Can Vaginal Seeding at Birth Improve Health Outcomes of Cesarean Section-Delivered Infants? A Scoping Review

Although Cesarean section (C-section) delivery is often a necessary medical intervention, it also increases the risk of the infant developing chronic inflammatory, metabolic, and neurodevelopmental disorders. The association of C-section with the development of these conditions is thought to be partially mediated by the effects of the C-section on the infant's microbiome development and subsequent immune regulation. C-section-delivered infants acquire a different set of microbes compared with infants who are vaginally delivered. "Vaginal seeding" exposes C-section-delivered infants to the maternal vaginal microbiome directly after birth, partly replicating the microbial exposures they would have received during a vaginal delivery. Studies have shown that vaginal seeding at birth partially restores the infant microbiome towards that of a vaginally delivered infant. More recently, preliminary studies have shown a potential benefit of vaginal seeding on health outcomes. Here, we examine the evidence from observational studies and randomized controlled trials that have evaluated microbiome restoration after C-section, and we discuss new research assessing the potential impact of vaginal seeding on immune, metabolic, and neurodevelopmental outcomes and the underlying mechanisms. Collectively, we review the potential health benefits, safety risks, regulatory implications, and future directions for the use of vaginal seeding in infants delivered by C-section.