The impact of cesarean section delivery on intestinal microbiota: mechanisms, consequences, and perspectives: a narrative review

Abstract

Cesarean section (CS) delivery has become an increasingly prevalent mode of childbirth worldwide. While it is a critical intervention in specific medical scenarios, its impact on neonatal gut microbiota (GM) has raised concerns. Infants born via CS bypass exposure to maternal vaginal and intestinal microbes, resulting in a distinct and often less diverse microbial composition compared to vaginally delivered infants. This disruption, exacerbated by prophylactic antibiotic use, has been linked to long-term health consequences, including an increased risk of immune-mediated disorders such as allergies and asthma, as well as metabolic conditions like obesity and type 2 diabetes. Breastfeeding, probiotics, and synbiotics have emerged as key interventions to mitigate microbial dysbiosis in CS-born infants. Breastfeeding supports GM by delivering human milk oligosaccharides (HMOs) that promote beneficial bacteria, while probiotics and synbiotics restore microbial balance and diversity. Alternative strategies, such as vaginal seeding and targeted dietary modifications, have shown potential but require further research to confirm their efficacy and safety. This narrative review underscores the complex interplay between CS delivery, microbiota, and health, highlighting the need for evidence-based interventions. By addressing microbial disruptions early, healthcare professionals can improve short- and long-term outcomes for CS-born infants, paving the way for healthier generations.