The intrauterine microbiome–neurodevelopment axis: decoding the prenatal microbial imprint on lifelong mental health

Abstract Introduction The traditional view of a sterile intrauterine environment has been challenged by sequencing studies detecting low-biomass microbial DNA in placenta, amniotic fluid, and fetal tissues. These findings suggest that maternal microbiota-derived signals may contribute to fetal brain development and influence long-term neuropsychiatric outcomes. Content This narrative review synthesizes evidence from over 90 preclinical and clinical studies examining maternal microbiota–fetal brain interactions. Maternal immune activation – characterized by elevated cytokines such as interleukin (IL)-6 and IL-17A – has been shown in mouse models to disrupt cortical layering and synaptic organization, while human cohort studies involving more than 250,000 pregnancies link maternal inflammatory markers to increased autism spectrum disorder (ASD) risk. Microbial metabolites, including short-chain fatty acids (butyrate, acetate, propionate), bile acids, and tryptophan derivatives, regulate microglial maturation, blood–brain barrier integrity, and hippocampal neurogenesis. Epigenetic mechanisms – DNA methylation, histone acetylation, and chromatin remodeling – have been observed in placenta and cord blood from pregnancies affected by obesity or dysbiosis. Large-scale epidemiological studies also associate prenatal infection and antibiotic exposure with higher rates of ASD and attention-deficit/hyperactivity disorder (ADHD). Summary Collectively, the evidence indicates that maternal microbiota influence fetal brain development through converging immune, metabolic, epigenetic, and hormonal pathways. Strong mechanistic insights come from animal models, whereas human data remain largely observational, limiting causal interpretation. Outlook Recognizing the maternal microbiome as a modifiable prenatal factor highlights opportunities for prevention. Early translational approaches – including maternal microbiota profiling, dietary optimization, and probiotic supplementation – are under investigation, but require rigorous clinical validation before integration into prenatal care.