CESAREAN DELIVERY AND THE DEVELOPMENT OF THE INFANT GUT MICROBIOTA: EARLY-LIFE ALTERATIONS, HEALTH CONSEQUENCES, AND POTENTIAL STRATEGIES FOR MICROBIOTA MODULATION

Kamila Zmysłowska; Klaudia Aleksandra Stadnik; Anna Szatkowska; Malwina Kwaśniewska; Adam Hajdaniak; Jan Mateusz Kiersztyn; Aleksandra Grabowska; Natalia Seńcio

doi:10.31435/ijitss.3(51).2026.6652

Authors

Kamila Zmysłowska Nicolaus Copernicus Voivodeship Hospital in Koszalin, Tytusa Chałubińskiego 7, 75-581 Koszalin, Poland https://orcid.org/0009-0002-2413-0806
Klaudia Aleksandra Stadnik Regional Hospital in Szczecinek, Tadeusza Kościuszki 38, 78-400 Szczecinek, Poland https://orcid.org/0009-0006-2601-3813
Anna Szatkowska Jan Mikulicz-Radecki University Hospital in Wrocław, Borowska 213, 50-556 Wrocław, Poland https://orcid.org/0009-0003-9970-3354
Malwina Kwaśniewska Nicolaus Copernicus Voivodeship Hospital in Koszalin, Tytusa Chałubińskiego 7, 75-581 Koszalin, Poland https://orcid.org/0009-0006-0775-8174
Adam Hajdaniak Jan Mikulicz-Radecki University Hospital in Wrocław, Borowska 213, 50-556 Wrocław, Poland https://orcid.org/0009-0005-1401-3122
Jan Mateusz Kiersztyn Dr Jurasz University Hospital No.1 in Bydgoszcz, Marii Skłodowskiej Curie 9, 85-094, Bydgoszcz, Poland https://orcid.org/0009-0004-4714-0868
Aleksandra Grabowska Regional Hospital in Kołobrzeg, Edmunda Łopuskiego 31-33, 78-100 Kołobrzeg, Poland https://orcid.org/0009-0003-6112-1260
Natalia Seńcio Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701 Poznań, Poland https://orcid.org/0009-0009-4358-7511

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6652

Keywords:

Cesarean Delivery, Infant Gut Microbiota, Neonatal Microbiome, Bifidobacterium, Bacteroides, Probiotics, Vaginal Seeding, Maternal Microbial Transfer

Abstract

The establishment of the intestinal microbiota during early life is a dynamic developmental process that contributes to maturation of the gastrointestinal tract, immune system, metabolic pathways, and intestinal barrier. Mode of delivery is among the earliest factors associated with differences in microbial colonization. Infants born by cesarean delivery commonly demonstrate delayed acquisition of selected maternal-associated microorganisms, particularly Bacteroides and Bifidobacterium, as well as altered microbial succession during the first weeks and months of life. At the same time, cesarean-associated microbiota alterations cannot be attributed exclusively to the absence of exposure to the maternal vaginal microbiota. Perinatal antibiotic exposure, breastfeeding, gestational age, indication for cesarean delivery, duration of labor, maternal health, and environmental factors interact with delivery mode and may substantially influence microbial development.

This structured narrative review summarizes current evidence concerning the development of the infant gut microbiota following cesarean delivery, potential health consequences of altered early-life microbial trajectories, and available strategies for microbiota modulation. Particular attention is given to probiotics, prebiotics, synbiotics, breastfeeding, vaginal seeding, and maternal microbial transfer. Current evidence indicates that microbiota differences associated with cesarean delivery are most pronounced during early infancy and may partially diminish with maturation. Epidemiological associations between cesarean delivery and allergic, respiratory, gastrointestinal, and metabolic outcomes are biologically plausible but do not establish a microbiome-mediated causal pathway. Nutritional interventions can modify microbial composition, especially by increasing Bifidobacterium, but evidence for long-term clinical benefits remains limited. Vaginal seeding and other forms of maternal microbial transfer demonstrate potential for modifying microbial profiles but remain experimental because efficacy, safety, and long-term clinical relevance have not been adequately established. Future research should use longitudinal, standardized, multi-omics and clinically oriented approaches to determine whether targeted modulation of the infant microbiome can improve health outcomes following cesarean birth.

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