Holobiont: Does Your Obstetrician Know This Word?

As Maya Angelou says, "We did then, what we knew how to do. Now that we know better, we do better."

Holobiont

An effort to do better must be characterized by an appreciation of the most powerful determinant of not only our health, but our very existence in the fabric of life on this earth – the microbiome. In a powerful essay, A holobiont birth narrative: the epigenetic transmission of the human microbiome, the mother-baby unit is reconceptualized to include the microbial populations in the mother, fetus, and then infant. These microbial communities are reconfigured throughout pregnancy, influenced by birth modality, and by breastfeeding in a way that reflects our co-evolution with the microbial world. In this way,

"Birth is the process of leaving of one symbiotic association system and forming another."

Obstetrics has traditionally regarded the woman and fetus as two largely separate entities coexisting during gestation, a perspective upended by the advent of epigenetic science and our understanding of the relevance of a woman's lifestyle preconception and during pregnancy. From a gene-centric paradigm, pregnancy complications were not preventable, and genes ruled any manifest pathology. Through the lens of the holobiont, however, genetic information passed from mother to baby includes nuclear, mitochondrial, and bacterial genes, and the bacteria themselves carry out many epigenetic processes that influence the expression of genes including detoxification of chemicals, production of nutrients, and foods.

An appreciation for holistic pregnancy care and birthing – the midwifery model – looks at the mother-baby unit and prizes the powerful dialogue between the two. One of the more profound examples of bidirectional influence is that of microchimerism, or the influence of the baby on the mother's physiology, a near sci-fi suggestion of cellular enmeshment between mom and baby.

The Puppet Masters

Passing on the right flora from the mother's gut during a vaginal birth, is acknowledged to be the most important role of the maternal micriobiome. It turns out that there are more tasks on the bacterial to-do list including:

• Colonization of the placenta, primarily by maternal oral bacteria
• Induction of adiposity or weight gain as the flora changes over the course of the pregnancy to reflect a dominance of Proteobacteria and Actinobacteria between weeks 13 and 33 in preparation for breastfeeding.
• Insulin resistance, a natural means to help support glucose availability to the fetus, but also one that can lead to gestational diabetes when coupled with the wrong diet.
• Influence food cravings that suit propagation of dominant flora.

Infant Immunity

Depending on the setting of colonization, gut microbiota determine what bacteria may stay, and what pathogens should go. Acceptance or rejection of other microbes is determined by the original postpartum residents in the neonate.

In the natural anti-inflammatory phenotype of a newborn, breastmilk is intended to provideimmune factors, bacteria, and prebiotics to continue the tailored maturation of the infant gut, where >70% of the immune system is housed.

Resident microflora are also responsible for response to vaccines and may predispose infants and children to vaccine injury. Specifically, the presence of bifidobacteria, notably absent in some populations, may determine "uptake" versus inflammatory response:

"Bifidobacterium predominance may enhance thymic development and responses to both oral and parenteral vaccines early in infancy, whereas deviation from this pattern, resulting in greater bacterial diversity, may cause systemic inflammation (neutrophilia) and lower vaccine responses. Vaccine responsiveness may be improved by promoting intestinal bifidobacteria and minimizing dysbiosis early in infancy."

The early seeding of the microbiome may dictate stress response and immunity, as

"It appears that the composition of the early microbiome dictates whether the response of the cells is inflammatory or tolerant".

Within Us, Around Us

With 90% of what we call human, microbial cells, 45% of our genome viral in origin and our very mitochondria ancient bacteria, we can no longer live under the delusion of our separateness from the environment and the ecology of life. It is leveraging this connection that will ultimately allow us to optimize our health rather than cutting off our nose to despite our face in aggressive acts of sanitation.

How to support your holobiont:

1. Open wide – Oral hygiene and health is the foundation of the gastrointestinal tract and early digestion. Consider using a water pick, oil pulling, and consulting a biological dentist.
2. Eat right – Detox your diet of microbiota-altering pesticides, sugar, and inflammatory vegetable oils. Read more here!
3. Eat the bugs – Fermented foods such as sauerkraut provide myriad strains of beneficial bacteria, most of which we have coevolved with, and that optimize our gut/brain axis.
4. Feed the bugs – Prebiotics such as starchy vegetables help to promote growth of beneficial bacteria if you don't have severe imbalances or small intestinal bacterial overgrowth. This is some of the rationale behind a moderate carb diet in pregnancy and postpartum.
5. Hippie birthing – Based on recent data that exposes differences in infant and child health and microbiota based on location of birth, a home microbiome is less hospitable to the pathogen Clostridium difficile which may mitigate food allergies and asthma incidence. Consider taking back the birth experience for the transformative and empowering act of transcendence it can be.
6. Mother's milk – Consider a low sugar diet to support healthy milk supply, and optimize your experience of breastfeeding with lactation support. It's so much more than "food".

Mammals and microbes such as bifidobacteria have a 200 million+ year history of coevolution as evidenced  by fragments of DNA specifically designed to eat prebiotics in mother's milk.  When we view our relationship to our environment as a cooperative rather than a dominance, it opens up a sense of wonder about the sanctity of food as information, the relevance of the natural world, and of the passage, through generations, of this collected biological wisdom. It's such a very different perspective than one that suggests sterile operating rooms, antibiotics, and formula are functional equivalents to the birth narrative described herein.