Pregnancy and breastfeeding can be a wonderful experience for any women, but unfortunately some women will experience complications. In recent years there has been a growing focus on the impact of the gut microbiome on human health and disease, suggesting that an imbalanced state of the gut bacteria, termed “dysbiosis”, may be associated with growing number of conditions such as inflammatory bowel disease, irritable bowel syndrome, obesity, type 2 diabetes, allergies, and neurological disorders. Hippocrates himself, the father of modern medicine, stated, “All disease begins in the gut.”
What does gut bacteria have to do with pregnancy?
It has been found that during pregnancy the composition of the bacteria in the gut, vagina and placenta changes. The maternal gut bacteria influence not only the mother’s health but also that of her offspring. Additionally, an imbalance of the microbiome could contribute to pregnancy complications.
One way to manipulate the gut bacteria during pregnancy in order to improve pregnancy outcomes is to take probiotic supplementation.
What are probiotics?
You have probably heard of the term ‘probiotics’ – the type of good bacteria defined by the World Health Organization (WHO) as ‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’. It is the type of beneficial bacteria that can be found in in the form of dietary supplements and fermented foods.
Probiotics include many strains and species of bacteria, alone or in combination; the most commonly used are live bacteria such as Lactobacillus and Bifidobacterium species. Supplements can be taken as capsules, tablets, powders, and sachets.
Probiotics in pregnancy
Probiotics taken during pregnancy may help lower the risk of some pregnancy complications.
Preeclampsia
Preeclampsia is a serious pregnancy complication that can occur during the second half of pregnancy or the first few days after the birth. It is characterised by high blood pressure and damage to multiple organs in the body, and can severely affect both the mother and her unborn baby. Data on more than 70,000 pregnancies from a Norwegian study revealed that probiotic intake was associated with a 20% lower risk of developing preeclampsia.
Probiotics species: Lactobacillus acidophilus, Lactobacillus rhamnosus GG, Bifidobacterium lactis is good for: pregnant women at high risk for developing preeclampsia – first pregnancy, women with a history of high blood pressure, preeclampsia or kidney disease, women whose sisters and mothers had preeclampsia, women carrying multiple babies, women younger than 20 years and older than age 40, and women who are obese or have a BMI of 30 or greater. It should be started in late pregnancy.
Gestational diabetes
This form of diabetes occurs during pregnancy, affecting between 12% and 14% of pregnant women. It usually occurs around the 24th to 28th week of pregnancy. Gestational diabetes causes high blood sugar that usually returns to normal soon after delivery, but can put you at risk for type 2 diabetes later in life, as well as result in preterm delivery or in delivering a very large baby.
Probiotic supplementation in women with gestational diabetes is associated with significant reductions in insulin resistance – insulin is the hormone that controls your blood sugar levels. In insulin resistance, your body cells do not respond properly to insulin and thus cannot easily absorb sugar from the blood. As a result, blood sugar levels remain high.
Probiotics species: Bifidobacterium, Lactobacillus rhamnosus is good for: women diagnosed with gestational diabetes or women at risk - 40 years or over, have a personal or family history of type 2 diabetes or a first-degree relative (mother or sister) who has had gestational diabetes, overweight, have had elevated blood glucose levels in the past, have previously given birth to a large baby (weighing more than 4.5kg), taking some types of anti-psychotic or steroid medications, and have gained weight too rapidly in the first half of pregnancy. It should be started from 14 to 16 weeks’ gestation.
Mastitis
This painful inflammation of the breast usually occurs within the first 6 to 12 weeks after giving birth and can make you feel like you have the flu. It affects 1 in 5 breastfeeding mothers, and many stop breastfeeding earlier than planned due to the condition. One study showed that probiotics are as effective as antibiotics in treating mastitis. It has also been suggested that the anti inflammatory properties of probiotics may prevent the development of mastitis, but studies are still ongoing.
Probiotics species: Lactobacillus Fermentum is good for: women with mastitis and should be started in the first 2 months following birth.
Eczema (Atopic dermatitis)
The prevalence of this inflammatory skin condition is increasing in infants. More than 50% of eczema sufferers show signs within their first 12 months of life.
Eczema can significantly affect the child’s quality of life due to itching and scratching, sleep disturbances, pain, bleeding, and dietary limitations.
Taking probiotics during pregnancy has been found to reduce the incidence of eczema in the offspring by almost 80%.
Probiotics species: Lactobacillus rhamnosus GG is good for: pregnant women at high risk for having an allergic child - high risk for allergy in a child is defined as biological parent or sibling with existing or history of allergic rhinitis, asthma, eczema, or food allergy. It should be started at 34–36 weeks of gestation and continue in the postpartum period until the baby was 3–6 months of age (or until weaned).
Cystitis
Urinary tract infection (UTI), often called cystitis, is an infection in part of the urinary system mostly in the lower urinary tract - the bladder. The vast majority of UTIs are caused by E. coli bacteria, a type of bacteria that usually live in the digestive tracts of humans and animals but can invade the urinary tract, attach to the lining of the bladder and lead to inflammation. Around 50% of women and 5% of men will experience at least one UTI in their lifetime. UTI is a common complication of pregnancy, and can result in risks to both the foetus and the mother. Probiotics inhibit the growth of bacteria that are likely to cause UTIs, replenish your normal flora, and stimulate your immune function. Preliminary studies using probiotics supplements show promise for prevention and treatment of UTIs.
Probiotics species: Lactobacillus is good for pregnant women with cystitis or with a history of recurrent cystitis.
Strep B.
Vaginal colonisation of Group B Streptococcal is a leading cause of infections in newborns. It is transmitted to the baby via the amniotic fluid during delivery and can lead to potentially life-threatening conditions. A study from Taiwan showed that probiotics given to pregnant women who were tested positive for Group B Strep infection reduced the vaginal and rectal colonisation rate.
Probiotics species: Lactobacillus rhamnosus, Lactobacillus reuteri is good for: women who test positive for Group B Strep infection and started. For prevention - early in pregnancy; for treatment - soon after diagnosis.
The bottom line
Probiotic supplementation is considered safe in pregnancy and breastfeeding, but in some cases they may cause mild stomach upset. Nevertheless, complications of pregnancy can have devastating effects, so if you are pregnant or breastfeeding, you should always talk with your doctor before taking a probiotic supplement.
References
- Arroyo, R. et al., 2010. Treatment of Infectious Mastitis during Lactation: Antibiotics versus Oral Administration of Lactobacilli Isolated from Breast Milk. Clinical Infectious Diseases, 50(12), pp.1551–1558. Available at: https://academic.oup.com/cid/article-lookup/doi/10.1086/652763
- Battcock, M., Azam-Ali, S., & Food and Agriculture Organization of the United Nations. (1998). Fermented fruits and vegetables : a global perspective. Food and Agriculture Organization of the United Nations. Retrieved from: http://www.fao.org/docrep/x0560e/x0560e00.htm
- Brantsaeter, A.L. et al., 2011. Intake of Probiotic Food and Risk of Preeclampsia in Primiparous Women: The Norwegian Mother and Child Cohort Study. American Journal of Epidemiology, 174(7), pp.807–815. Available at: https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kwr168
- Elias, J., Bozzo, P. & Einarson, A., 2011. Are probiotics safe for use during pregnancy and lactation? Canadian family physician Medecin de famille canadien, 57(3), pp.299–301. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21402964
- Gomez Arango, L.F. et al., 2015. Probiotics and Pregnancy. Current Diabetes Reports, 15(1), p.567. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25398206
- Ho, M. et al., 2016. Oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 to reduce Group B Streptococcus colonization in pregnant women: A randomized controlled trial. Taiwanese Journal of Obstetrics and Gynecology, 55(4), pp.515–518. Available at: http://www.ncbi.nlm.nih.gov/pubmed/27590374
- Lindsay, K.L. et al., 2013. Probiotics in pregnancy and maternal outcomes: a systematic review. The Journal of Maternal-Fetal & Neonatal Medicine, 26(8), pp.772–778. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23205866
- Nordqvist, M. et al., 2018. Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway. BMJ open, 8(1), p.e018021. Available at: http://www.ncbi.nlm.nih.gov/pubmed/29362253
- Taylor, B.L. et al., 2017. Effect of Probiotics on Metabolic Outcomes in Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 9(5). Available at: http://www.ncbi.nlm.nih.gov/pubmed/28475161
- Wickens, K.L. et al., 2017. Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: a randomised controlled trial. The British journal of nutrition, 117(6), pp.804–813. Available at: http://www.ncbi.nlm.nih.gov/pubmed/28367765
- Schippa, S., & Conte, M. P. (2014). Dysbiotic events in gut microbiota: impact on human health. Nutrients, 6(12), 5786–805. http://doi.org/10.3390/nu6125786
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