To the Editor Madan and colleagues1 are to be congratulated on their interesting and insightful study of the association of cesarean birth and formula feeding with the gut microbiota of young infants. The authors succinctly mention metabolic and immune-mediated diseases of children and adolescents that have been associated with cesarean delivery. Current thinking is that cesarean delivery contributes to the pathogenesis of these diseases by delaying the assembly of the infant microbial population, thereby altering the microbiota’s central role in metabolism and immune maturation including switching from T-helper 2–dominated to T-helper 1–dominated cellular immunity.2 Peripartum antibiotic use, especially with cesarean delivery, is a confounding factor that unfortunately Madan et al1 could not evaluate.
Goedert JJ. Intestinal Microbiota and Health of Adults Who Were Born by Cesarean Delivery. JAMA Pediatr. 2016;170(10):1027. doi:10.1001/jamapediatrics.2016.2310
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