The Maternal-Child

Microbiome
Tom Johnston
MSN, CNM, IBCLC
Methodist University
Disclosures

• I have no disclosures to declare

Objectives

•Identify the Maternal-Newborn Microbiome

•Discuss the value of the microbiome and its
effect on wellness
•Identify implications of the microbiome and
dysbiosis
The Microbiome
What is it

• The universe inside your body

• 100x more non-human DNA than human DNA
• Each non-human DNA requires an immune response
• Each has a will to survive, provides a function, and a
service in the body
• Mother’s microbiome passes to baby over the first
year
 Humans - The “Holobiont”

What if the “human” part of us really is only 10%? What does that mean?

Dietert, R & Dietert J (2015) Healthcare, 2; 100-123

Oro-mammary communication

•Mothers give their immune system to baby

• NOT an immature immune system
•Colostrum contains 1013 cells/ml
• Leukocytes
• Human Milk Oligosaccharides (HMO)
• Epithelial cells
• Human Breast Milk Stem Cells (hBMSC)
Gomez et al. Science 2016
Leukocytes

• 13-70% of total cell count

• Active, motile and interactive
• Increases during maternal AND infant illness
• Particularly macrophages
• Likely retrograde flow of pathogens from infant to mother
causes greater response
• May some day be used to test for infection
 HMO

Bode (2012) Glycobiology

HMO

• Ever heard of “Lactobacillus bifidus” or “Bifidus

factor”?
• More than 100 different HMO
• Not all women make all of them
• Each has a different function
• Most are still not well understood
Five Possible Beneficial Effects

• Probiotics
• Sometimes, not always
• Anti-adhesive antimicrobials
• They act as decoys to virus and bacteria
• Immune system modulators?
• Lymphocyte maturity and T-cell response
• Natural protection against NEC
• 6-10 fold reduction in breastfed preterm infants
• Nutrients for brain development
• Sialic Acid (Sia-type) invade the brain
Bode (2012) Glycobiology
Epithelial Cells

•Ductal, luminal, alveolar, and lactocytes

•Not a result of cell death or wasting
•Cells are active, alive and functioning
• May serve as building blocks to baby
• Form clusters in the breastmilk
Human Milk Alveoli of the lactating breast

Functioning mammospheres producing beta casein

Hassiotou, Geddes, & Hartman (2013) JHL
Pluripotent Stem Cells

• Can form many cell lines

• Mammary cells, Neurons, cardiomyocytes, chondroblasts,
adipocytes, hepatocytes, and pancreatic beta cells
• Can even form all 3 germ layers (fetal development)
• MicoChimerism - hBMSC enter infant blood stream
and are encorporated into the infant’s organs
• May some day be able to bank them for future use
(replace umbilical cord blood banking)
But what about the Microbiome?

We are infants trying to drive

 Incredibly complex

Backhed et al (2015) Cell Host & Microbe

Backhed et al.

• Birth, 4 mo, 12 mo, and their mothers

• Neontal Microbiome comes from mother
• SVD babies had 135 of the 187 bacterial families of their
mother
• CS babies had only 55 of these families
• Phosphotransferase system (PTS) Prevalent
• Lactose-specific transporter
• Highest at 4 months
More

•Bacterial colonies responsible for:

• Vitamin Production
• B-complex, K
• Iron absorption
• Amino Acid absorption
• Carbohydrate Absorption
• Methanobrevibactor smithii
Methanobrevibactor Smithii
Extremophile

https://microbewiki.kenyon.edu/index.php/File:Figure1U.jpg
What about breastfeeding?

•Exclusively BF babies had

•More immature guts
• More Probiotic bacteria
• More bacteria responsible for
• oxidative phosphorylation
• Riboflavin production
• Biotin
• Amylase

Maturation of the Gut happens soon after

cessation of breastfeeding
Microbiome and health

•Allergic and Auto-immune Disease

• Requires Diverse Microbiota
• Farm life
• Green spaces
• Multiple Siblings
• Pets?
• Diet mediated
• Fiber (polysaccharides digested by microbiota not the host)
• Decreased inflammation

Bloomfield et al (2016)
 Antibiotics

•Decreased Biodiversity
•Long term effects on the microbiota of
children
• Asthma
• Obesity
•Mothers – Disruption in mother are
transmitted to baby

Bloomfield et al (2016) Perspectives in Public Health

Emerging Information on dysbiosis

•Possible links to
• Autism Spectrum Disorder (van De Sande, 2014)
• Depression and Anxiety (Mayer, 2015)
• Obesity (Levy 2015)
• Irritable Bowel Disorder (Levy 2015)
• Alzheimer’s Disease (Borre 2015)
• Asthma (Bloomfield 2016)
 Microbiome Endocrinology

Neuman, et al. (2015) FEMS Microbiology Reviews, 39, 2015, 509–521

Take Away

•Breastmilk is a complex biosystem, it is not

just food
•We are finally beginning to understand how
the “benefits” of breastfeeding work
•Microbiome science is in its infancy
• We can’t make any claims to “know” much
Bibliography
• NPR (2013) The invisible universe of the human microbiome. Retrieved Oct 1, 2016.
https://www.youtube.com/watch?v=5DTrENdWvvM
• Borre, O’Keefe, Clarke, Stanton, Dinan, Cryan (2014) Microbiota and neurodevelopmental windows:
implications for brain disorders. Trends in Molecular Medicine, 20(9); 509-518. DOI:
http://dx.doi.org/10.1016/j.molmed.2014.05.002
• Gomez de Aquera, M, Ganal-Vonarburg, S., McCoy, K., Macpherson, A. (2016) The maternal microbiota drives
early postnatal innate immune development. Vol. 351, Issue 6279, pp. 1296-1302 DOI:
10.1126/science.aad2571
• Backhed, F., Roswall, J, Dahlgren, J., Wang, J. (2015) Dynamics and stabilization of the Human Gut Microbiome
during the first year of life. Cell Host & Microbe, 17, 690-703
• Bloomfield, S., Rook, G., Scott, E., Shanahan, F., Stanwell-Smith, R., Turner, P. (2016) Time to abandon the
hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention
and the role of targeted hygiene. Perspecitves in Public Health, 136(4) 213
• Mayer, E.,. Tillisch, K., Gupta, A (2015) Gut/Brain axis and the microbiota. J of Clinical Investigation, 125(3) 926
• vanDe Sand, M., vanBuul, V., Brouns, F. (2014) Autism and nutrition: the role of the gut-brain axis. Nutrition
research reviews, 27 p 199-214
• Bode, L (2015) The functional biology of human milk oligosaccharides. Early Human Development, 91 p. 619-
622
• Bode, L (2012) Human milk oligosaccharides: Every baby needs a sugar mama. Glycobiology, 22(9) p 1147-1162
• Hassiotou, F., Geddes, D., Hartmann, P (2013) Cells in Human milk: State of the science. J Human Lactation,
29(2) 171-182
• Levy, M., Thaiss, C., Elinav, E. (2015) Metagenomic cross-talk: The regulatory interplay between
immunogenomics and the microbiome. Genome Medicine 7:120