Microflore de la mère et du nouveau-né : quelques aspects périnataux

Summary: The vaginal bacterial ecosystem is at higher risk for disturbances during pregnancy. And yet, its maintenance at an adequate level is probably the best way to decrease the risk of getting urogenital infections in the mother. Bacterial vaginosis and urinary infections are the most common ones and cannot be dissociated from each other as pregnant women with vaginal bacteriosis are at increasing risk for urinary tract infections. These urogenital infections can favour chorioamnionitis with or without a rupture of membranes. The biochemical factors accompanying both infections are contributors of initiating the inflammatory cascade and by the end a preterm labour. Antibiotics can in part prevent or resolve these infections and are therefore very often used in clinical practice. However, these drugs will also further accentuate the vaginal dysbacteriosis favouring the colonisation of the vaginal tract of the mother and the intestine of the neonate with multiresistant microorganisms, realizing in such a way a real vicious circle. Birth is the only time in our life when the gastrointestinal tract, while sterile, is colonised by bacteria originating from the maternal flora as well as by that of the close direct birth environment. There is now evidence that the invasive microbial environment, first encountered during the birth process, is opportunistically used by the host to initiate its own defence mechanisms but also all immune mechanisms allowing oral tolerance to diet antigen. In fact, these mechanisms are still immature at that stage. Recent epidemiological data support the hypothesis that some increasing immune deviances observed in the last decades could have been originated from a modification of the bacterial environment in young populations. Our modern approach to perinatal care may, to some extent, have modified inadequately the overall quality of this bacterial–host interface. Keeping all above data in mind but without any denigration of each evidence-based data already got, which have been associated with an improvement of our perinatal care, it is nevertheless urgent to focus now on this maternal and neonatal bacterial environment at birth, which could have been secondarily modified. It is with the aim of finding the best way to ameliorate, in the future, the bacterial colonisation of the newborn. It is indeed of concern in terms of public health owing all these putative associated short and long terms morbidities in the mother and her baby related to the disturbances of the bacterial environment at birth. [Copyright &y& Elsevier]