I love my growing belly, but one thing that’s driving me crazy right now is how much it itches. I developed eczema after moving to cold, dry Massachusetts after happy years spent in warm and humid climates. In trying to better understand the causes of my eczema, I’m learning a tremendous amount about the bacteria that live in our guts and how it might be linked to other things, like my childhood allergies. As a future mom, I'd love for my child to not have to suffer through the things I did. Here's what I've learned.
In our cultural relishing of post-enlightenment individualism it can be a little unnerving to realize that we are not ourselves; in fact, 80% of our cells are bacteria. These bacteria are just about everywhere in our bodies, but here I’ll discuss those incredibly important little guys in our guts. There are lots of different species of bacteria, some of which are harmful and some of which are so helpful that we now understand that we’ve evolved symbiotically for our mutual benefit. Go team! Our healthy gut bacteria play a variety of useful roles, from limiting pathogenic bacteria, regulating gut development, building and training our immune systems, and making vitamins that we couldn’t otherwise make, including vitamin K.
The composition of our gut flora has a direct impact on our health. For example, we now know that people who suffer from autoimmune diseases such as allergies, asthma, eczema, celiac disease, and crohn’s disease have a different array of bacteria than other people. Gut health has now also been linked to cancer, depression and anxiety, and type 2 diabetes. Studies have shown that infant’s gut flora can actually predict what kinds of diseases will show up in their lives. The rising interest in gut health in the medical world has produced a variety of studies in recent years that indicate how our bacterial composition is impacted by such factors as diet, stress, Vitamin D deficiency, obesity, antibiotic usage, use of hormonal contraceptives, mode of delivery (vaginal vs. cesarean), and even place of birth (hospital vs. home).
So, when we approach the causes of and solutions to infant eczema we need to go beneath the skin to the gut.
During the preconception period (give yourself a year!), in addition to bringing your body into balance using nourishing herbs, eating an excellent diet, and building up your folate levels, work on your gut. Include a daily probiotic as well as food probiotics such as fermented foods and beverages, and eat plenty of fresh fruits and vegetables—the raw materials that healthy gut bacteria love to eat (sometimes called “pre-biotics”). This is especially important if you’ve been treated recently with antibiotics, or if you’ve had a high lifetime exposure to antibiotics, or if you’ve used hormonal contraception as birth control. Hormonal contraception (HC) changes the composition of bacteria in our bodies and especially in our vaginas, reducing levels of healthy Lactobacillus (which is one reason why women on HC tend to have more urinary tract infections and other issues). You'll feel better having a healthy gut, but—and I haven't seen studies on this, yet—I'd be curious to see how bacterial composition impacts things like UTIs during pregnancy, preterm labor, premature rupture of membranes, and Group-B strep testing, so I'd wager that a healthy gut will support a healthy pregnancy.
Multiple recent studies have shown that the mode of delivery has a major impact on the colonization of gut flora. While researchers are challenging the previously held belief that babies' guts are sterile prior to birth, big changes happen in baby's guts right after birth. Babies born vaginally tend to be dominated by Lactobacillus species while babies born via cesarean section (CS) tend to have more potentially pathogenic bacteria, including Staphylococcus, which is typical of what we find on care providers’ skin and on hospital surfaces. These effects manifest for a long time—one study found the impact of CS delivery on seven year olds.
Set your intentions on a vaginal birth, and take the necessary steps to ensure the best possible outcomes. Find out what the cesarean rates are at local hospitals and with individual practitioners and go with a practice with a low rate, and avoid an induction. As midwives tend to have lower cesarean rates than obstetricians, find a practice where you can work with nurse midwives. Or, consider a home birth. Interestingly, babies born at home are less likely than those born in hospitals to experience autoimmune conditions like eczema due to the types of bacteria present in the different settings.
Lastly, include in your birth preferences something like “if I must receive an emergency cesarean, I want my baby to be swiped with my vaginal fluids at birth.” Yes, you might get some funny looks, but you’ve got the studies to back up this request (see references).
Antibiotics targeting unhealthy bacteria kill off healthy bacteria as well, with possible long term effects. In pregnancy, do your research on Group B Streptococcus (you’ll be tested around 36 weeks). Women who are “GBS-positive,” that is, whose vaginas show a high prevalence of GBS, are typically treated with antibiotics when labor starts, though some women prefer alternatives. Depending on the length of labor, multiple courses of antibiotics may be given. Women undergoing a CS also receive antibiotics as well as moms whose water breaks prior to the onset of active labor.
Antibiotics are a good thing—they save lives—although we use them with alarming, baiting-the-apocalypse frequency. Set your intentions on an antibiotic free pregnancy, and if you do require antibiotic treatment, immediately follow up with lots of pro- and pre-biotics as mentioned above. Plan to work on both yourself and your baby’s gut in the coming days, weeks, and months.
Once you’ve got those healthy bacteria in place, they need to be fed. And, if your baby didn’t get the benefit of contacting those vaginal flora, then breastfeeding is an important way to improve gut flora especially in combination with other gut support for your baby. Breastfed babies are more likely to show colonization by species of Bifidobacterium, whereas formula-fed babies have lower numbers of these bacterial allies but higher numbers of bacteria such as E. coli.
Learn about breastfeeding before you have your baby, find out about the importance of colostrum, and meet with a hospital lactation consultant (LC) before leaving. Have a LC’s number on hand and call her when problems arise—breastfeeding challenges are best solved when dealt with immediately. Cesarean delivery is associated with a delay in lactation, so some babies born via CS are hit again when they don’t receive colostrum and breast milk, another thing to keep in mind. Lastly, breastfeeding is just not possible for all moms, some of whom lack the much needed support that it takes, or may have diseases or be on medications that can negatively harm infants through breastfeeding. There are a growing number of breast milk sharing services, from milk banks to grassroots local efforts, which can help.
Babies and children with eczema have a tough time (adults, too!), and addressing eczema involves a multipronged approach, one strand of which should be forming an alliance with all those healthy bacteria out there in the world, and ideally in baby’s gut. There are many factors that determine the composition of gut flora that we can take into account to help prevent eczema and other issues, and when challenges arise—an emergency cesarean, inability to breastfeed—know that it’s not the end of the world. Dietary changes (a GAPS diet, for example) is the first step in healing our guts. Keep up that healthy diet, consider infant probiotics, work with a holistic pediatric nutritionist, join your local La Leche League, and share what works!
Nicolas Bakalar, "Probiotics May Ease Stomach Upset in Babies," The New York Times, January 16, 2014.
Joseph Neu and Jona Rushing, Cesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis, Clinical Perinatology, 2012.
John Penders, et al. Factors Influencing the Composition of the Intestinal Microbiota in Early Infancy, Pediatrics, 2006.
Michael Pollan, “Say hello to the 100 Trillion Bacteria That Make Up Your Microbiome,” The New York Times, May 15, 2013.
Moises Velasquez-Manoff, "A Cure for the Allergy Epidemic?" The New York Times, November 10, 2013.
Moises Velasquez-Manoff, An Epidemic of Absence, (2013). This is a great review of the recent literature on the relationship between bacteria, parasites, and our immune system, and a fascinating read.