Carl Seashore, MD Professor of Pediatrics, UNC School of Medicine

Breastfeeding and the Microbiome “It’s complicated”

Disclosures

• I have no financial disclosures or conflicts to resolve

• I will not discuss off-label use of medications

• I am a general pediatrician, not a microbiome-ologist

Learning Objectives

• Describe the current understanding of the human microbiome and its relationship to health and disease

• Describe the role the breastfeeding plays in the development of the human microbiome

• Determine practices you can adopt do to support breastfeeding mother-baby dyads-and their microbiomes

Why breastfeeding 🤱?

• Improved maternal health outcomes

• Improved child health outcomes

• Immense cost savings

• It is the biological norm for our species

• And sometimes it just doesn’t work for some dyads, and that is OK too.

What is the microbiome, anyway?

Components of the Human Microbiome

• Bacterial colonization/symbiosis in:

– Gastrointestinal tract

– Skin and mucous membranes

– Respiratory tract and nasopharynx

– Genitourinary tract (particularly in females)

– Human Milk!

The microbiome and human health

• https://doi.org/10.1016/J.ENG.2017.01.008

• 100 Trillion organisms identified in the human body

• 150 times as much DNA as the human genome

• Complex interactions between environment, host, and the microbiome

The microbiome and human health

The microbiome and human health

– Mental health

– Infectious diseases

– Obesity

– CVD

– Diabetes

– Autoimmune diseases

– Inflammatory conditions

– Cancers

– Liver disease

– Allergy

Understanding the Human Microbiome

• It’s complicated

• Adult ≠ Child

• Dynamic in life

• Delivery route

• Feeding method

• Antibiotics

• Infections

Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life

Bäckhed, Fredrik et al. Cell Host & Microbe , Volume 17 , Issue 5 , 690 - 703

Impact of breastfeeding on the microbiome

• Respiratory disease in breast vs formula fed infants

– 101 each breast and formula fed infants

– Colonization at 6 weeks of age

– Significantly different colonization patterns

– BF infants had Dolosigranulum abundance

– Dolosigranulum abundance associated with less future wheezing and less severe respiratory infections

https://doi.org/10.1164/rccm.201401-0073OC

• Gastrointestinal disease and infections

• Necrotizing enterocolitis in premature infants

• Earlier recovery of microbiome following infection

• Lower susceptibility to GI pathogens

• Future development of inflammatory bowel disease

• Liver diseases such as cirrhosis, NAFLD

Impact of breastfeeding on the microbiome

• Enhanced recovery of the microbiome after infection

• Exclusively breastfed infants show faster recovery of their microbiome following infection, which may lend to less morbidity and even mortality after common childhood infections

• Unclear if this is due to composition of the microbiome prior to infection or ongoing breastfeeding

Impact of breastfeeding on the microbiome

• Microbiome of Human Milk

• 200 phylotypes have been identified

• Composition of microbes changes with gestational age of the infant and as they grow

• Rich in bifodobacteria and lactobaccilus spp.

• These aid in digestion of milk oligosaccharides

• Truly tailor made for each baby

Impact of breastfeeding on the microbiome

• Later life outcomes?

• Heart and Cardiovascular diseases

• Diabetes and Obesity

• Inflammatory Bowel Disease

• Mental Health conditions

Impact of breastfeeding on the microbiome

Ways you can support the breastfeeding dyad

• What is your work environment?

• What about traveling?

• Is your office breastfeeding friendly?

• How about your own experiences?

Ways you can support the breastfeeding dyad

• What more can be done to support breastfeeding in the work environment?

• Discussion

Ways you can support the breastfeeding dyad

Discussion and Questions

• How do you interact with pregnant or new mothers

• What do you do to support breastfeeding dyads

• Are there research questions that you can answer

• Who knew 💩 was so complicated?

References

• https://doi.org/10.1016/J.ENG.2017.01.008

• https://doi.org/10.3945/ajcn.112.037382

• https://doi.org/10.1164/rccm.201401-0073OC

• https://doi.org/10.1016/j.chom.2015.04.004

• https://www.sciencedirect.com/topics/medicine-and-dentistry/gut-microbiome

• https://doi.org/10.1016/j.jped.2017.05.013

• https://doi.org/10.1016/j.jpedp.2017.11.003

• https://www.ncbi.nlm.nih.gov/pubmed/29868719

• https://www.ncbi.nlm.nih.gov/pubmed/29519955

• https://www.ncbi.nlm.nih.gov/pubmed/29550235

• https://medlineplus.gov/breastfeeding.html\

Thank you!! Discussion and Questions

seashore@unc.edu