“Vaginal seeding,” or the process of transferring vaginal flora to the newborn infant’s mouth, nose, or skin, is not recommended or encouraged, according to the American College of Obstetricians and Gynecologists (ACOG).
Citing lack of adequate data about safety and benefits of the process, vaginal seeding should not be performed outside of an institutional board-approved research protocol setting, stated the ACOG Committee on Obstetric Practice.
But if a patient insists on doing the procedure herself, ob/gyns should discuss what types of pathogenic organisms have the potential to transfer to the infant, the committee wrote in Obstetrics and Gynecology.
Vaginal seeding was studied as a potential way to change the microbiome of infants born via cesarean section, but the practice remains controversial. The committee members noted that there is an increased interest in the topic due to the increase in asthma, atopic disease, and immune disorders that mirrored the increase in the rate of C-section delivery, even though there is no evidence to prove causation.
A prior practice advisory in November 2016 addressed the issue, once again citing the lack of research on the procedure. But because it was becoming “increasingly common” for patients undergoing C-section delivery to discuss this procedure with their ob/gyn, the committee opinion was “prepared in response to the public interest.”
The committee cited research that there may be an association between mode of delivery and gut microbiota during the first year of life, “diversity and colonization pattern were significantly associated with mode of delivery from birth to 3 months … [but] the difference disappeared after 6 months.”
Moreover, there is only one pilot study where four infants born via C-section delivery underwent vaginal seeding, with “no long-term follow up.” Notably, this study was conducted among women who were not carriers of group B streptococci and had no signs of vaginosis. Because of this, researchers characterized the risk of vaginal seeding in the general population as “unknown,” partly due to the fact that 20% of pregnant women are carriers of group B streptococci. They also cited one clinical trial currently underway, but added that it is designed to examine neonatal microbiota, not “clinical outcomes” of the procedure.
The committee said that if a woman is to perform the procedure herself, she should first undergo risk stratification in the form of serum testing for group B streptococci, and other infectious diseases such as herpes simplex virus, Chlamydia trachomatis, and Neisseria gonorrhea. The committee also recommended that the pediatrician or family physician caring for the infant should be informed that the procedure was done.
ACOG also continues to recommend exclusive breastfeeding for the first 6 months of life, citing its “multiple known benefits” to infants, for women who are physically and medically able to breastfeed. But due to the “paucity of data” on vaginal seeding, more research is needed, according to the committee.