Gastrointestinal consequences of cesarean section birth: A systematic review of short- and long-term effects in infancy and beyond

Table 10 Interventions to restore gut microbiota in cesarean section-born infants

Ref.	Intervention	Microbiota composition	Microbial diversity	Duration of effect	Modifiable factors	Population	Risk of bias
Song et al[50], 2021	Vaginal seeding (swab)	Aligned with vaginally born	Improved	Up to 12 months	Maternal microbiota	United States, Hispanic/Latino	Moderate (small cohort, no randomization)
Wilson et al[36], 2021	Oral vaginal seeding	No significant effect	No change	Up to 3 months	Administration method	New Zealand	High (pilot nature, small sample, no control)
Mueller et al[38], 2023	Vaginal seeding (RCT)	↑ Maternal strains	↓ Alpha-diversity	1 month	Delivery timing	United States	Low (RCT, good design)
Lagkouvardos et al[37], 2023	Synbiotic formula (L. fermentum + GOS)	↑ Bifidobacterium, ↓ Blautia	↑ at 4 months	Up to 24 months	Baseline microbiota	European	Low (long follow-up, intervention control)
Chua et al[39], 2017	Synbiotic (scGOS/LcFOS + B. breve)	↑ Bifidobacteria, ↓ Enterobacteriaceae	Improved by week 8	12 weeks post	Feeding method	Multinational (Asia)	Low (RCT, multinational)
Wang et al[40], 2025	Synbiotic (B. breve + scGOS/LcFOS)	↑ Parabacteroides, Bacteroides	↑ Diversity	Up to 12 months	Feeding, birth mode	China	Low (RCT design, stratified by C-section)
Garcia Rodenas et al[41], 2016	L. reuteri-enriched formula	Modulated toward VD profile	↑ Diversity	4 months	Strain selection	Greece	Moderate (no blinding stated)
Yang et al[42], 2021	Probiotics (varied dose)	↑ Bifidobacterium, Lactobacillus	↑ To VD levels	28 days	Dosage	China	Moderate (dose variability, controlled)
Gong et al[43], 2023	Probiotics (B. longum, L. acidophilus)	↑ Faecalibacterium, ↓ Klebsiella	Improved	42 days	Antibiotic exposure	China	Moderate (strain-specific findings)
Hurkala et al[44], 2020	Probiotics (B. breve, L. rhamnosus)	↑ LAB, ↓ pathogens	Significant	30 days	Early start post-C-section	Poland	Moderate (observational, small sample)
Akagawa et al[45], 2019	Breastfeeding vs formula	Restoration by 1 month	Equalized	1 month	Feeding type	Japan	Moderate (observational, controlled)
Wu et al[46], 2023	Breastfeeding in C-section infants	↑ SCFA metabolism stability	Enhanced	3 months	Feeding type	China	Low (well-controlled feeding study)
Korpela et al[47], 2018	Probiotic mixture (4 strains)	Corrected dysbiosis in C-section infants	Improved	3 months	Breastfeeding	Finland	Low (strong probiotic trial, adjusted)
Bellomo et al[48], 2024	B. bifidum only	↑ Bacteroides, ↓ Shigella, ↑ α-diversity	Sustained ↑	12 months	Feeding mode	Italy	Low (well-controlled, single strain tested)
Yang et al[49], 2025	Bovine colostrum vs fortifier	Minor changes	No significant change	1 month	Fortifier type	Denmark	Moderate (neutral result, no microbiome endpoint)
Dominguez-Bello et al[51], 2016	Vaginal swabbing	Partial restoration (Bacteroides)	Mild increase	30 days	Swabbing technique	United States, multiethnic	High (pilot nature, small number)

Clinical Pearls 4: Cesarean section delivery is strongly associated with early gut dysbiosis, characterized by reduced microbial diversity and delayed colonization by beneficial bacteria, such as Bifidobacteria and Bacteroides. This imbalance can persist for up to 12 months and may predispose infants to gastrointestinal and immune-related conditions. Breastfeeding, probiotic/synbiotic supplementation, and limiting perinatal antibiotic exposure are key strategies to support microbiota recovery in cesarean section-born infants. C-section: Cesarean section; LAB: Lactic acid bacteria; L. fermentum: Limosilactobacillus fermentum; SCFA: Short-chain fatty acids; VD: Vaginal delivery; RCT: Randomised controlled trial.