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1. Birth mode, breastfeeding and childhood infectious morbidity in the Yucatec Maya

   https://doi.org/10.1002/ajhb.23218  

   Veile, Amanda ; Faria, Amy A. ; Rivera, Sydney ; Tuller, Sydney M. ; Kramer, Karen L. ( January 2019 , American Journal of Human Biology)

   Cesarean delivery is linked to breastfeeding complications and child morbidity. These outcomes may disproportionately affect Latin American indigenous populations that are experiencing rising cesarean delivery rates, but often inhabit environments that exacerbate postnatal morbidity risks. We therefore assess relationships between birth mode, infant feeding practices, and childhood infectious morbidity in a modernizing Yucatec Maya community, where prolonged breastfeeding is the norm. We predicted that under these conditions, cesarean delivery would increase risk of childhood infectious morbidity, but prolonged breastfeeding postcesarean would mitigate morbidity risk.

   Using a longitudinal child health dataset (n = 88 children aged 0‐60 months, 24% cesarean‐delivered, 2290 observations total), we compare gastrointestinal infectious (GI) and respiratory infectious (RI) morbidity rates by birth mode. We model associations between cesarean delivery and breastfeeding duration, formula feeding and child nutritional status, then model GI and RI as a function of birth mode, child age, and feeding practices.

   Cesarean delivery was associated with longer breastfeeding durations and higher child weight‐for‐age, but not with formula feeding, GI, or RI. Adolescent motherhood and RI were risk factors for GI; formula feeding and GI were risk factors for RI. Regional housing materials protected against GI; breastfeeding protected against RI and mitigated the effect of formula feeding.

   We find no direct link between birth mode and child infectious morbidity. Yucatec Maya mothers practice prolonged breastfeeding, especially postcesarean, and in conjunction with formula feeding. This practice protects against childhood RI, but not GI, perhaps because GI is more susceptible to maternal and household factors.

    

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2. Early life growth and adult telomere length in a Filipino cohort study

   https://doi.org/10.1002/ajhb.23299  

   Masterson, Erin E. ; Hayes, M. Geoffrey ; Kuzawa, Christopher W. ; Lee, Nanette R. ; Eisenberg, Dan T. A. ( August 2019 , American Journal of Human Biology)

   We investigated the relationship between early life growth patterns and blood telomere length (TL) in adulthood using conditional measures of lean and fat mass growth to evaluate potentially sensitive periods of early life growth.

   This study included data from 1562 individuals (53% male; age 20‐22 years) participating in the Cebu Longitudinal Health and Nutrition Survey, located in metropolitan Cebu, Philippines. Primary exposures included length‐for‐agez‐score (HAZ) and weight‐for‐agez‐score (WAZ) at birth and conditional measures of linear growth and weight gain during four postnatal periods: 0‐6, 6‐12, and 12‐24 months, and 24 months to 8.5 years. TL was measured at ~21 years of age. We estimated associations using linear regression.

   The study sample had an average gestational age (38.5 ± 2 weeks) and birth size (HAZ = –0.2 ± 1.1, WAZ = –0.7 ± 1.0), but by age 8.5 years had stunted linear growth (HAZ = –2.1 ± 0.9) and borderline low weight (WAZ = –1.9 ± 1.0) relative to World Health Organization references. Heavier birth weight was associated with longer TL in early adulthood (P= .03), but this association was attenuated when maternal age at birth was included in the model (P= .07). Accelerated linear growth between 6 and 12 months was associated with longer TL in adulthood (P= .006), whereas weight gain between 12 and 24 months was associated with shorter TL in adulthood (P= .047).

   In Cebu, individuals who were born heavier have longer TL in early adulthood, but that birthweight itself may not explain the association. Findings suggest that childhood growth is associated with the cellular senescence process in adulthood, implying early life well‐being may be linked to adult health.

    

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3. Metagenomic analysis examines oral microbiome changes and interplay with immune response following prenatal total oral rehabilitation

   https://doi.org/10.1186/s12967-023-03997-9  

   Wu, Tong Tong ; Sohn, Michael ; Manning, Samantha ; Beblavy, Robert ; Gill, Steven ; Quataert, Sally ; Vasani, Shruti ; Jang, Hoonji ; Zeng, Yan ; Bruno, Jennifer ; et al ( December 2023 , Journal of Translational Medicine)

   Suboptimal maternal oral health during pregnancy is potentially associated with adverse birth outcomes and increased dental caries risks in children. This study aimed to assess the oral microbiome and immune response following an innovative clinical regimen, Prenatal Total Oral Rehabilitation (PTOR), that fully restores women’s oral health to a “disease-free status” before delivery.

   This prospective cohort study assessed 15 pregnant women at baseline and 3 follow-up visits (1 week, 2 weeks, and 2 months) after receiving PTOR. The salivary and supragingival plaque microbiomes were analyzed using metagenomic sequencing. Multiplexed Luminex cytokine assays were performed to examine immune response following PTOR. The association between salivary immune markers and oral microbiome was further examined.

   PTOR was associated with a reduction of periodontal pathogens in plaque, for instance, a lower relative abundance ofTannerella forsythiaandTreponema denticolaat 2 weeks compared to the baseline (p < 0.05). The alpha diversity of plaque microbial community was significantly reduced at the 1-week follow-up (p < 0.05). Furthermore, we observed significant changes in theActinomyces defective-associated carbohydrate degradation pathway andStreptococcus Gordonii-associated fatty acid biosynthesis pathway. Two immune markers related to adverse birth outcomes significantly differed between baseline and follow-up. ITAC, negatively correlated with preeclampsia severity, significantly increased at 1-week follow-up; MCP-1, positively correlated with gestational age, was elevated at 1-week follow-up. Association modeling between immune markers and microbiome further revealed specific oral microorganisms that are potentially correlated with the host immune response.

   PTOR is associated with alteration of the oral microbiome and immune response among a cohort of underserved US pregnant women. Future randomized clinical trials are warranted to comprehensively assess the impact of PTOR on maternal oral flora, birth outcomes, and their offspring’s oral health.

    

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4. Childhood body mass is positively associated with cesarean birth in Y ucatec M aya subsistence farmers

   https://doi.org/10.1002/ajhb.22920  

   Veile, Amanda ; Kramer, Karen L. ( October 2016 , American Journal of Human Biology)

   The epidemiologic link between cesarean birth and childhood obesity is unresolved, partly because most studies come from industrialized settings where many post‐birth factors affect the risk for obesity. We take advantage of an unusual ethnographic situation where hospital and cesarean birth modes have recently been introduced among Yucatec Maya subsistence farmers, but young children have had minimal exposure to the nutritional transition. While we expect to find very low rates of childhood obesity, we predict that cesarean‐born children will be larger and heavier than vaginally born children.

   Weight and height were collected monthly on 108 children aged 0–5 (3576 observations total). Birth mode and birthweight were collected by maternal interview. Data were analyzed using linear mixed models that compare child growth [Maya population‐specificZ‐scores for weight‐for‐age and body mass index‐for‐age (WAZ and BMIZ)] in cesarean and vaginally born children aged 0–5 years.

   The cesarean rate was 20%, no children were obese, and 5% were overweight. Cesarean birth was a significant predictor of child WAZ and BMIZ after accounting for maternal effects, child birthweight, and sex. Children who were born by cesarean to mothers with high BMI had the highest WAZ of all children by 5 years of age, and the highest BMIZ of all children at all ages.

   Cesarean‐born Maya children had higher BMI than vaginally born children, even in the absence of many known confounding factors that contribute to childhood obesity. Child growth was most sensitive to birth mode when mothers had high BMI.

    

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5. Pathways linking caesarean delivery to early health in a dual burden context: Immune development and the gut microbiome in infants and children from Galápagos, Ecuador

   https://doi.org/10.1002/ajhb.23219  

   Thompson, Amanda L. ; Houck, Kelly M. ; Jahnke, Johanna R. ( January 2019 , American Journal of Human Biology)

   Global increases in caesarean deliveries are exposing more infants to perinatal environments that are evolutionarily novel and potentially increasing their risks for inflammatory conditions. Yet, the pathways linking caesareans to later health outcomes are not well understood, particularly in dual burden contexts. We test two of the hypothesized pathways, altered immune function and gut microbiota, which may link delivery mode to later health outcomes and test whether these associations persist when controlling for postnatal nutritional and pathogenic exposures.

   Data come from infants, aged 0 to 2 (n = 41), and young children, aged 2 to 11 (n = 135), from the Galápagos, Ecuador. Differences in morbidity, C‐reactive protein (CRP), and gut microbiota by delivery type were tested using linear and logistic regression models adjusted for nutritional and pathogenic exposures and infant age.

   Over half of infants and over 40% of children were delivered by caesarean. Morbidity and CRP did not differ between infants or children born by caesarean or vaginally. Microbial taxa abundance differed by delivery mode. Infants born by caesarean had a higher abundance of Firmicutes and a lower relative abundance of Bacteroidales. Children born by caesarean had a higher abundance of Proteobacteria and Enterobacteriales. These differences remained after adjustment for environmental exposure.

   Caesarean delivery is associated with differences in gut microbiota across childhood even in this dual burden context. Our results highlight the importance of examining caesarean delivery across diverse contexts to better understand the impact of perinatal interventions on short‐ and longer‐term health outcomes.

    

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