Background: Intestinal microbiota composition is fundamental to human health and undergoes critical changes within the first two years of life. Factors probably influencing the microbiota are the maternal microbiota and the general environment in Switzerland. However, the development of the intestinal microbiota is incompletely understood. Gaining knowledge of the trajectory of microbiota maturation is likely key to the understanding of the pathogenesis of many pathologies in childhood.
Aims: The investigators aim for a deep understanding of the maturation of the healthy infant intestinal microbiota regarding composition, diversity and metabolic activities. The investigators aim for identifying parameters affecting microbiota maturation and effects of the microbiota on infant outcome.
Methods: The investigators will recruit 250 pregnant mothers who will be followed as mother-baby pairs until 10 years of age. Infants will be followed clinically to determine adequate growth and development as well as pathology including abdominal pain. Epidemiological parameter and infant nutrition will be assessed. The investigators will collect biological samples such as stool, maternal milk, vaginal swaps and skin swaps.
Species composition and diversity will be assessed by 16S sequencing. Metagenomic shotgun sequencing and bacterial messenger ribonucleic acid (mRNA) analysis will inform about metabolic potential and metabolic activity of the microbiota. Mass spectrometry will assess the small molecule content of stool and maternal milk samples. Network analysis will be used to assess the complex relationships between bacteria metabolic activities and small molecular content.
Expected results: The investigators expect an increase in complexity and metabolic potential and activity with age. Microbiota parameters will differ according to nutrition and might predict infant outcomes such as growth and abdominal pain. Systematic analysis of sequential maternal and infant bacteria samples from stool, skin and maternal milk will help characterizing bacterial transfer from mother to infant Conclusion: The investigators propose an observational study of healthy Bern mother baby pairs with clinical characterisation and biological sampling. Advanced analysis tools will be used to characterise the microbiota and address mechanistic questions.
Signed informed consent.
Ability to understand and follow study procedures and understand informed consent
From week 20 of pregnancy until birth
General good health, i.e. absence of major severe medical/ surgical/ psychiatric condition requiring ongoing management. Minor well controlled conditions (e.g. medically controlled arterial hypertension, occupational asthma, gestational diabetes mellitus) may be present.
None
At recruitment: Healthy pregnant women in the area of Bern. On Follow-up: baby-mother pairs in the area of Bern
Cohort
Prospective
Not listed
Maturation of a healthy infant intestinal microbiota regarding complexity of species composition and metabolic activities.
The investigators are aiming for a deep understanding of the maturation of a healthy infant intestinal microbiota considering composition, diversity and metabolic activities. The investigators will characterise the composition, metabolic potential and activity at various time points by advanced techniques (16S sequencing, metagenomics shotgun sequencing and mRNA sequencing) and the metabolites present by mass spectrometry (see "detailed description") . Using this information, the investigators will estimate networks of metabolic activity of the microbiota. Network analysis can be informed by information regarding small molecules present. The trajectories shared by the microbiota of most healthy infants will be considered normal.
Maturation of a healthy infant intestinal microbiota regarding complexity of species composition and metabolic activities.
The investigators are aiming for a deep understanding of the maturation of a healthy infant intestinal microbiota considering composition, diversity and metabolic activities. The investigators will characterise the composition, metabolic potential and activity at various time points by advanced techniques (16S sequencing, metagenomics shotgun sequencing and mRNA sequencing) and the metabolites present by mass spectrometry (see "detailed description") . Using this information, the investigators will estimate networks of metabolic activity of the microbiota. Network analysis can be informed by information regarding small molecules present. The trajectories shared by the microbiota of most healthy infants will be considered normal.
Maturation of a healthy infant intestinal microbiota regarding complexity of species composition and metabolic activities.
The investigators are aiming for a deep understanding of the maturation of a healthy infant intestinal microbiota considering composition, diversity and metabolic activities. The investigators will characterise the composition, metabolic potential and activity at various time points by advanced techniques (16S sequencing, metagenomics shotgun sequencing and mRNA sequencing) and the metabolites present by mass spectrometry (see "detailed description") . Using this information, the investigators will estimate networks of metabolic activity of the microbiota. Network analysis can be informed by information regarding small molecules present. The trajectories shared by the microbiota of most healthy infants will be considered normal.
Maturation of a healthy infant intestinal microbiota regarding complexity of species composition and metabolic activities.
The investigators are aiming for a deep understanding of the maturation of a healthy infant intestinal microbiota considering composition, diversity and metabolic activities. The investigators will characterise the composition, metabolic potential and activity at various time points by advanced techniques (16S sequencing, metagenomics shotgun sequencing and mRNA sequencing) and the metabolites present by mass spectrometry (see "detailed description") . Using this information, the investigators will estimate networks of metabolic activity of the microbiota. Network analysis can be informed by information regarding small molecules present. The trajectories shared by the microbiota of most healthy infants will be considered normal.
Impact of variations of the normal environment in Switzerland on microbiota development.
To understand the impact of variations of the normal environment in Switzerland on microbiota development. To this end we will use parameters for nutrition and socioeconomic status, microbiota characteristics, and metabolomics and correlate those with parameters for infant development and immunity.
Transfer of the maternal microbiota to the infant
To understand the transfer of the maternal microbiota to the infant. The investigators will identify bacterial species (or operational taxonomic units, OTU) in the maternal microbiota in maternal stool, maternal skin, vaginal environment, maternal placenta, as well as maternal milk at various points in time and correlate these parameters to identified species/ OTU in the intestinal and skin microbiota of the infant at various points in time (for methodology see "detailed description"). Biological samples will be collected at: * Maternal vaginal swab: Enrolment. * Placenta swab: Birth. * Maternal stool and skin swabs: Enrolment, 10 days, 6 months and 1 year after birth. * Maternal milk samples, if nursing: 0-3 days, 10 days, 6 weeks, 10 weeks, 14 weeks, 24 weeks, 36 weeks, 48 weeks, 96 weeks after birth. * Infant stool and skin probes: 0-3 days, 10 days, 6 weeks, 10 weeks, 14 weeks, 24 weeks, 36 weeks, 48 weeks, 96 weeks, 5 years and 10 years after birth.
Impact of the microbiota on child development and health.
To understand the impact of the microbiota on child development and health. The investigators will correlate infant microbiota characteristics from the primary endpoint with 1. Parameters for physical development (size, weight, percentiles, head circumference, mid upper arm circumference, waist to hip ratio) 2. Parameters for neurodevelopment and child behaviour 3. Onset/ occurrence of pathology (obesity, abdominal pain, new onset of allergies, asthma, eczema, number of infectious complications, physician consultations outside regular preventive medical checkups). Using questionnaires, the investigators will assess clinical parameters and parameters for child development but also acquire information regarding infectious complications, allergies and abdominal pain at enrolment and on the same follow-up dates as stated in the primary outcome section.
Impact of low resources with poor nutrition and poor hygiene in developing countries on the maturation of the intestinal microbiota
To understand the impact of low resources with poor nutrition and poor hygiene in developing countries on the maturation of the intestinal microbiota. Children from the University of Zimbabwe birth cohort were followed in a similar manner as planned for the children from the Bern infant microbiota study with the same acquisition of biological samples. The investigators will use microbiota characteristics from endpoint 1 to compare microbiota maturation in healthy Swiss infants to microbiota maturation in healthy Zimbabwean children as well as children with environmental enteropathy and stunted growth.
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Insel Gruppe AG, University Hospital Bern
Lead sponsor
University of Bern
Collaborator
