The science

What is the microbiome?

The human microbiome refers to the genetic material and products made by the vast numbers of microorganisms - bacteria, yeast, viruses, and archaea - that live with each other and with us. The gut microbiome is sometimes referred to as an “organ” that affects multiple systems throughout the body.

To give a little perspective, you have about one bacterial cell for every human cell. If you ignore red blood cells, this means that you have ten bacterial cells for every one human cell.  

Even more impressive: There’s an estimated 3.3 million bacterial genes in your gut, which is 150 times more than the human genome.

But what does that have to do with our health?

Some bacteria produce vitamins and train your immune system. Other bacteria, like  bifidobacteria, help your baby digest specialized sugars in breastmilk called HMOs (human milk oligosaccharides).

From immune education and neurodevelopment to nutrient breakdown, maintaining energy levels, and more, bacteria - and their genes - are critical to our health.

Where does my baby’s microbiome come from?

This one’s on you, mom.

While there are similarities in microbiome composition between family members, a baby gets the majority of their microbiome from the mother. This is called vertical transmission. Or in early life, seeding. Both vertical transmission and seeding describe the microbial transfer that takes place at birth and through later interactions with mom.

Factors that influences a baby’s microbiome include:

- A mother’s diet during pregnancy
- Antibiotic use and medication
- How a baby is born, vaginal or C-section
- Gestational age at birth
- How long a baby is breastfed
- When and what solids are first introduced
- What environment a baby is exposed to

When does the baby gut mature?

As a baby grows, their gut microbiome matures and their immune system gets a little more skilled at identifying friend versus foe.

Ideally, a baby’s gut starts off dominated by bifidobacteria. During this time, breastmilk can suppress the development of harmful bacteria and keep the baby's gut health in check. Then, the first major leap we see is when a baby starts solids and weans from breastmilk. At this point, microbial diversity suddenly shoots up.

Parents have the greatest potential to impact a baby’s gut health during pregnancy and the baby’s first 12 months. As a toddler, there are gradual shifts towards a more diverse and adult-like microbiome that stabilizes between 3 and 5 years old.

Factors that affect baby gut health include vaginal birth or C-section, breastfeeding or formula feeding, the use of antibiotics and medications, exposures in the home and environment, time of weaning, and nutrition.

What is gut dysbiosis in a baby?

Dysbiosis in a baby means something similar as in an adult. Essentially it’s an imbalance of the microbial communities that live in the gut.

However, unlike the adult gut, the baby gut is developing and flexible to changes in the environment. For better or worse. This window of development - a baby’s first 1,000 days - is the period during which chronic diseases can take root.

This means that off-kilter immune development, metabolic issues, and inflammation linked to dysbiosis can translate into obesity, allergies, asthma, and autoimmune disease later on in adulthood.

In early life, dysbiosis can look like low levels of certain beneficial bacteria. In your baby, this may manifest as colic, eczema, food allergies, or tummy troubles.

The parent report

Should I take a gut and vaginal health test during pregnancy?

While many expectant mothers are encouraged to take a prenatal vitamin and DHA during pregnancy, less is often said about gut and vaginal health.

But as it turns out, the microbes you live with - on your skin and in your body - have a big impact on your baby’s development during pregnancy and a baby’s first two years.

This window of time is commonly referred to as a baby’s first 1,000 days. In addition to important vitamins, minerals, and fatty acids, we now know that optimal immune and brain development takes place with the help of beneficial microbes that a baby inherits from their mother.

Our test will help you find out if you have the right microbes to pass on to your baby and how you can take action to start nurturing your own gut health.

We also offer support in how to best ensure a healthy pregnancy with the use of nutrition, supplements, and simple lifestyle suggestions that can reduce pregnancy complications such as preterm birth and vaginal infection, and painful baby conditions such as eczema or food allergies.

When should I test or resample as a parent?

The timing of your Tiny Health test does matter.

We recommend that you test in the first trimester so that you can take action where needed and again in the third trimester of your pregnancy to track if there’s been a positive change. If your vaginal sample returns a CST4 result, resampling may also be necessary.

Does my microbiome affect my fertility or preterm birth?

Just like the gut, the vaginal microbiome can also experience dysbiosis. What’s more, certain communities of bacteria are linked to early labor or are pro-inflammatory, increasing the risk of vaginal or systemic infection.
To keep things simple, you could say that a vaginal microbiome dominated by Lactobacillus is “good” and that anything else is “bad.” But the reality is a little more complex than that.

For starters, researchers are just beginning to get a sense of what a healthy vaginal microbiome might look like. And if you bounce from study to study, there’s a struggle to find consistent signatures. In addition to this, there are other factors to consider. For example, genetics and pregnancy history.

It’s safe to say that there are multiple moving pieces to the puzzle. However, the information we currently have suggests that taking care of your immune system and your microbes can reduce the likelihood of pregnancy complications and provide long-term health benefits.

I had a C-section. What does this mean for my baby’s gut health?

C-section delivery is typically associated with specific gut microbiome shifts in the infant. Breastfeeding may help correct gut microbial imbalances caused by C-section birth.

By testing mom and baby, we can give advice on how best to shift the baby's microbiome to a more ideal state.

The baby report

What can Tiny Health’s Baby Report tell me?

The baby report provides an overview of your little one’s gut microbial environment, including information about beneficial bacteria, inflammation, and disease associations.

We are very interested in looking at a baby's stool sample 7-day after birth, because the first microbes that colonize the baby’s gut will leave an immune imprint that will last a long time. This early sample will give time to positively change the gut microbiome.

The 3-month and 12-month samples can shed some light on whether a baby has biomarkers associated with eczema, allergies, and asthma. The 6-month sample can explain how a change in diet may impact a baby’s microbiome. For example, how breastmilk, formula, or solids change the microbiome.

For a toddler 1 year old and up, we track gut microbiome maturation and diversity, the capacity to produce butyrate, and inflammatory markers.

Our research-backed reports include actionable recommendations customized according to your unique health history, microbiome composition, symptoms, and experiences.

Is it best for my baby to take a gut health test in the first year of life?

During the first year, an incredible amount of development takes place, which includes immune system training through the microbiome.

This immune training - especially programmed in the first 3 to 6 months of life - contributes to a child’s lifelong health and has been directly linked to a wide range of metabolic and immune-mediated chronic disease.

Eczema, allergies, asthma, type 1 diabetes, inflammatory bowel disease, and obesity have all been strongly linked to a suboptimal baby microbiome. Weaker associations include those for ADHD, autism, and other autoimmune conditions.

By testing at several time points during the year, you may be able to influence the trajectory of your baby’s microbiome and immune development.

When should I get my baby’s gut microbiome profiled?

The best way to track a baby’s gut health is with a series of tests, because the baby’s microbiome changes very rapidly in the first few years.

The earlier you test, the more impact a potential intervention may have for their lifelong health. Because of this, we strongly encourage you to submit your baby’s first sample as soon as possible and not wait.

From a scientific point of view, the 7-day post birth sample is the most important one. The pioneering microbes that colonize a baby’s gut may leave an immune imprint important for their long-term development. And it will give enough time to improve the microbiome when necessary.

The 3-month and 12-month samples may shed some light on whether a baby has biomarkers associated with eczema, allergies and asthma. The 6-month sample may show how changes in diet (such as breastmilk, formula, solids) impact a baby’s microbiome.

For a toddler 1 year old and up, we track other important biomarkers for overall gut health such as gut microbiome maturation, microbiome diversity, butyrate production capacity, and inflammation markers.

We also encourage you to resample when there is a big change in your or your baby’s feeding patterns, use of medications like antibiotics, a new medical diagnosis, new symptoms (like allergies, eczema, or bloody stool), or a change in behavior, such as digestive complaints or sleep issues.

Terminology 101

What is taxonomy?

Taxonomy refers to the naming system used to describe all living organisms. Organisms are classified according to different levels: domain, kingdom, phylum, class, order, family, genus, species, and strain. You can think of these taxonomic descriptions as Russian nesting dolls where domain is the largest and strain is the smallest.

Microbial names usually include genus and species information, such as Bifidobacterium (genus name) infantis (species name) or Candida albicans, which may be abbreviated as B. infantis or C. albicans, respectively.

What are antibiotics?

Anti- is a prefix meaning “opposed” or “against.” Biotic relates to living things.

True to their name, antibiotics have a knack for working against living things (microbes) in your body. Depending on the antibiotic, this means all bacterial life, including the beneficial microbes that we want to keep around.

Antibiotics have revolutionized medicine and made many formerly catastrophic diseases easily manageable. But the flip of this is that they also kill bacteria that are beneficial to us. Short term side effects, such as diarrhea and vaginal yeast infections, are also common after antibiotics.

Destroying large groups of bacteria indiscriminately gives opportunistic microbes a chance to grow. For this reason, we want to pay special attention to antibiotic use in your baby’s first 1,000 days.

What are probiotics?

According to the International Scientific Association for Probiotics and Prebiotics (ISAPP), probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”

There’s a good chance you’ve encountered probiotics before, as they’re commonly sold as dietary supplements. However, not all probiotics are created equal.

The strains in most formulas consist of lactic acid bacteria and bifidobacteria which are not necessarily adapted to live in the gut. And that’s where the power of some probiotics teeters out. It may often be better to stimulate the friendly bacteria that are already living in the gut.

It’s worth understanding how to protect and nourish the microbes that support everyday health. And that’s what we at Tiny Health are all about.

What are prebiotics?

Prebiotics selectively feed specific gut microbes and are defined as“nondigestible food ingredients that beneficially affect the host.”

Prebiotics include human milk oligosaccharides (HMOs) in breastmilk, fibers in plant foods, and polyphenols in fruit. Many of these can also be taken as supplements.

What are postbiotics?

Postbiotics are the metabolites that microbes make to help us out, such as vitamins, secondary bile acids, and short-chain fatty acids such as butyrate. Some of these compounds can be taken as supplements or are being developed into medications.

What are pathobionts?

Pathobionts are organisms that only cause harm under certain circumstances and generally at high levels. Microbes cannot neatly be categorized as either “good” or “bad.”

This realization has led researchers to focus more on overall ecology, e.g. who else is there besides just this species? In other words, context matters.

The technology

What are the different sequencing methods? And why should I care?

When it comes to sequencing, think of it as a picture. When you send us your sample, we analyze it and you get a snapshot of where you're at.

Now, think about the picture itself. Depending on its quality, you might have a boxy, pixelated image that makes it tough to zoom in. Or maybe your picture is high resolution, with crisp edges and a whole lot of detail.

In a broad sense, the tools we use for sequencing are similar. One method, the one we at Tiny Health use, gives us a high resolution snapshot. The other methods, not so much.

Let’s break this down:

1. PCR / qPCR: These test whether specific known microbes are present and can be very sensitive.

2. 16S rRNA amplicon profiling: This tells us which high-level groups of bacteria and archaea are present but - because the image is little unclear - it can be tough to tell the difference between similar species.

3. Shotgun metagenomics: This gives us the highest resolution picture, helping us to not only identify the microbes present in your microbiome down to the species and strain level, but even discover new bacterial genes that have yet to be identified or named.

The ultra sharp image we get with shotgun metagenomics allows us to look at some viruses, yeast, and other microbes that make up the living ecosystem of your microbiome. And while currently less explored than bacteria, these other microbes also interact with bacteria and your baby’s immune system, affecting its development.

Are your services CLIA-compliant?

Yes, we process submitted samples through a CLIA-certified laboratory to provide our microbiome sequencing services.

CLIA-certified laboratories are required to meet strict quality standards and ensure the accuracy and reliability of your results.

The wellness microbiome test

What is the difference between a diagnostic test and a wellness test?

Diagnostic testing aims to provide clinical insights into disease risks or conditions and require FDA approval. Tiny Health tests, on the other hand, are currently exclusively intended to be used for wellness purposes.

Our reports are for informational and educational purposes. The tests we offer are not intended to prevent, diagnose, or treat disease or to substitute for a physician’s consultation.

How are Tiny Health’s microbiome tests different from other microbiome tests?

Unlike other commercial microbiome services, Tiny Health currently offers the first direct-to-consumer microbiome test with analytic services tailored for infants.

Our recommendations are also specific to the health needs of expectant and pregnant women and young infants. Additionally, our shotgun metagenomics sequencing offers more comprehensive, in-depth microbiome data compared to that obtained with amplicon-based options (see The Technology section of FAQs).