest that dirt pica is the body’s attempt to consume minerals and that it may be linked to iron deficiency, which occurs in many expectant women. Still, it is not known for certain what drives some mothers-to-be to eat dirt.
The rates of dirt pica vary depending on culture and socioeconomic status. In Kenya, it is so common that people see it as a sign of pregnancy, with 56 percent of pregnant women following this practice. Even in the US, 38 percent of low-income women from southern Mississippi claim to crave dirt or clay. Dirt pica is common enough that you can order dirt online to satisfy your craving! However, pregnant women are also more vulnerable to infectious diseases, and eating dirt may prove dangerous. Dirt is a known source of pathogens, toxins, and even lead, making it a bad option for those hard-to-curb cravings.
4:Birth: Welcome to the World of Microbes
The Best Laid Plans
At 3:50 a.m. a week before her due date, Elsa realized she was in labor. She was sleeping (sleeping should really have a different name in late pregnancy, as it is just not the same thing) when her water broke, alerting her and her startled husband that it was time. Soaking wet, they nervously laughed at the realization that they were going to meet their baby boy soon. They had a hospital delivery plan written down—labor in a bathtub, “laughing gas” for pain management, clear communication about interventions—and then, when the contractions became closer together, they would calmly put on comfortable clothes, gather their already-packed hospital bag (which included magazines, an iPad to serve as a music player and video camera, a massage device, and a heating pad), gather snacks and energy drinks, phone the grandparents, and drive to the hospital. The infant car seat had been installed in their car for about a month, and they had even practiced driving the route they were going to take. They already knew the best place to park in the hospital parking lot and the exact location of the maternity ward. Elsa and her husband had it all covered . . . or so they thought!
The first thing that kiboshed their perfect plan was having her water break before feeling contractions, also known as PROM (premature rupture of membranes). Elsa wanted to labor at home, but she knew that she had to go to the hospital right then. When the water breaks, the bag full of amniotic fluid, which keeps the baby protected, ruptures. It’s not unusual for it to occur before labor, with 1 in 10 women experiencing that, but babies need to be monitored when this happens due to an increased risk in complications, such as an umbilical cord prolapse or an infection.
Within fifteen minutes they were out the door. They got dressed, grabbed the bag, forgot the snacks (oops), and decided to call their parents on the way to the hospital. It took Elsa another ten minutes to find a not-too-uncomfortable position to sit in the car, and just then, she started