Environmental Exposures Influence on the Antenatal Microbiome and Health of Offspring

Background: Environmental exposures relevant to health outcomes occur from preconception through death. Maternal exposures are believed to be especially influential in programming health outcomes in offspring since they occur during a critical developmental period. The interaction between maternal and fetal environments plays a critical role in high risk birth outcomes, fetal development, and later adult onset of disease. There is accumulating evidence that these exposures may alter the antenatal microbiome and subsequent microbiome and health of the offspring.

Objectives: The purpose of this presentation is to summarize and evaluate the current state of knowledge regarding the assessment of the antenatal microbiome on the health of human offspring. A summary of the known factors affecting the human microbiome and studies that assessed relationships between the antenatal microbiome and short- or long-term health outcomes of the offspring will be discussed.

Method: An integrative review was conducted to examine human research studies that focused on the antenatal microbiome and the health of the offspring using the electronic databases PubMed/Medline and CINAHL from 2004 to the present.

Results: In addition to the known individual factors that are associated with establishment of the microbiome, the results of the integrative review suggest that medications including antibiotics, comorbidities including infectious diseases, diet, socioeconomic status and exposure to toxicants should also be measured.

Discussion: The maternal and fetal microbiomes are important mediators of short and long-term health outcomes in offspring. In order to advance understanding of the role of the antenatal microbiome on health and disease risk of the offspring, it will be important to further elucidate the composition of a healthy microbiome and specific mechanisms that contribute to altered health in later life.

Clinical Implications: Although we are far from understanding the precise mechanisms by which these interactions influence health, there is reason to believe that there is a certain degree of plasticity involved in fetal programming that may prove amenable to therapeutic nursing strategies. Implications of microbiome research in the antepartum period include information concerning newborn delivery decision-making, physiology behind the lifelong benefits of breast-feeding exposure in infancy, limiting or altering antibiotic regimens for common infectious diseases, targeted use of specific probiotics to treat and prevent disease, and ultimately individualization of medical regimens for the fetus and newborn based on microbial profiles. A deeper understanding of the influence of the antenatal microbiome on the health of the offspring may provide new insight on the origins of chronic disease as well as inform evidence-based practice and healthcare decision making.