medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.medsovet-2691Research ArticleНЕОНАТОЛОГИЯNEONATOLOGYКесарево сечение. Оправдан ли выбор? Риски для здоровья детейCesarean section. Is the choice justified? Risks to children’s healthЗахароваИ. Н.ZakharovaI. N.

Захарова Ирина Николаевна – профессор, доктор медицинских наук, заслуженный врач России, заведующая кафедрой педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

Москва

ОсмановИ. М.OsmanovI. M.

Османов Исмаил Магомедович – главный внештатный детский специалист-нефролог, главный врач Детской клинической больницы им. З.Л. Башляевой ДЗМ, директор Университетской клиники педиатрии ГБОУ ВПО РНИМУ им. И.И. Пирогова МЗ РФ, профессор кафедры госпитальной педиатрии № 1 ГБОУ ВПО РНИМУ им. Н.И. Пирогова МЗ РФ

Москва 

БережнаяИ. В.BerezhnayaI. V.

Бережная Ирина Владимировна – кандидат медицинских наук, окружной детский гастроэнтеролог СЗАО г. Москвы, доцент кафедры педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

Москва 

КольцовК. А.KoltsovК. A.

Кольцов Константин Анатольевич – кафедра педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

Москва 

ДедиковаO. В.DedikovaO. V.

Дедикова Ольга Валерьевна – кафедра педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

Москва 

КучинаА. Е.KuchinaA. Е.

Кучина Анастасия Евгеньевна – аспирант кафедры педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

Москва 

СазановаЮ. О.SazanovaYu. O.

Сазанова Юлия Олеговна – аспирант педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

Москва 

МартыненкоЛ. Е.MartynenkoL. E.

Мартыненко Людмила Евгеньевна – кафедра педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

Москва 

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuing Vocational Education of the Ministry of Health of RussiaRussian FederationДетская городская клиническая больница им. З.А. Башляевой Департамента здравоохраненияРоссияZ.A. Bashlyaeva Children’s City Clinical Hospital of the Moscow City Health DepartmentRussian Federation2018191020180171621Copyright © Захарова И.Н., Османов И.М., Бережная И.В., Кольцов К.А., Дедикова O.В., Кучина А.Е., Сазанова Ю.О., Мартыненко Л.Е., 20182018Захарова И.Н., Османов И.М., Бережная И.В., Кольцов К.А., Дедикова O.В., Кучина А.Е., Сазанова Ю.О., Мартыненко Л.Е.Zakharova I.N., Osmanov I.M., Berezhnaya I.V., Koltsov К.A., Dedikova O.V., Kuchina A.Е., Sazanova Y.O., Martynenko L.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2691

Показатели перинатальной и ранней неонатальной смертности детей в Российской Федерации за последние десятилетия неуклонно снижаются, что связано с объективными причинами. Оперативное родоразрешение является одной из профилактических мер снижения материнской и перинатальной смертности. Однако необходимо учитывать риски оперативного родоразрешения как для матери, так и для младенца. Проведение планового кесарева сечения не позволяет в полной мере активировать адаптационные механизмы младенца, что нарушает цитокиновый каскад и приводит к различным иммунологическим расстройствам, одним из которых является аллергия. Последний метаанализ 13 исследований показал высокий риск развития бронхиальной астмы у детей, рожденных путем кесарева сечения. В данной группе достоверно чаще прослеживаются аутоиммунные заболевания, онкологическое процессы, системные заболевания. В данной статье рассматриваются вопросы рисков для детей, рожденных путем планового кесарева сечения, в краткосрочной и долгосрочной перспективе и возможности профилактики по данным современных исследований.

Operative delivery is one of the preventive measures to reduce maternal and perinatal mortality. Due to objective reasons, the indicators of perinatal and early neonatal deaths of children in the Russian Federation have been steadily declining over the past decades. Operative delivery is one of the preventive measures to reduce maternal and perinatal mortality. However, it is necessary to take into account the risks of operative delivery for both mother and baby. The planned caesarean section does not allow to fully activate the adaptive mechanisms of the baby, which disrupts the cytokine cascade and leads to various immunological disorders, one of which is allergy. The last meta-analysis of 13 trials showed a high risk of developing bronchial asthma in children born by cesarean section. Autoimmune diseases, oncological processes and systemic diseases is clearly in evidence in this group. This article discusses the risks for children born by planned cesarean section in the short and long term and the possibility of prevention according to modern trials.

кесарево сечениедетипищевая аллергиябронхиальная астмамикробиомпробиотикиL. fermentum hereditum CECT 5716cesarean sectionchildrenfood allergybronchial asthmamicrobiomeprobioticsL. fermentum hereditum CECT 5716ReferencesОксенойт Г.К., Никитина С.Ю. и др. Здравоохранение в России. 2017: Стат. сб. Росстат. М., 2017. 170 с.Oxenoite GK, Nikitina SYu. et al. Public health in Russia. 2017: Stat. Sat. Rosstat. M., 2017. 170 p.Lindmeier C. Кесарево сечение должно выполняться только при наличии медицинских показаний. 2015. Электронный ресурс. Официальный сайт Всемирной организации здравоохранения. URL:http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/ru/Lindmeier C. Caesarean section should be performed only for medical reasons. 2015. Electronic resource. Official website of the World Organization URL:http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/ru/Радзинский В.Е., Князев С.А. Сократить долю кесаревых сечений: настоятельные рекомендации ВОЗ о снижении доли кесаревых сечений. Status Presens, 2015, 6: 11-20.Radzinsky VYe, Knyazev SA. Reduce the proportion of caesarean sections: WHO’s urgent recommendations to reduce the proportion of caesarean sections. Status Presens, 2015, 6: 11-20.Радзинский В.Е. Акушерская агрессия. М.: Изд-во журнала StatusPraesens, 2017. 872 с. / Radzinsky VE. Obstetric aggression. Moscow: StatusPraesens Publishing House, 2017. 872 p.Radzinsky VE. Obstetric aggression. Moscow: StatusPraesens Publishing House, 2017. 872 p.Дианов М.А., Никитина С.Ю. и др. Здраво охранение в России. 2015: Стат. сб. Росстат. М., З-46 2015. 174 с.Dianov MA, Nikitina SYu, et al. Public health in Russia. 2015: Rosstat Statistics Digest. M., Z-46 2015. 174 p.Sevelsted A, Stokholm J, Bonnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Obstetrical & Gynecological Survey, 2015, 135(1): 92-8.Sevelsted A, Stokholm J, Bonnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Obstetrical & Gynecological Survey, 2015, 135(1): 92-8.Kim K et al. Cesarean section and disease associated with immune function. Journal of Allergy and Clinical Immunology, 2015, 137(2): 587-590.Kim K et al. Cesarean section and disease associated with immune function. Journal of Allergy and Clinical Immunology, 2015, 137(2): 587-590.Yektaei-Karin E, Moshfegh A, Lundahl J, Berggren V, Hansson LO, Marchini G. The stress of birth enhances in vitro spontaneous and IL-8-induced neutrophil chemotaxis in the human newborn. Pediatr Allergy Immunol, 2007, 18(8): 643-51.Yektaei-Karin E, Moshfegh A, Lundahl J, Berggren V, Hansson LO, Marchini G. The stress of birth enhances in vitro spontaneous and IL-8-induced neutrophil chemotaxis in the human newborn. Pediatr Allergy Immunol, 2007, 18(8): 643-51.Liao S-L, Tsai M-H, Yao T-C, et al. Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing. Scientific Reports, 2017, 7: 9053. doi: 10.1038/s41598-017-07894-2.Liao S-L, Tsai M-H, Yao T-C, et al. Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing. Scientific Reports, 2017, 7: 9053. doi: 10.1038/s41598-017-07894-2.Шабалов Н.П. Неонатология: учеб. пособие: В 2 т. 3-е изд. М.: МЕДпресс-информ, 2009. Т. 1. 608 с.Shabalov NP. Neonatology: Textbook. In 2 Volumes. 3rd ed. Moscow: MEDpress-Inform, 2009. T. 1. 608 p.Шейбак Л.Н. «Катехоламиновый всплеск» и его значение для новорожденных. Проблемы здоровья и экологии, 2015, 3 (45): 24-28.Sheybak LN. «Catecholamine burst» and its significance for newborns. Problemy Zdoroviya i Ekologii, 2015, 3 (45): 24-28.Ипполитова Л.И. Особенности гормональной адаптации новорожденных, извлеченных путем операции кесарева сечения. Педиатрия, 2010, 89(1): 31-36.Ippolitova LI. Features of hormonal adaptation of newborns extracted by cesarean section. Pediatriya, 2010, 89 (1): 31-36.Sanchez-Borges M, Martin BL et al. The importance of allergic disease in public health: an iCAALL statement. World Allergy Organ J, 2018, 11(1): 8.Sanchez-Borges M, Martin BL et al. The importance of allergic disease in public health: an iCAALL statement. World Allergy Organ J, 2018, 11(1): 8.Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med, 2018, 15(1): e1002494.Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med, 2018, 15(1): e1002494.Sui-Ling L, Ming-Han T, Tsung-Chieh Y, ManChin H, Kuo-Wei Y, Chih-Yung C, Kuan-Wen S, Shih-Yin H, Chuan-Chi K, Shen-Hao L, Jing-Long H. Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing. Scientific Reports, 2017, 7: 9053. doi:10.1038/s41598-017-07894-2.Sui-Ling L, Ming-Han T, Tsung-Chieh Y, ManChin H, Kuo-Wei Y, Chih-Yung C, Kuan-Wen S, Shih-Yin H, Chuan-Chi K, Shen-Hao L, Jing-Long H. Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing. Scientific Reports, 2017, 7: 9053. doi:10.1038/s41598-017-07894-2.Кривушкин Н.А. Пособие по изучению иммунного ответа. ЛитРес. 2017, 170 с.Krivushkin NA. The manual for immune response. LitRes. 2017, 170 p.Jutel M, Akdis CA. T-cell Subset Regulation in Atopy. Current Allergy and Asthma Reports, 2011, 11(2): 139-145. doi: 10.1007/s11882-011-0178-7.Jutel M, Akdis CA. T-cell Subset Regulation in Atopy. Current Allergy and Asthma Reports, 2011, 11(2): 139-145. doi: 10.1007/s11882-011-0178-7.Gessler P, Dahinden C. Increased respiratory burst and increased expression of complement receptor3 (CD11b/CD18) and of IL-8 receptorA in neutrophil granulocytes from newborns after vaginal delivery. Biol Neonate, 2003, 83(2): 107–112.Gessler P, Dahinden C. Increased respiratory burst and increased expression of complement receptor3 (CD11b/CD18) and of IL-8 receptorA in neutrophil granulocytes from newborns after vaginal delivery. Biol Neonate, 2003, 83(2): 107–112.Zanardo V, Solda G, Trevisanuto D. Elective cesarean section and fetal immune-endocrine response. Int J Gynaecol Obstet, 2006, 95(1): 52–53.Zanardo V, Solda G, Trevisanuto D. Elective cesarean section and fetal immune-endocrine response. Int J Gynaecol Obstet, 2006, 95(1): 52–53.Cardwell CR, Stene LC, Joner G Cinek O, Svensson J, Goldacre MJ, Parslow RC, Pozzilli P, Brigis G, Stoyanov D, Urbonaite B, Sipetić S, Schober E, IonescuTirgoviste C, Devoti G, de Beaufort CE, Buschard K, Patterson CC. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia, 2008, 51(5): 726–735.Cardwell CR, Stene LC, Joner G Cinek O, Svensson J, Goldacre MJ, Parslow RC, Pozzilli P, Brigis G, Stoyanov D, Urbonaite B, Sipetić S, Schober E, IonescuTirgoviste C, Devoti G, de Beaufort CE, Buschard K, Patterson CC. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia, 2008, 51(5): 726–735.Huurre A, Kalliomaki M, Rautava S, Rinne M, Salminen S, Isolauri E. Mode of delivery effects on gut microbiota and humoral immunity. Neonatology, 2008, 93(4): 236–240.Huurre A, Kalliomaki M, Rautava S, Rinne M, Salminen S, Isolauri E. Mode of delivery effects on gut microbiota and humoral immunity. Neonatology, 2008, 93(4): 236–240.Van Beijsterveldt T, Boomsma DI. Asthma and Mode of Birth Delivery: A Study in 5-Year-Old Dutch Twins. Twin Research and Human Genetics, 2007, 11(2): 156–160.Van Beijsterveldt T, Boomsma DI. Asthma and Mode of Birth Delivery: A Study in 5-Year-Old Dutch Twins. Twin Research and Human Genetics, 2007, 11(2): 156–160.Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy, 2008, 38(4): 629–633.Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy, 2008, 38(4): 629–633.Metsala J, Kilkkinen A, Kaila M, Tapanainen H, Klaukka T, Gissler M, Virtanen SM. Perinatal factors and the risk of asthma in childhood–a population-based register study in Finland. Am J Epidemiol, 2008, 168(2): 170–178.Metsala J, Kilkkinen A, Kaila M, Tapanainen H, Klaukka T, Gissler M, Virtanen SM. Perinatal factors and the risk of asthma in childhood–a population-based register study in Finland. Am J Epidemiol, 2008, 168(2): 170–178.Hyde MJ, Mostyn A, Modi N, Kemp PR. The health implications of birth by Caesarean section. Biol Rev Camb Philos Soc, 2012, 87(1): 229–243.Hyde MJ, Mostyn A, Modi N, Kemp PR. The health implications of birth by Caesarean section. Biol Rev Camb Philos Soc, 2012, 87(1): 229–243.Renz-Polster H, David MR, Buist AS et al. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy, 2005, 35(11): 1466–1472.Renz-Polster H, David MR, Buist AS et al. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy, 2005, 35(11): 1466–1472.Roduit C, Scholtens S, de Jongste JC, Wijga AH, Gerritsen J, Postma DS, Brunekreef B, Hoekstra MO, Aalberse R, Smit HA. Asthma at 8 years of age in children born by caesarean section. Thorax, 2009, 64: 107–113. doi:10.1136/thx.2008.100875.Roduit C, Scholtens S, de Jongste JC, Wijga AH, Gerritsen J, Postma DS, Brunekreef B, Hoekstra MO, Aalberse R, Smit HA. Asthma at 8 years of age in children born by caesarean section. Thorax, 2009, 64: 107–113. doi:10.1136/thx.2008.100875.Cnattingius S, Zack M, Ekbom A, Gunnarskog J, Linet M, Adami HO. Prenatal and neonatal risk factors for childhood myeloid leukemia. Cancer Epidemiol Biomarkers Prev, 1995, 4(5): 441–445.Cnattingius S, Zack M, Ekbom A, Gunnarskog J, Linet M, Adami HO. Prenatal and neonatal risk factors for childhood myeloid leukemia. Cancer Epidemiol Biomarkers Prev, 1995, 4(5): 441–445.Thomopoulos TP, Skalkidou A, Dessypris N et al. Prelabor cesarean delivery and early-onset acute childhood leukemia risk. European Journal of Cancer Prevention, 2016, 25(2): 155-610.Thomopoulos TP, Skalkidou A, Dessypris N et al. Prelabor cesarean delivery and early-onset acute childhood leukemia risk. European Journal of Cancer Prevention, 2016, 25(2): 155-610.Marcotte EL, Thomopoulos TP, Infante-Rivard C et al. Caesarean delivery and risk of childhood leukaemia: a pooled analysis from the Childhood Leukemia International Consortium (CLIC). Lancet Haematol, 2016, 3(4): 176–85.Marcotte EL, Thomopoulos TP, Infante-Rivard C et al. Caesarean delivery and risk of childhood leukaemia: a pooled analysis from the Childhood Leukemia International Consortium (CLIC). Lancet Haematol, 2016, 3(4): 176–85.McLaughlin CC, Baptiste MS, Schymura MJ, Zdeb MS, Nasca PC. Perinatal risk factors for neuroblastoma. Cancer Causes Control, 2009, 20(3): 289–301.McLaughlin CC, Baptiste MS, Schymura MJ, Zdeb MS, Nasca PC. Perinatal risk factors for neuroblastoma. Cancer Causes Control, 2009, 20(3): 289–301.Urayama KY, Von Behren J, Reynolds P. Birth characteristics and risk of neuroblastoma in young children. Am J Epidemiol, 2007, 165(5): 486–495.Urayama KY, Von Behren J, Reynolds P. Birth characteristics and risk of neuroblastoma in young children. Am J Epidemiol, 2007, 165(5): 486–495.Cook MB, Akre O, Forman D, Madigan MP, Richiardi L, McGlynn KA. A systematic review and meta-analysis of perinatal variables in relation to the risk of testicular cancer–experiences of the mother. Int J Epidemiol, 2009, 38(6): 1532–1542.Cook MB, Akre O, Forman D, Madigan MP, Richiardi L, McGlynn KA. A systematic review and meta-analysis of perinatal variables in relation to the risk of testicular cancer–experiences of the mother. Int J Epidemiol, 2009, 38(6): 1532–1542.Blustein J, Attina T, Liu M et al. Association of caesarean delivery with child adiposity from age 6 weeks to 15 years. Int J Obes (Lond), 2013, 37(7): 900–906.Blustein J, Attina T, Liu M et al. Association of caesarean delivery with child adiposity from age 6 weeks to 15 years. Int J Obes (Lond), 2013, 37(7): 900–906.Kuhle S, Tong OS, Woolcott CG. Association between caesarean section and childhood obesity: a systematic review and meta-analysis. Obes Rev, 2015, 16(4): 295–303.Kuhle S, Tong OS, Woolcott CG. Association between caesarean section and childhood obesity: a systematic review and meta-analysis. Obes Rev, 2015, 16(4): 295–303.Jakobsson HE, Abrahamsson TR, Jenmalm MC, Harris K, Quince C, Jernberg C, Bjorksten B, Engstrand L, Andersson AF. Decreased gut microbiota diversity, delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by caesarean section. Gut, 2014, 63: 559–566.Jakobsson HE, Abrahamsson TR, Jenmalm MC, Harris K, Quince C, Jernberg C, Bjorksten B, Engstrand L, Andersson AF. Decreased gut microbiota diversity, delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by caesarean section. Gut, 2014, 63: 559–566.Backhed F, Roswall J, Peng Y, Feng Q, Jia H, Kovatcheva-Datchary P. Dynamics and stabilization of the human gut microbiome during the first year of life. Cell Host Microbe, 2015, 17(5): 690-703. doi: 10.1016/j.chom.2015.04.004.Backhed F, Roswall J, Peng Y, Feng Q, Jia H, Kovatcheva-Datchary P. Dynamics and stabilization of the human gut microbiome during the first year of life. Cell Host Microbe, 2015, 17(5): 690-703. doi: 10.1016/j.chom.2015.04.004.Rutayisire E, Huang K, Liu Y, Tao F. The mode of delivery affects the diversity and colonization pattern of the gut microbiota during the first year of infants’ life: a systematic review. BMC Gastroenterol, 2016, 30, 16(1): 86. doi: 10.1186/s12876-016-0498-0.Rutayisire E, Huang K, Liu Y, Tao F. The mode of delivery affects the diversity and colonization pattern of the gut microbiota during the first year of infants’ life: a systematic review. BMC Gastroenterol, 2016, 30, 16(1): 86. doi: 10.1186/s12876-016-0498-0.Shin H, Pei Z, Martinez KA, Rivera-Vinas JI, Mendez K, Cavallin H, Dominguez-Bello MG. The first microbial environment of infants born by C-section: the operating room microbes. Microbiome, 2015, 3(59): 1-6. doi: 10.1186/s40168-015-0126-1.Shin H, Pei Z, Martinez KA, Rivera-Vinas JI, Mendez K, Cavallin H, Dominguez-Bello MG. The first microbial environment of infants born by C-section: the operating room microbes. Microbiome, 2015, 3(59): 1-6. doi: 10.1186/s40168-015-0126-1.Stokholm J, Thorsen J, Chawes BL et al. Cesarean section changes neonatal gut colonization. J Allergy Clin Immunol, 2016 April.Stokholm J, Thorsen J, Chawes BL et al. Cesarean section changes neonatal gut colonization. J Allergy Clin Immunol, 2016 April.Goedert JJ, Hua X, Yu G, Shi J. Diversity and composition of the adult fecal microbiome associated with history of cesarean birth or appendectomy: Analysis of the American Gut Project. EBioMedicine, 2014, 1(2–3): 167–172.Goedert JJ, Hua X, Yu G, Shi J. Diversity and composition of the adult fecal microbiome associated with history of cesarean birth or appendectomy: Analysis of the American Gut Project. EBioMedicine, 2014, 1(2–3): 167–172.Walker WA, Iyengar RS. Breast milk, microbiota, and intestinal immune homeostasis. Pediatric Research, 2015, 77(1): 220-228.Walker WA, Iyengar RS. Breast milk, microbiota, and intestinal immune homeostasis. Pediatric Research, 2015, 77(1): 220-228.Jost T, Lacroix C, Braegger C, Chassard C. Impact of human milk bacteria and oligosaccharides on neonatal gut microbiota establishment and gut health. Nutrition Reviews, 2015, 73(7): 426-37.Jost T, Lacroix C, Braegger C, Chassard C. Impact of human milk bacteria and oligosaccharides on neonatal gut microbiota establishment and gut health. Nutrition Reviews, 2015, 73(7): 426-37.Palmer C, Bik EM, Di Giulio DB, Relman DA, Brown PO. Development of the human infant intestinal microbiota. Plos Biology, 2010, 5: 1566–73.Palmer C, Bik EM, Di Giulio DB, Relman DA, Brown PO. Development of the human infant intestinal microbiota. Plos Biology, 2010, 5: 1566–73.Round JL, Mazmanian SK. The gut microbiota shapes intestinal responses during health and disease. Nat Rev Immunol, 2009, 9: 313–23.Round JL, Mazmanian SK. The gut microbiota shapes intestinal responses during health and disease. Nat Rev Immunol, 2009, 9: 313–23.Heikkila MP, Saris P. Inhibition of Staphylococcus aureus by the commensal bacteria of human milk. J Appl Microbiol, 2003, 95: 471–8.Heikkila MP, Saris P. Inhibition of Staphylococcus aureus by the commensal bacteria of human milk. J Appl Microbiol, 2003, 95: 471–8.Artis D. Epithelial-cell recognition of commensal bacteria and maintenance of immune homeostasis in the gut. Nat Rev Immunol, 2008, 8: 411–20.Artis D. Epithelial-cell recognition of commensal bacteria and maintenance of immune homeostasis in the gut. Nat Rev Immunol, 2008, 8: 411–20.Mc Auley JL, Linden SK, Png CW et al. MUC 1 cell surface mucin is a critical element of the mucosal barrier to infection. J Clin Invest, 2007, 117: 2313–24.Mc Auley JL, Linden SK, Png CW et al. MUC 1 cell surface mucin is a critical element of the mucosal barrier to infection. J Clin Invest, 2007, 117: 2313–24.Shen L, Turner JR. Role of epithelial cells in initiation and propagation of intestinal inflammation. Eliminating the static: tight junction dynamics exposed. Am J Physiol Gastrointest Liver Physiol, 2006, 290: 577–82.Shen L, Turner JR. Role of epithelial cells in initiation and propagation of intestinal inflammation. Eliminating the static: tight junction dynamics exposed. Am J Physiol Gastrointest Liver Physiol, 2006, 290: 577–82.Sjogren YM, Tomicic S, Lundberg A et al. Influence of early gut microbiota on the maturation of childhood mucosal and systemic immune responses. Clin Exp Allerg, 2009, 39: 1842-1851.Sjogren YM, Tomicic S, Lundberg A et al. Influence of early gut microbiota on the maturation of childhood mucosal and systemic immune responses. Clin Exp Allerg, 2009, 39: 1842-1851.Радзинский В.Е. Натурализация акушерства. Прогрессивное ретро. Status Presens, 2015, 6: 7-9.Radzinsky VE. Naturalization of obstetrics. Progressive retro. Status Presens, 2015, 6: 7-9.Ballard O, Morrow AL. Human Milk Composition: Nutrients and Bioactive Factors. Pediatr Clin North Am, 2013, 60(1): 49–74.Ballard O, Morrow AL. Human Milk Composition: Nutrients and Bioactive Factors. Pediatr Clin North Am, 2013, 60(1): 49–74.Rautava S, Luoto R, Salminen S et al. Microbial contact during pregnancy, intestinal colonization and human disease. Nat Rev Gastroenterol Hepatol, 2012, 9: 565-576.Rautava S, Luoto R, Salminen S et al. Microbial contact during pregnancy, intestinal colonization and human disease. Nat Rev Gastroenterol Hepatol, 2012, 9: 565-576.Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr, 2012, 95(5): 1113-1135.Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr, 2012, 95(5): 1113-1135.Hyde MJ, Mostyn A, Modi N, Kemp PR. The health implications of birth by caesarean section. Biol Rev Camb Philos Soc, 2012, 87: 229–43.Hyde MJ, Mostyn A, Modi N, Kemp PR. The health implications of birth by caesarean section. Biol Rev Camb Philos Soc, 2012, 87: 229–43.Gueimonde M, Laitinen K, Salminen S et al. Breast-milk: a source of bifidobacteria for infant gut development and maturation? Neonatology, 2007, 92: 64-66.Gueimonde M, Laitinen K, Salminen S et al. Breast-milk: a source of bifidobacteria for infant gut development and maturation? Neonatology, 2007, 92: 64-66.Jost T, Lacroix C, Braegger C et al. Assessment of bacterial diversity in breastmilk using culturedependent and culture independent approaches. Br J Nutr, 2013, 110: 1253-62.Jost T, Lacroix C, Braegger C et al. Assessment of bacterial diversity in breastmilk using culturedependent and culture independent approaches. Br J Nutr, 2013, 110: 1253-62.Martin R, Olivares M et al. Probiotic potential of 3 lactobacilli strains isolated from breast milk. J Hum Lact, 2005, 21: 8-17.Martin R, Olivares M et al. Probiotic potential of 3 lactobacilli strains isolated from breast milk. J Hum Lact, 2005, 21: 8-17.Grbnlund MM, Gueimonde M, Laitinen К et al. Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease. Clin Exp Allergy, 2007, 37(12): 1764-72.Grbnlund MM, Gueimonde M, Laitinen К et al. Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease. Clin Exp Allergy, 2007, 37(12): 1764-72.Forestier C, De Champs C, Vatoux C, Joly B. Probiotic activities of Lactobacillus casei rhamnosus: in vitro adhe rence to intestinal cells and antimicrobial properties. Res Microbiol, 2001, 152: 167-73.Forestier C, De Champs C, Vatoux C, Joly B. Probiotic activities of Lactobacillus casei rhamnosus: in vitro adhe rence to intestinal cells and antimicrobial properties. Res Microbiol, 2001, 152: 167-73.Silva M, Jacobus NV, Deneke C, Gorbach SL. Antimicrobial substance from a human Lacto bacillus strain. Antimicrob Agents Chemother, 1987, 31: 1231.Silva M, Jacobus NV, Deneke C, Gorbach SL. Antimicrobial substance from a human Lacto bacillus strain. Antimicrob Agents Chemother, 1987, 31: 1231.Braat H, De Jong EC, Van den Brande JM et al. Dichotomy between Lactobacillus rhamnosus and Klebsiella pneumoniae on dendritic cell phenotype and function. J Mol Med, 2004, 82(3): 197–205.Braat H, De Jong EC, Van den Brande JM et al. Dichotomy between Lactobacillus rhamnosus and Klebsiella pneumoniae on dendritic cell phenotype and function. J Mol Med, 2004, 82(3): 197–205.Rinkinen M, Westermarck E, Salminen S, Ouwehand AC. Absence of host specificity for in vitro adhesion of probiotic lactic acid bacteria to intestinal mucus. Vet Microbiol, 2003, 97: 55–61.Rinkinen M, Westermarck E, Salminen S, Ouwehand AC. Absence of host specificity for in vitro adhesion of probiotic lactic acid bacteria to intestinal mucus. Vet Microbiol, 2003, 97: 55–61.Mitropoulou G, Nedovic V, Goya A, Kourkoutas Y. Immobilization Technologies in Probiotic Food Production. Journal of Nutrition and Metabolism, 2013, 15: 1-15. Article ID 716861, 15 pages. http://dx.doi.org/10.1155/2013/716861.Mitropoulou G, Nedovic V, Goya A, Kourkoutas Y. Immobilization Technologies in Probiotic Food Production. Journal of Nutrition and Metabolism, 2013, 15: 1-15. Article ID 716861, 15 pages. http://dx.doi.org/10.1155/2013/716861.FAO/WHO. Guidelines for the Evaluation of Probiotics in Food. Report of a joint FAO/WHO working group on drafting guidelines for the evaluation of probiotics in food. Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food. 2002.FAO/WHO. Guidelines for the Evaluation of Probiotics in Food. Report of a joint FAO/WHO working group on drafting guidelines for the evaluation of probiotics in food. Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food. 2002.

The authors declare that there are no conflicts of interest present.