Perinatal Programming of Asthma: The Role of Gut Microbiota

Table 1

Summary of perinatal exposures that may influence the programming of asthma via modification of infant gut microbiota.

Perinatal exposure	Effect on gut microbiota	Effect on asthma development
Caesarean delivery	Prevents exposure to maternal fecal microbes.; ↓ Bifidobacteria and Bacteroides [57, 58],; ↑ C. difficile [53, 56].; Differences may persist for years [58–61].	Increases risk of asthma [62]; recent studies inconsistent [53, 63, 64].
Breastfeeding	Confers beneficial gut microbiota through prebiotic properties [66] or direct transfer of bacteria [67, 68].; ↑ Bifidobacteria, ↓C. difficile [56, 57, 65].	Protects against asthma [69–73], except when mother is atopic [43, 44].
Antibiotics	Suppresses commensal bacteria, permits emergence of C. difficile [22, 56, 77].; Disturbance may persist for years [78, 79].; Even indirect exposure is harmful [57].	Increases risk of asthma [80–83], except when parents are atopic [82, 88].; Even indirect exposure is harmful [55, 84–87].; Some studies may be confounded [91, 92].
Probiotics	Direct or indirect exposure beneficially influences gut microbiota composition [94–96].	Protects against asthma in animal studies [97, 98]; human trials inconclusive [100–103].
Perinatal stress	Causes transient and long-lasting changes to gut microbiota in animal studies [104–107].	Increases risk of asthma [114, 115].

“Indirect exposure” refers to exposure occurring via the mother, during pregnancy or lactation.