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“Vaginal seeding” of infants born by caesarean section

BMJ 2016; 352 doi: (Published 23 February 2016) Cite this as: BMJ 2016;352:i227

Author's Reply

I am grateful to Clever Banda and Amali Lokugamage for their comments on the recent editorial "“Vaginal seeding” of infants born by caesarean section" (1). Both make reference a recent study published in Nature Medicine by Dominguez-Bello and colleagues which reports that vaginal seeding results in partial restoration of the microbiota of caesarian-born infants (2). I would like to assure them that we did not selectively ignore this evidence.

Our editorial article was written several months ago, was accepted for publication on 8th January 2016, and we approved the proofs on 19th January 2016. The article by Dominguez-Bello et al. was not published on-line until 1st February 2016. Banda suggests that we should consider this study as: "in principle providing scientific support for the practice of ‘vaginal seeding’." It certainly provides proof of concept that transfer of bacteria at birth can alter the developing microbiota. Indeed, it would be very surprising if this did not happen. However, it provides absolutely no evidence that this has any health benefit, as the authors themselves stress in the article. Furthermore, we cannot make any generalizations about safety of the procedure because only four caesarean-born infants received seeding, and they had all undergone screening for Group B streptococcus. Thus the findings of this study do not contradict any of the messages we aimed to convey in our editorial.

1. Cunnington A J, Sim K, Deierl A, Kroll JS, B Eimear, Darby J. “Vaginal seeding” of infants born by caesarean section BMJ 2016; 352 :i227
2. Dominguez-Bello MG, De Jesus-Laboy KM, Shen N, Cox LM, Amir A, Gonzalez A et al. Partial restoration of the microbiota of Caesarian-born infants via vaginal microbial transfer. Nat Med, 2016. doi: 10.1038/nm.4039.

Competing interests: No competing interests

28 February 2016
Aubrey J. Cunnington
Clinical Senior Lecturer in Paediatric Infectious Diseases
Imperial College
Medical School Building