Yuan Jing, Wang Yabing, Liu Lijuan
Anesthesiology and Surgical Department, Zhongshan Campus of the Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, 050000, People's Republic of China.
Obstetrics Department, Shijiazhuang Fourth Hospital, Shijiazhuang, Hebei, 050000, People's Republic of China.
Int J Womens Health. 2025 Jun 12;17:1763-1770. doi: 10.2147/IJWH.S526040. eCollection 2025.
The gut microbiota and metabolic profiles of pregnant women undergo dynamic changes throughout gestation, potentially influencing the mode of delivery. Emerging evidence suggests that dysbiosis of gut microbiota and metabolic perturbations may contribute to the rising cesarean section (CS) rates. This study aimed to investigate gestation-specific alterations in gut microbiota and serum metabolomes and evaluate their association with CS risk.
We conducted a retrospective analysis of 80 healthy pregnant women with singleton pregnancies who delivered at our hospital between January 2022 and December 2023. Participants were stratified into CS (n=40) and vaginal delivery (VD, n=40) groups based on delivery mode, matched for maternal age, pre-pregnancy BMI, and gestational age. Fecal samples were collected one month prior to delivery for gut microbiota analysis using 16S rRNA gene sequencing. Serum samples were subjected to targeted metabolomics via UHPLC-QTOF-MS, focusing on markers of energy metabolism. Peripheral blood was analyzed for T cell subsets and regulatory T cells (Tregs) by flow cytometry. Spearman correlation analysis was performed to assess associations between gut microbial taxa and serum metabolites.
The CS group exhibited significantly lower gut microbial α-diversity (Shannon index: 3.22 vs 4.10, P<0.001), reduced Bacteroidetes (15.3% vs 20.1%, P=0.021), and increased Firmicutes (50.2% vs 46.4%, P=0.015), resulting in an elevated Firmicutes/Bacteroidetes ratio (P=0.008). Metabolomic analysis showed higher levels of pyruvic acid and lactate and lower levels of phenylalanine in the CS group (all P<0.05). Immune analysis revealed increased CD4⁺ T cells, CD8⁺ T cells, and Tregs in the CS group (P=0.042, 0.029, 0.015, respectively). Correlation analysis indicated that Bacteroidetes abundance positively correlated with lactate (r=0.45, P<0.001), Firmicutes with phenylalanine (r=0.37, P=0.012), and Lactobacillus negatively with pyruvic acid (r=-0.28, P=0.045).
Gestational gut microbiota dysbiosis and metabolic dysregulation are significantly associated with increased CS risk. These findings highlight potential biomarkers for early risk stratification and suggest that personalized microbiota-directed interventions during pregnancy might help optimize delivery outcomes. Further mechanistic studies are warranted to validate causality.
孕妇的肠道微生物群和代谢谱在整个孕期会发生动态变化，这可能会影响分娩方式。新出现的证据表明，肠道微生物群失调和代谢紊乱可能导致剖宫产（CS）率上升。本研究旨在调查肠道微生物群和血清代谢组在孕期的特异性变化，并评估它们与剖宫产风险的关联。
我们对2022年1月至2023年12月在我院分娩的80名单胎健康孕妇进行了回顾性分析。根据分娩方式将参与者分为剖宫产组（n = 40）和阴道分娩组（VD，n = 40），并根据产妇年龄、孕前BMI和孕周进行匹配。在分娩前一个月采集粪便样本，使用16S rRNA基因测序进行肠道微生物群分析。血清样本通过超高效液相色谱-四极杆飞行时间质谱（UHPLC-QTOF-MS）进行靶向代谢组学分析，重点关注能量代谢标志物。通过流式细胞术分析外周血中的T细胞亚群和调节性T细胞（Tregs）。进行Spearman相关性分析以评估肠道微生物分类群与血清代谢物之间的关联。
剖宫产组的肠道微生物α多样性显著降低（香农指数：3.22对4.10，P < 0.001），拟杆菌门减少（15.3%对20.1%，P = 0.021），厚壁菌门增加（50.2%对46.4%，P = 0.015），导致厚壁菌门/拟杆菌门比值升高（P = 0.008）。代谢组学分析显示，剖宫产组的丙酮酸和乳酸水平较高，苯丙氨酸水平较低（均P < 0.
