Does vaginal seeding boost health?

Should Caesarean-section babies be smeared with a sample of their mother’s vaginal fluids as soon as they are born?

“Vaginal seeding” is not mainstream medicine, but it is growing in popularity.

The idea is to give these newborns something they missed when they emerged into the world – the good bacteria that live in their mother’s vagina.

A swab is taken of mum’s vaginal fluid, which is then rubbed on to her child’s skin and mouth.

The hope is this microbial gift will boost their child’s long-term health – particularly by reducing their risk of immune disorders.

It is a crucial time.

We might have been sterile in the womb, but in our first few moments of life an invisible bond is being established between baby and bacteria.

It’s a relationship that will last a lifetime, and the first contact is as important as a first date.

“The first time a baby’s own immune system has to respond are to those first few bacteria,” says Prof Peter Brocklehurst, from the University of Birmingham.

“That we believe is important for, in some way, setting the baby’s immune system.”

There is a noticeable difference between the microbiomes – the collection of bacteria, viruses, fungi and archaea – of babies born vaginally and by Caesarean section.

It lasts for about the first year of life.

A baby born vaginally is first exposed and colonised by microbes from their mother’s vagina and gut.

But for Caesarean-section babies, the first exposure “if they’re lucky”, says Prof Brocklehurst, comes from the very different organisms on their mother’s skin.

He is running the Baby Biome Study to see if these different microbial colonists on Caesarean-section babies explain why they have higher rates of diseases such as asthma and allergies later in life.

The microbiome

  • You’re more microbe than human – if you count all the cells in your body, only 43% are human
  • The rest is our microbiome and includes bacteria, viruses, fungi and single-celled archaea
  • The human genome – the full set of genetic instructions for a human being – is made up of 20,000 instructions called genes
  • But add all the genes in our microbiome together and the figure comes out at between two million and 20 million microbial genes
  • It’s known as the second genome and is linked to diseases including allergy, obesity, inflammatory bowel disease, Parkinson’s, whether cancer drugs work and even depression and autism

    More than half your body is not human

    Gut Instinct: Why I put my poo in the post

    The early interaction between the immune system and microbes appears crucial.

    Obviously our bodies do attack the dangerous ones – but the overall relationship between microbial and immune cells is about more than conflict, it’s a far deeper dynamic.

    Graham Rook, a professor of medical microbiology at University College London, says the microbiome is the immune system’s teacher.

    “This is a learning system, it is like the brain. Now, the thing about the adaptive immune system is it needs data, just like the brain needs data.”

    Listen to The Second Genome on BBC Radio 4.

    The next episode airs 11:00 BST Tuesday April 17, repeated 21:00 BST Monday April 23 and on the BBC iPlayer

    And that “data” is coming from microbes and the chemicals they produce. They provoke a reaction in the immune system that can last a lifetime.

    Prof Rook says: “The initial setting up of the immune system occurs during the first weeks and months of life.

    “We know that because there’s a window of opportunity during those first months of life when if you give antibiotics you can disrupt the microbiota and then in adulthood those individuals are more likely to have immunological problems and are more likely to put on weight.”

    This is the idea that some parents are buying into when they perform vaginal seeding.

    Do dogs boost a baby’s microbiome?

    Even the type of home you bring your baby back to may affect their long-term health.

    Research has shown households with dogs have lower rates of asthma.

    The idea is they help us swim against the hygiene tide by traipsing their muddy paws round the house and sticking their noses into everything.

    “The speculation has always been that the dog brings, from the outside, microbes that are helpful in stimulating the infant’s immune system,” says Prof Anita Kozyrskyj, from the University of Alberta.

    She is analysing data on about 3,500 families in the Canadian Healthy Infant Longitudinal Development Study.

    One of its findings is that the microbiomes of three-month-olds is far richer and more diverse (a good sign) if there is a pet in the house.

    Two types of beneficial bacteria seemed to be more common.

    “The Oscillospira have been associated with leanness and the Ruminococcus have been associated with reduced risk of allergic disease.”

    Breastfeeding or formula, antibiotics and method of delivery all affect the microbiome.

    But studies into the microbiome and long-term health have often been too small to be definitive.

    The Baby Biome study is aiming to collect faecal samples from 80,000 babies.

    That will be a lot of soiled nappies to analyse, but it will be an unparalleled resource for interrogating the impact of decisions made around birth.

    Many of those will be out of parents’ hands.

    No doctor or parent would hold back on life-saving antibiotics because of an uncertain long-term impact.

    Breast milk feeds gut bacteria

    This study will let scientists see which microbes the body first hooks up, what that means years later and, tantalisingly, whether damaging relationships with the wrong bacteria can be repaired.

    The faecal samples will end up at the Wellcome Sanger Institute in Cambridge and in the hands of microbial enthusiasts such as Dr Trevor Lawley.

    “My latest favourite microorganism is Bifidobacterium,” he says.

    “It is one of the first bugs to colonise humans early in life, and we believe they feed off sugars in the breast milk.

    “So, there’s a very sophisticated evolutionary set-up where the bugs are passed from the mother to child and the mother nurtures that bug to establish the early microbiome.”

    Dr Lawley’s lab will be trying to uncover every microbe that colonises a newborn and what that means later in life.

    He thinks the end result of the project will be to change policy around avoidable antibiotic use and Caesarean sections.

    Or, alternatively, “maybe we could culture the bugs from the mums to purposefully colonise the babies to allow their microbiome to mature and develop properly” – in other words, a scientifically controlled version of vaginal seeding.

    So are some parents just ahead of the game?

    Prof Brocklehurst says: “At the moment some parents believe this hypothesis enough that they are doing their own vaginal seeding.

    “Now, there could be real downsides to that.”

    One concern is dangerous bugs could be transferred.

    Up to a quarter of women are thought to carry group-B strep in their vagina, and exposing babies to this bacterium could be fatal.

    Prof Brocklehurst says: “It too early to start introducing bacteria artificially into the baby until we’ve got a good handle on how likely this is to be the mechanism or not.”

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New ban on epilepsy drug in pregnancy

An epilepsy drug that can damage unborn babies must no longer be prescribed to girls and women of childbearing age in the UK unless they sign a form to say that they understand the risks.

Drug regulator the MHRA says the new measures it’s introducing will keep future generations of children safe.

Those already on valproate medication should see their GP to have their treatment reviewed.

No woman or girl should stop taking it without medical advice though.

It is thought about 20,000 children in the UK have been left with disabilities caused by valproate since the drug was introduced in the 1970s.

Affected families have called for a public inquiry and compensation.

Epilepsy charities say one in five women on sodium valproate are unaware that taking it during pregnancy can harm the development and physical health of an unborn baby.

And more than one in four have not been given information about risks for their unborn child.

The MHRA has changed the licence for valproate, which means any doctor prescribing it will have to ensure female patients are put on a Pregnancy Prevention Programme, which means:

  • The patient can see her doctor every year to discuss the risks of this drug to an unborn baby
  • She signs an acknowledgement form at least every year
  • She is told about the importance of using contraception throughout treatment and having a pregnancy test if she thinks she could be pregnant

    If valproate is taken during pregnancy, up to four in 10 babies are at risk of developmental disorders, and approximately one in 10 are at risk of birth defects.

    Dr June Raine, from the MHRA, said: “Patient safety is our highest priority. We are committed to making sure women and girls are aware of the very real risks of taking valproate during pregnancy. However, we also know it is vitally important women don’t stop taking valproate without first discussing it with their doctor.

    “I would like to particularly thank the families involved in the Valproate Stakeholder Network who have shared their experiences and expertise with us. Their support will help keep future generations of children safe.”

    Simon Wigglesworth, deputy chief executive of Epilepsy Action, said: “We know there are still far too many women who haven’t been made aware of the potential risks of taking sodium valproate in pregnancy.

    “It is vitally important that healthcare professionals ensure that all women with epilepsy taking sodium valproate are reviewed in line with the new guidelines.”

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Parents facing ‘unfair child abuse claims’ over bruising

Parents are being investigated for possible child abuse because of the misinterpretation of guidelines on bruising in babies, it’s claimed.

Official guidelines from health watchdog NICE for hospital workers suggest such bruising is very uncommon.

University of Central Lancashire research suggested the guidelines mean social services are investigating parents too often.

Its research said more than a quarter of babies are bruised accidentally.

One mother had her baby removed from her care for a year by social services, until its bruising was found to have been caused by a medical condition.

‘Exaggerated effects’

Lead researcher Prof Andy Bilson told the BBC’s Victoria Derbyshire programme that “social workers are in danger of having to take decisions based on really misleading interpretations of research”.

The NICE guidelines are used by local authorities to draw up their own policies.

Some 91 of the 152 councils in England have specific guidance on how staff should respond to possible abuse.

More than three-quarters (77%) of these do not give front-line staff such as nurses, health visitors and GPs the freedom to make judgements about the causes of a bruise, the university’s researchers said.

In five local authorities, a formal child protection investigation must be undertaken when a single bruise in a pre-mobile child – who cannot crawl or walk – is discovered.

This is despite research from 2015 showing accidental bruising occurred in 27% of pre-mobile babies – those that cannot crawl or walk – monitored over a seven to eight-week period, researchers said.

Chelsea and Theo’s story

Chelsea Kirtley had her baby Theo removed from her and the father’s care for more than a year.

She initially took him to the GP worried that the bruising was a sign of meningitis.

But when further marks appeared, Stockton Council social services accused them of harming their child.

“It felt they were out to get us,” Chelsea explained. “We got escorted by police off the hospital ward, with all the [other] parents looking at us.”

Her son was placed into the care of his aunt, and then his grandmother.

The case was only dropped after Ms Kirtley had Theo examined by a geneticist, who diagnosed him with hypermobility syndrome – a condition that causes people to bruise easily.

But she says the stress caused her to split from the father and leave her job.

She was made homeless and now lives with Theo and her mother in a hostel.

The council said it “relied heavily on medical views throughout” its assessment of Theo, and that the safety of a child always has to be its number one consideration.

The tragedies of children such as Victoria Climbie and Baby P, in which warning signs were missed by social workers, are thought to have changed how local authorities deal with cases of bruising.

Labour MP Emma Lewell-Buck used to be a social worker in Sunderland, which has some of the strictest guidance.

“I never came across a case where a [pre-mobile] baby had a bruise, and that bruise was purely accidental,” she said.

“I think you should always err on the side of caution.”

She said the public would want social services to “do the right thing and make sure they had a full medical assessment to find out whether or not this was deliberate”.

‘Other dangers’

Prof Bilson acknowledges social workers have a duty to look into incidents of bruising, but said some parents would be put off from taking their children to see a GP for fear of being investigated – stopping the child from getting the medical care it needs.

“If this puts into people’s minds even a hesitation of taking their child to a doctors, there’s a real chance sooner or later some child will die due to this policy,” he said.

NICE did not comment on the claim its guidelines could be misleading.

It said its original advice was aimed at medical professionals working in hospitals.

New guidance has been issued by NICE aimed more at social workers and teachers.

Watch the BBC’s Victoria Derbyshire programme on weekdays between 09:00 and 11:00 on BBC Two and the BBC News Channel.