Feles Elisabeth Al, Neidhöfer Claudio, Wessels Christina, Gruber Rosalie, Mattner Frauke
Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58455 Witten, Germany.
Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany.
J Clin Med. 2025 Jul 18;14(14):5104. doi: 10.3390/jcm14145104.
Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain underexplored. This systematic review synthesizes current evidence on how antibiotic prophylaxis during CS affects maternal gut microbiome composition and diversity-an underrepresented, but clinically relevant aspect of maternal-fetal medicine. A systematic literature search was conducted in Medline (PubMed), the Cochrane Library, and the WHO International Clinical Trials Registry Platform (ICTRP) through November 2024. Inclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies used molecular techniques to report maternal gut microbiome outcomes (alpha- and beta-diversity). The search concentrated on beta-lactam antibiotics. Reference lists were screened, but no additional grey literature was searched. Synthesis followed the Synthesis Without meta-analysis (SWiM) approach. No review protocol was registered. The review received no external funding. Out of 1011 records, three studies (total 286 mothers) met the inclusion criteria. All reported maternal microbiome outcomes secondarily to infant-focused research. Only one study provided pre- and post-birth stool samples. Applied antibiotic regimens, sequencing methods, and reported microbiome metrics for alpha- and beta-diversity varied considerably, thus limiting comparability of results. Due to high heterogeneity, no formal risk of bias was assessed. While taxonomic diversity changes were inconsistent, significant shifts in functional diversity metrics were observed postpartum. Evidence on maternal microbiome disruption following perioperative antibiotic prophylaxis in CS is methodologically fragmented and limited by small sample sizes and inconsistent antibiotic protocols. Nonetheless, functional diversity appears sensitive to antibiotic exposure. To improve clinical understanding and safety, maternal-focused studies using standardized protocols are urgently needed. The maternal microbiome may play a key role in both recovery and shaping the newborn's early microbial environment.
剖宫产（CS）占全球分娩总数的20%以上，通常需要围手术期抗生素预防（PAP）以减少手术部位感染。虽然这种预防措施对新生儿微生物群发育的影响已有充分描述，但对母体肠道微生物群的影响仍未得到充分研究。本系统评价综合了当前关于剖宫产期间抗生素预防如何影响母体肠道微生物群组成和多样性的证据——这是母胎医学中一个研究较少但具有临床相关性的方面。通过2024年11月，在医学文献数据库（PubMed）、考克兰图书馆和世界卫生组织国际临床试验注册平台（ICTRP）上进行了系统的文献检索。纳入标准根据系统评价和Meta分析的首选报告项目（PRISMA）指南确定。符合条件的研究使用分子技术报告母体肠道微生物群结果（α和β多样性）。检索集中在β-内酰胺类抗生素。对参考文献列表进行了筛选，但未检索其他灰色文献。综合采用了无Meta分析的综合方法（SWiM）。未注册综述方案。该综述未获得外部资金。在1011条记录中，三项研究（共286名母亲）符合纳入标准。所有研究都是在以婴儿为重点的研究中次要报告母体微生物群结果。只有一项研究提供了产前和产后的粪便样本。应用的抗生素方案、测序方法以及报告的α和β多样性微生物群指标差异很大，因此限制了结果的可比性。由于高度异质性，未评估正式的偏倚风险。虽然分类多样性变化不一致，但产后观察到功能多样性指标有显著变化。剖宫产围手术期抗生素预防后母体微生物群破坏的证据在方法上零散，且受样本量小和抗生素方案不一致的限制。尽管如此，功能多样性似乎对抗生素暴露敏感。为了提高临床认识和安全性，迫切需要使用标准化方案进行以母体为重点的研究。母体微生物群可能在恢复和塑造新生儿早期微生物环境方面都发挥关键作用。
