During the last decades, changes in diet and lifestyle have increased the risk of non-communicable diseases (NCD) in the western countries. It is known that once these NCD are established in the childhood, they continue into adult life with the associated negative impact on health, quality of life and health care costs. The gastrointestinal tract (GIT) is not just the place where the digestion takes place, it is an important endocrine organ which harbours a very complex and dynamic microbial community, the so called intestinal microbiota (IM). The GIT-IM interaction results essential during early life for the development of a fully functional immune system and the maintenance of the host physiological homeostasis and health. The correct establishment of the IM in the early days of life plays an important role in the reduction of chronic disease, such as obesity, allergies, infection, inflammatory or brain disorders. Moreover, the early stage of life constitutes a critical window-of-opportunity for IM modulation towards a healthy profile. This fact entails the need to fully elucidate the factors driving the initial establishment and later development of the intestinal microbial community from the very early days of life. Several factors affecting this process have been extensively assessed; however, other specific perinatal factors like the intrapartum antimicrobial prophylaxis (IAP), in spite of been present on over 30% of total deliveries, have been much less studied. A large body of evidence supports that postnatal antibiotic administration to babies induce an irreversible disrupt of the natural microbiota succession and delay in the IM maturation, associated with NCD. Nevertheless, the effect of perinatal antibiotic administration to mothers during delivery as prophylaxis (IAP) still remained to be elucidated. On the other hand, the antibiotic resistance (AR) is nowadays rising to hazardously high levels in all parts of the world and is one of the main threats to global health. Different approaches have to be taken at all levels of society to reduce the impact and limit the spread of resistance. The IM can be considered as a reservoir of antibiotic gene resistance (ARG), and elucidating how the antibiotic exposure since the beginning of life is affecting this pool of gene is also of great importance. IAP is an effective procedure, used since the 80s, for the reduction of the neonatal mortality by invasive Group B streptococcal disease when mothers are colonized; however, it is also frequently used in other clinical situation in which a clear benefit has not been demonstrated.
The MSCA-funded IAPEMIDE project aimed to elucidate the impact of the IAP (a) on the IM establishment in the neonate, and (b) on the human antibiotic resistant genes reservoir (resistome) establishment at early stages of life. To investigate these questions, the following objectives were suggested: a) to identify the alterations induced by maternal IAP in the neonatal IM development; b) to study the potential role of infant feeding in the modulation of the microbiota´s effects derived of IAP administration; c) to identify the antibiotic resistance genes (ARG) that the IM carried as consequence of this early treatment; and d) to design specific dietary strategies for minimizing the impact of this common and potentially deleterious clinical practice on the IM establishment.
