The Impact of Mode of Delivery on the Development of Gut Microbiota and the Risk of Atopic Diseases in Children: A Literature Review
DOI:
https://doi.org/10.12775/QS.2026.54.70823Keywords
atopic diseases, gut microbiota, dysbiosis, cesarean section, vaginal delivery, breastfeeding, allergy, gut–immune axisAbstract
Introduction: In recent years, the prevalence of atopic diseases among children has increased. Increasing evidence suggests that early gut microbiota development, shaped in part by the mode of delivery, feeding practices, and perinatal antibiotic exposure, may play an important role in the pathogenesis of these conditions.
Aim: This study aimed to investigate the association between mode of delivery, early-life gut dysbiosis, and the risk of developing atopic diseases in children, including atopic dermatitis, allergic asthma, allergic rhinitis, and food allergies.
Methods: A review of observational studies, cohort studies, meta-analyses, and review articles published between 2005 and 2025 was conducted using the PubMed and Google Scholar databases.
Results: Vaginal delivery promotes favourable colonization of the neonatal gut, whereas caesarean section is associated with delayed maturation of the gut microbiota and a predominance of bacteria typically found on the skin and in the hospital environment. In numerous studies, caesarean section has been associated with an increased risk of asthma, allergic rhinitis, atopic dermatitis, and food allergy. Breastfeeding demonstrated a protective effect, while perinatal antibiotic exposure may further disrupt microbiota homeostasis. Probiotics and synbiotics are being considered as potential tools for microbiota modulation; however, their efficacy has not been conclusively confirmed.
Conclusions: Caesarean section should be considered a potential risk factor rather than a direct cause of atopy. Supporting the proper development of the gut microbiota may be an important component of the early prevention of atopic diseases in children.
References
1. H. Ke, H. Yao, and P. Wei, “Advances in research on gut microbiota and allergic diseases in children,” Jan. 01, 2025, Elsevier Ltd. doi: 10.1016/j.crmicr.2025.100362.
2. S. Tanaka and K. Furuta, “Roles of ige and histamine in mast cell maturation,” Aug. 01, 2021, MDPI. doi: 10.3390/cells10082170.
3. I. Mrkić Kobal, D. Plavec, Ž. Vlašić Lončarić, I. Jerković, and M. Turkalj, “Atopic March or Atopic Multimorbidity—Overview of Current Research,” Jan. 01, 2024, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/medicina60010021.
4. A. C. Pantazi et al., “Development of Gut Microbiota in the First 1000 Days after Birth and Potential Interventions,” Aug. 01, 2023, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/nu15163647.
5. C. Lai et al., “Effect of different delivery modes on intestinal microbiota and immune function of neonates,” Sci. Rep., vol. 14, no. 1, Dec. 2024, doi: 10.1038/s41598-024-68599-x.
6. Z. Jiang et al., “The Microecological-Immune Axis in Pediatric Allergic Diseases: Imbalance Mechanisms and Regulatory Interventions,” Sep. 01, 2025, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/nu17182925.
7. J. Wang et al., “Pathogenesis of allergic diseases and implications for therapeutic interventions,” Dec. 01, 2023, Springer Nature. doi: 10.1038/s41392-023-01344-4.
8. J. Vitte, S. Vibhushan, M. Bratti, J. E. Montero-Hernandez, and U. Blank, “Allergy, Anaphylaxis, and Nonallergic Hypersensitivity: IgE, Mast Cells, and beyond,” Jan. 11, 2022, S. Karger AG. doi: 10.1159/000527481.
9. R. S. Q. Geng and R. G. Sibbald, “Atopic Dermatitis: Clinical Aspects and Treatments,” Adv. Skin Wound Care, vol. 37, no. 7, pp. 346–352, Jul. 2024, doi: 10.1097/ASW.0000000000000161.
10. A. C. Pantazi et al., “Gut microbiota profile and atopic dermatitis in the first year of life,” J. Med. Life, vol. 17, no. 10, pp. 948–952, Oct. 2024, doi: 10.25122/jml-2024-0287.
11. J. Martin, J. Townshend, and M. Brodlie, “Diagnosis and management of asthma in children,” Jan. 06, 2022, BMJ Publishing Group. doi: 10.1136/bmjpo-2021-001277.
12. F. Frati et al., “The role of the microbiome in asthma: The gut–lung axis,” Jan. 01, 2019, MDPI AG. doi: 10.3390/ijms20010123.
13. B. Sampaio Dotto Fiuza et al., “Gut microbiome signature and nasal lavage inflammatory markers in young people with asthma,” Journal of Allergy and Clinical Immunology: Global, vol. 3, no. 2, May 2024, doi: 10.1016/j.jacig.2024.100242.
14. K. Nakagome and M. Nagata, “The Possible Roles of IL-4/IL-13 in the Development of Eosinophil-Predominant Severe Asthma,” May 01, 2024, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/biom14050546.
15. G. Ciprandi and M. A. Tosca, “Probiotics in Children with Asthma,” Jul. 01, 2022, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/children9070978.
16. C.-S. Hsieh et al., “Altered IgA Response to Gut Bacteria Is Associated with Childhood Asthma in Peru,” The Journal of Immunology, vol. 207, no. 2, pp. 398–407, Jul. 2021, doi: 10.4049/jimmunol.2001296.
17. M. Cheng, Q. Dai, Z. Liu, Y. Wang, and C. Zhou, “New progress in pediatric allergic rhinitis,” 2024, Frontiers Media SA. doi: 10.3389/fimmu.2024.1452410.
18. Zhou MS, Zhang B, Gao ZL, et al. Altered diversity and composition of gut microbiota in patients with allergic rhinitis. Microb Pathog. 2021;161(Pt A):105272. doi:10.1016/j.micpath.2021.105272
19. A. Ignacio, S. Czyz, and K. D. McCoy, “Early life microbiome influences on development of the mucosal innate immune system,” May 01, 2024, Academic Press. doi: 10.1016/j.smim.2024.101885.
20. L. A. Schwerdtfeger et al., “Gut microbiota and metabolites are linked to disease progression in multiple sclerosis,” Cell Rep. Med., vol. 6, no. 4, Apr. 2025, doi: 10.1016/j.xcrm.2025.102055.
21. Li J, Shen N, He W, et al. Gut microbiome impact on childhood allergic rhinitis and house dust mite IgE responses. Pediatr Res. 2025;97(7):2405-2414. doi:10.1038/s41390-024-03645-y
22. S. G. Tedner, A. Asarnoj, H. Thulin, M. Westman, J. R. Konradsen, and C. Nilsson, “Food allergy and hypersensitivity reactions in children and adults—A review,” Mar. 01, 2022, John Wiley and Sons Inc. doi: 10.1111/joim.13422.
23. M. Hara et al., “Gut microbiota of one-and-a-half-year-old food-allergic and healthy children,” Allergology International, vol. 73, no. 4, pp. 550–555, Oct. 2024, doi: 10.1016/j.alit.2024.03.004.
24. T. Shao et al., “The gut ecosystem and immune tolerance,” Dec. 01, 2023, Academic Press. doi: 10.1016/j.jaut.2023.103114.
25. K. Z. Sanidad and M. Y. Zeng, “Neonatal gut microbiome and immunity,” Aug. 01, 2020, Elsevier Ltd. doi: 10.1016/j.mib.2020.05.011.
26. C. S. Méndez, S. M. Bueno, and A. M. Kalergis, “Contribution of Gut Microbiota to Immune Tolerance in Infants,” 2021, Hindawi Limited. doi: 10.1155/2021/7823316.
27. W. Lin et al., “Allergic dysregulation and hyperimmunoglobulinemia e in Foxp3 mutant mice,” Journal of Allergy and Clinical Immunology, vol. 116, no. 5, pp. 1106–1115, Nov. 2005, doi: 10.1016/j.jaci.2005.08.046.
28. M. G. Dominguez-Bello et al., “Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns,” Proc. Natl. Acad. Sci. U. S. A., vol. 107, no. 26, pp. 11971–11975, Jun. 2010, doi: 10.1073/pnas.1002601107.
29. M. B. Azad et al., “Gut microbiota of healthy Canadian infants: Profiles by mode of delivery and infant diet at 4 months,” CMAJ. Canadian Medical Association Journal, vol. 185, no. 5, pp. 385–394, Mar. 2013, doi: 10.1503/cmaj.121189.
30. C. J. Hill et al., “Evolution of gut microbiota composition from birth to 24 weeks in the INFANTMET Cohort,” Microbiome, vol. 5, no. 1, 2017, doi: 10.1186/s40168-016-0213-y.
31. Stokholm J, Thorsen J, Blaser MJ, et al. Delivery mode and gut microbial changes correlate with an increased risk of childhood asthma. Sci Transl Med. 2020;12(569):eaax9929. doi:10.1126/scitranslmed.aax9929
32. M. O. Coker et al., “Infant Feeding Alters the Longitudinal Impact of Birth Mode on the Development of the Gut Microbiota in the First Year of Life,” Front. Microbiol., vol. 12, Apr. 2021, doi: 10.3389/fmicb.2021.642197.
33. Liu X, Zhou J, Chen J, et al. Risk of Asthma and Allergies in Children Delivered by Cesarean Section: A Comprehensive Systematic Review. J Allergy Clin Immunol Pract. 2024;12(10):2764-2773. doi:10.1016/j.jaip.2024.06.022
34. Z. Zhong et al., “Association of cesarean section with asthma in children/adolescents: a systematic review and meta-analysis based on cohort studies,” BMC Pediatr., vol. 23, no. 1, Dec. 2023, doi: 10.1186/s12887-023-04396-1.
35. Z. Liu et al., “Cesarean section and the risk of allergic rhinitis in children: a systematic review and meta-analysis,” Sci. Rep., vol. 13, no. 1, Dec. 2023, doi: 10.1038/s41598-023-44932-8.
36. X. Yang et al., “The prevalence of food allergy in cesarean-born children aged 0–3 years: A systematic review and meta-analysis of cohort studies,” Jan. 18, 2023, Frontiers Media SA. doi: 10.3389/fped.2022.1044954.
37. K. Tamai, N. Matsumoto, T. Mitsui, H. Masuyama, and T. Yorifuji, “Association between cesarean delivery and childhood allergic diseases in a longitudinal population-based birth cohort from Japan,” Sci. Rep., vol. 15, no. 1, Dec. 2025, doi: 10.1038/s41598-025-03703-3.
38. Ho NT, Li F, Lee-Sarwar KA, et al. Meta-analysis of effects of exclusive breastfeeding on infant gut microbiota across populations. Nat Commun. 2018;9(1):4169. Published 2018 Oct 9. doi:10.1038/s41467-018-06473-x
39. Ma J, Li Z, Zhang W, et al. Comparison of gut microbiota in exclusively breast-fed and formula-fed babies: a study of 91 term infants. Sci Rep. 2020;10(1):15792. Published 2020 Sep 25. doi:10.1038/s41598-020-72635-x
40. Odiase E, Frank DN, Young BE, et al. The Gut Microbiota Differ in Exclusively Breastfed and Formula-Fed United States Infants and are Associated with Growth Status. J Nutr. 2023;153(9):2612-2621. doi:10.1016/j.tjnut.2023.07.009
41. Liu Y, Qin S, Song Y, et al. The Perturbation of Infant Gut Microbiota Caused by Cesarean Delivery Is Partially Restored by Exclusive Breastfeeding. Front Microbiol. 2019;10:598. Published 2019 Mar 26. doi:10.3389/fmicb.2019.00598
42. Morreale C, Giaroni C, Baj A, et al. Effects of Perinatal Antibiotic Exposure and Neonatal Gut Microbiota. Antibiotics (Basel). 2023;12(2):258. Published 2023 Jan 28. doi:10.3390/antibiotics12020258
43. Azad MB, Konya T, Persaud RR, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG. 2016;123(6):983-993. doi:10.1111/1471-0528.13601
44. Iqbal F, Shenoy PA, Lewis LES, Siva N, Purkayastha J, Eshwara VK. Influence of perinatal antibiotic on neonatal gut microbiota: a prospective cohort study. BMC Pediatr. 2025;25(1):560. Published 2025 Jul 21. doi:10.1186/s12887-025-05907-y
45. Xi Z, Fenglin X, Yun Z, Chunrong L. Efficacy of probiotics in the treatment of allergic diseases: a meta-analysis. Front Nutr. 2025;12:1502390. Published 2025 Mar 4. doi:10.3389/fnut.2025.1502390
46. Wang L, Xu L. The impact of prebiotics, probiotics and synbiotics on the prevention and treatment of atopic dermatitis in children: an umbrella meta-analysis. Front Pediatr. 2025;13:1498965. Published 2025 Mar 21. doi:10.3389/fped.2025.1498965
47. Wang HZ, Hayles EH, Fiander M, Sinn JK, Osborn DA. Probiotics in infants for prevention of allergic disease. Cochrane Database Syst Rev. 2025;6(6):CD006475. Published 2025 Jun 13. doi:10.1002/14651858.CD006475.pub3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Paweł Rot, Joanna Mioduszewska, Piotr Poniewozik, Natalia Dziuba, Aleksandra Sim, Maja Pernal, Zofia Roguska, Andrzej Paweł Zuzak, Paweł Poniewozik, Krzysztof Grabowski

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 107
Number of citations: 0