Department of Obstetrics and Gynecology, College of Medicine, University of Florida (UF), Gainesville, FL, USA.
Morsani College of Medicine, University of South Florida (USF), Tampa, FL, USA.
Eur J Obstet Gynecol Reprod Biol. 2023 Jun;285:130-147. doi: 10.1016/j.ejogrb.2023.03.042. Epub 2023 Apr 1.
Studies have demonstrated the importance of the gut microbiota during pregnancy, and there is emerging literature on the postpartum maternal gut microbiota. The primary objective of this paper was to synthesize the literature on the postpartum gut microbiome composition and diversity measured in stool samples from healthy mothers of predominantly term infants. The secondary objectives were (1) to identify biological and environmental factors that influence postpartum maternal gut microbiota and (2) to assess health conditions and clinical intermediate measures associated with postpartum gut microbiota changes in all mothers. Electronic searches were conducted November 9, 2020 and updated July 25, 2021 without publication time limits on PubMed, Embase, CINHAL, Scopus, Cochrane Library, BioArchives, and OpenGrey.eu. Primary research on maternal gut microbiota in the postpartum (up to one year after childbirth) were eligible. Postpartum gut microbiota comparisons to pregnancy or non-pregnancy gut microbiota were of interest, therefore, studies examining these in addition to the postpartum were included. Studies were excluded if they were only conducted in animals, infants, pregnancy, or microbiome of other body locations (e.g., vaginal). Data extraction of microbial composition and diversity were completed and synthesized narratively. Studies were assessed for risk of bias. A total of 2512 articles were screened after deduplication and 27 were included in this review. Of the 27 included studies, 22 addressed the primary objective. Firmicutes was the predominant phylum in the early (<6 weeks) and late postpartum (6 weeks to 1 year). In early postpartum, Bacteroides was the predominant genus. Findings from longitudinal assessments of alpha and beta diversity from the early to the late postpartum varied. Nineteen of the 27 studies assessed biological and environmental factors influencing the postpartum gut microbial profile changes. Timing of delivery, probiotic supplementation, triclosan exposure, and certain diets influenced the postpartum gut microbiota. Regarding health conditions and intermediate clinical measures assessed in 8 studies; inflammatory bowel disease, postpartum depression, early-onset preeclampsia, gestational diabetes, excessive gestational weight gain, and anthropometric measures such as body mass index and waist-to-hip ratio were related to gut microbiota changes. There is limited data on the maternal postpartum gut microbiota and how it influences maternal health. We need to understand the postpartum maternal gut microbiome, establish how it differs from non-pregnancy and pregnancy states, and determine biological and environmental influencers. Future research of the gut microbiome's significance for the birthing parent in the postpartum could lead to a new understanding of how to improve maternal short and long-term health.
研究表明，肠道微生物群在妊娠期间非常重要，并且越来越多的文献研究了产后产妇的肠道微生物群。本文的主要目的是综合研究主要为足月婴儿的健康母亲的粪便样本中产后肠道微生物组组成和多样性。次要目标是：(1) 确定影响产后产妇肠道微生物群的生物学和环境因素；(2) 评估所有产妇的与产后肠道微生物群变化相关的健康状况和临床中间措施。于 2020 年 11 月 9 日进行电子检索，并于 2021 年 7 月 25 日更新，对 PubMed、Embase、CINHAL、Scopus、Cochrane 图书馆、BioArchives 和 OpenGrey.eu 没有发布时间限制。对产后(分娩后一年)产妇肠道微生物群的主要研究是合格的。对产后与妊娠或非妊娠肠道微生物群进行比较的研究也很感兴趣，因此，除了产后之外还包括了这些研究。如果研究仅在动物、婴儿、妊娠或其他身体部位(如阴道)进行，则将其排除在外。完成了微生物组成和多样性的数据提取和叙述性综合。对研究进行了偏倚风险评估。在去重后共筛选出 2512 篇文章，其中 27 篇被纳入本综述。在纳入的 27 项研究中，22 项研究解决了主要目标。厚壁菌门是早期(<6 周)和晚期(6 周至 1 年)产后的主要门。在早期产后，拟杆菌属是主要的属。从早期到晚期对α和β多样性进行的纵向评估的结果有所不同。27 项研究中的 19 项评估了影响产后肠道微生物群谱变化的生物学和环境因素。分娩时间、益生菌补充剂、三氯生暴露和某些饮食会影响产后肠道微生物群。在 8 项研究中评估了与健康状况和中间临床措施有关的情况；炎症性肠病、产后抑郁症、早发性子痫前期、妊娠糖尿病、过度妊娠体重增加以及身体质量指数和腰臀比等人体测量指标与肠道微生物群变化有关。关于产妇产后肠道微生物群及其如何影响产妇健康的资料有限。我们需要了解产妇产后肠道微生物组，确定它与非妊娠和妊娠状态的不同之处，并确定生物学和环境的影响因素。对肠道微生物组在后产期中对分娩父母重要性的进一步研究可能会使我们对如何改善产妇短期和长期健康有新的认识。
