Environmental enteric dysfunction: gut and microbiota adaptation in pregnancy and infancy

Carrie A. Cowardin, Sana Syed, Najeeha Iqbal, Zehra Jamil, Kamran Sadiq, Junaid Iqbal, Syed Asad Ali, Sean R. Moore

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)


Environmental enteric dysfunction (EED) is a subclinical syndrome of intestinal inflammation, malabsorption and barrier disruption that is highly prevalent in low- and middle-income countries in which poverty, food insecurity and frequent exposure to enteric pathogens impair growth, immunity and neurodevelopment in children. In this Review, we discuss advances in our understanding of EED, intestinal adaptation and the gut microbiome over the ‘first 1,000 days’ of life, spanning pregnancy and early childhood. Data on maternal EED are emerging, and they mirror earlier findings of increased risks for preterm birth and fetal growth restriction in mothers with either active inflammatory bowel disease or coeliac disease. The intense metabolic demands of pregnancy and lactation drive gut adaptation, including dramatic changes in the composition, function and mother-to-child transmission of the gut microbiota. We urgently need to elucidate the mechanisms by which EED undermines these critical processes so that we can improve global strategies to prevent and reverse intergenerational cycles of undernutrition.

Original languageEnglish
Pages (from-to)223-237
Number of pages15
JournalNature Reviews Gastroenterology and Hepatology
Issue number4
Publication statusPublished - Apr 2023


Dive into the research topics of 'Environmental enteric dysfunction: gut and microbiota adaptation in pregnancy and infancy'. Together they form a unique fingerprint.

Cite this