MOdification Of THe Early-Life Respiratory Microbiome Through Vaginal SEEDing

Purpose

This is a single-center, parallel-arm, blind, sham-controlled, feasibility randomized controlled trial (RCT) to be conducted in healthy cesarean-born infants. Eligible infants will be randomized 1:1 to have their nose swabbed with either maternal vaginal secretions or a sterile swab (intervention vs. control group, respectively) following birth by cesarean section (C-section). The main hypothesis is that conducting an RCT assessing the utility of vaginal seeding in modifying the early-life upper respiratory tract (URT) microbiome of infants born by C-section is feasible and that the intervention is safe.

Conditions

  • Cesarean Section
  • Vaginal Seeding
  • Nose
  • Microbiome

Eligibility

Eligible Ages
Between 18 Years and 40 Years
Eligible Genders
Female
Accepts Healthy Volunteers
No

Inclusion Criteria

For the mother: - Female 18-40 years of age who is in good general health, is fully able to provide consent to participate in the study, anticipates being available for the duration of the study, and is willing to comply with all study procedures - Singleton pregnancy - Completed ≧3 prenatal care visits at Vanderbilt University Medical Center (VUMC) (any facility) - Scheduled for a planned C-section due to a repeat C-section at VUMC (main campus only) - Planning to have general pediatric care for the infant at VUMC (main campus or One Hundred Oaks campus) - Intention to breastfeed partially or exclusively - No intent to relocate outside the middle Tennessee region within 18-24 months of recruitment For the infant: - Estimated gestational age ≧37 weeks - Birth weight ≧2,500 grams

Exclusion Criteria

For the mother: - Previous child with Group B Streptococcus (GBS) infection at any age - Hepatitis B, hepatis C, or human immunodeficiency virus infection at any age - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the 4 weeks prior to delivery or a household contact with a confirmed SARS-CoV-2 infection in the 4 weeks prior to delivery - Fever (≧100.4°F [38°C]) in the 72 hours prior to delivery - Symptoms (e.g., dysuria, pruritus, or discharge) suggestive of a genitourinary infection (e.g., bacterial vaginosis, vaginal yeast infection, chorioamnionitis, or urinary tract infection) on the day of delivery - Physical exam findings (e.g., fever [≧100.4°F (38°C)] or vesicles, warts, or ulcers in the genital, perineal, or anal region) suggestive of a genitourinary infection on the day of delivery (performed as part of the screening procedures for this study if not performed as standard of care) - Laboratory evidence of any of the following: - GBS bacteriuria in urine samples collected at any time during current pregnancy (performed as standard of care) - GBS colonization in rectovaginal swabs collected at ≧35 weeks of current pregnancy (performed as standard of care) - Chlamydia, trichomoniasis, or gonorrhea in urine samples collected in the first trimester current pregnancy (performed as standard of care) - Chlamydia, trichomoniasis, or gonorrhea in urine samples collected at ≧35 weeks of current pregnancy (performed as part of the screening procedures for this study) - Hepatitis B, hepatis C, human immunodeficiency virus, or syphilis infection in blood samples collected in the first trimester current pregnancy (performed as standard of care) - Hepatitis B, hepatis C, human immunodeficiency virus, or syphilis in blood samples collected at ≧35 weeks of current pregnancy (performed as part of the screening procedures for this study) - SARS-CoV-2 infection in nasal swabs collected in the 72 hours prior to delivery (performed as standard of care) - Maternal vaginal pH>4.5 on the day of delivery (performed as part of the screening procedures for this study) - For women 21-29 years of age: Abnormal Pap smear in the 3 years prior to delivery (performed as standard of care) - For women 21-40 years of age: Abnormal Pap smear with cervical human papilloma virus co-testing in the 5 years prior to delivery, abnormal Pap Smear alone in the 3 years prior to delivery, or abnormal cervical human papilloma virus testing alone in the 5 years prior to delivery (performed as standard of care) - Pelvic inflammatory disease at any age - Diabetes (including type I, type II, and gestational diabetes) at any age - Any serious obstetric disease (e.g., preeclampsia, placenta previa, placental abruption, severe bleeding, or thromboembolic disease) - C-section scheduled for a genitourinary infection that would have interfered with vaginal delivery (e.g., genital herpetic lesions) - Lack of available prenatal screening tests - Expected preterm delivery - Need for a switch from a planned C-section to an emergency C-section - Onset of labor or rupture of membranes prior to delivery - Use of systemic (oral, intramuscular, or intravenous) antibiotics in the 4 weeks prior to delivery (except for those being administered as part of the C-section) - Use of systemic (oral, intramuscular, or intravenous) immunosuppressive, biologic, or chemotherapeutic agents in the 3 months prior to delivery (except for systemic immunosuppressive agents not being used for their immunosuppressive effects [e.g., prenatal intramuscular beclomethasone for fetal lung maturation]) - Pregnancy as the result of an assisted reproductive technology or surrogacy - Participation in another clinical trial that involves an intervention that could impact the quality or interpretation of the study data as deemed by the PI or co-investigators - Other past or current medical problems that could compromise the safety of participants, interfere with their ability to comply with study requirements, or impact the quality or interpretation of the study data as deemed by the PI or co-investigator For the infant: - Need for neonatal measures outside routine clinical care (i.e., drying, tactile stimulation, bulb syringe or catheter suction of nose and mouth, or temperature maintenance) or transfer to the neonatal intensive care unit immediately after delivery - Thick particulate meconium noted during delivery - Physical exam findings (e.g., tachypnea, nasal flaring, retractions, cyanosis, or grunting) suggestive of neonatal acute respiratory distress immediately after delivery (performed as part of the screening procedures for this study) - Prenatal or immediate postnatal diagnosis of a serious genetic, respiratory, cardiovascular, or neurological disease - Prenatal or immediate postnatal diagnosis of intrauterine growth restriction - Prenatal or immediate postnatal diagnosis of a major congenital anomaly (e.g., cleft lip or palate, cystic hygroma, or giant omphalocele) - Participation in another clinical trial that involves an intervention that could impact the quality or interpretation of the study data as deemed by the PI or co-investigators - Other past or current medical problems that could compromise the safety of participants, interfere with their ability to comply with study requirements, or impact the quality or interpretation of the study data as deemed by the PI or co-investigators

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
This is a single-center, parallel-arm, blind, sham-controlled, feasibility RCT to be conducted in healthy cesarean-born infants.
Primary Purpose
Other
Masking
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description
Participants, the principal investigator, co-investigators, data manager, and the lead biostatistician will be blinded to the actual group assignment until all statistical analyses of the data required to meet the primary and co-primary endpoints have occurred. The Data and Safety Monitoring Board will remain unmasked to actual group allocation throughout the pre-specified blinding period.

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Intervention Group
Vaginal Seeding
  • Procedure: Vaginal Seeding
    Following delivery by C-section, participating infants randomized to the intervention group will have their nasal cavity swabbed with maternal vaginal secretions.
Sham Comparator
Control Group
Sterile Swab
  • Procedure: Sterile Swab
    Following delivery by C-section, participating infants randomized to the control group will have their nasal cavity swabbed with a sterile swab.

Recruiting Locations

Vanderbilt University Medical Center
Nashville, Tennessee 37232
Contact:
Andrea E Lee
615-936-5552
motherseed@vumc.org

More Details

Status
Recruiting
Sponsor
Vanderbilt University Medical Center

Study Contact

MOTHER SEED Study Team
615-936-5552
motherseed@vumc.org

Detailed Description

Eligible infants will be randomized 1:1 to have their nose swabbed with either maternal vaginal secretions or a sterile swab (intervention vs. control group, respectively) following birth by C-section. The procedure will be performed immediately after the initial newborn care by the general pediatric team. The mother and infant will then receive usual medical care as determined by their health care providers. Follow-up will occur at multiple time points during the child's first year of life. One planned interim analysis to assess the safety of the procedure will be conducted. The intervention aims to transfer the maternal vaginal microbiome to the nasal cavity of cesarean-born infants at birth (i.e., vaginal seeding of the URT). Hence, the intervention simply attempts to replicate the natural exposure to maternal vaginal secretions during vaginal delivery in infants born by C-section.