Probiotics and Pregnant Women

Study regards safety of maternal probiotic supplementation during the first trimester

By Matthew Baral, ND

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Reference

Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr. 2010 Feb 4:1-8. [Epub ahead of print].
 

Design

Double-blind, placebo-controlled study.
 

Participants

256 pregnant women were recruited during their initial visit at a maternal welfare clinic in Turku, Finland. Pregnant women were randomized to 3 groups: control, dietary intervention (diet), and dietary intervention with probiotic supplementation (diet + probiotics). All groups received basic dietary counseling normally provided by the clinic. However, the dietary intervention group received additional intensive dietary counseling regarding specific fat and fiber recommendations. This group was then further randomized to create the diet + probiotics group. The study period began during the first trimester and ended when exclusive breastfeeding was discontinued. 238 mothers initially started the study, and 191 mother-child pairs followed through to completion. Exclusion criteria included any metabolic diseases, but any history of atopic disease was acceptable. In fact, 79% of the mothers had received a diagnosis of at least one allergic disease (atopic eczema, allergic rhinitis, or asthma) in the past.
 

Study Medication and Dosage

Probiotic treatment included Lactobacillus rhamnosus GG and Bifidobacterium lactis. Each probiotic was taken at 10 billion CFU per day.
 

Key Findings

The diet + probiotic group had a significantly reduced rate of gestational diabetes mellitus (GDM) when compared to controls; 13% of the diet + probiotic group developed GDM, versus 36% in the diet group and 34% in the control group (P=0.003). All groups breastfed their babies until at least until 6 months of age. GDM was linked to increased infant birth weights and lengths in all the groups, but the correlation was strongest in the control group.
 

Practice Implications

This is the first paper to be published on the safety of maternal probiotic supplementation during the first trimester. GDM and maternal obesity are interrelated, and GDM is associated with higher infant birth weight. The unfortunate long-term effects of GDM play a role in both the mother’s and infant’s endocrine and metabolic health: GDM mothers have a very high risk of developing type 2 diabetes later in life and experience a 3-fold increased risk of developing metabolic syndrome, while their children’s risk of diabetes at 19–27 years increases 8-fold.1
Research clearly shows that larger birth-weight babies are at higher risk for becoming obese later in life.
Research clearly shows that larger birth-weight babies are at higher risk for becoming obese later in life.2,3,4 This paper is quite interesting in that it demonstrates the benefits of a nutritional supplement not previously assumed to have a metabolic impact of this scale. Other important research reinforces the connection of probiotic supplementation and obesity. Specific bacterial ratios will either encourage or discourage obesity later in life and even predict obesity development.5 High numbers of bifidobacteria and low numbers of Staphylococcus aureus in infancy can help protect against overweight and obesity in children, possibly revealing a key reason that breastfed infants enjoy a healthier metabolic outcome.6 Not surprisingly, several studies show that breastfeeding is inversely related to childhood obesity.7,8,9 We do know that probiotics help modulate the immune system and therefore inflammation.10 Obesity can lead to a state of low-grade systemic inflammation, possibly explaining the increased incidence of asthma in obese patients.11 Since obesity and inflammation are related, it can be postulated that the probiotic control of inflammation plays a role in obesity prevention. Since 79% of the participants did have a history of allergic disease, it is understandable that probiotic supplementation would have a strong effect on this population and their offspring. This study strengthens support of probiotic use as a pre- and perinatal treatment. Previous research shows prenatal intake will benefit the child in preventing atopy. However, this recent discovery of how beneficial the use of probiotics is on the health of both the mother and child is exciting, adding an inexpensive, noninvasive treatment to the arsenal of obesity prevention tools.

About the Author

Matthew Baral, ND, received his naturopathic medical degree from Bastyr University, Kenmore, Washington, in 2000. He is chair of the Department of Pediatric Medicine at the Southwest College of Naturopathic Medicine and Health Sciences (SCNM), Tempe, Arizona, where he teaches pediatrics in the classroom and supervises student clinicians on clinical rotations. Baral designed the first naturopathic pediatric residency program in naturopathic medicine and serves as its director at SCNM. He is also the founding and current president of the Pediatric Association of Naturopathic Physicians.
 

References

1. Damm P. Future risk of diabetes in mother and child after gestational diabetes mellitus. Int J Gynaecol Obstet. 2009;104 Suppl 1:S25-26.
2. Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law C. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ. 2005;331(7522):929.
3. Druet C, Ong KK. Early childhood predictors of adult body composition. Best Pract Res Clin Endocrinol Metab. 2008;22(3):489-502.
4. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115(3):e290-296.
5. Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444(7122):1022-1023.
6. Kalliomäki M, Collado MC, Salminen S, Isolauri E. Early differences in fecal microbiota composition in children may predict overweight. Am J Clin Nutr. 2008;87(3):534-538.
7. Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity: a systemic review. Int J Obes Relat Metab Disord. 2004;28:1247-1256.
8. Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol. 2005;162:397-403.
9. Owen C, Martin R, Whincup P, Smith D, Cook D. The effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115:1367-1377.
10. Laitinen K, Hoppu U, Ha¨ma¨la¨inen M, Linderborg K, Moilanen E, Isolauri E. Breast milk fatty acids may link innate and adaptive immune response regulation: analysis of soluble CD14, prostaglandin E2, and fatty acids. Pediatr Res. 2006;59:723-727.
11. Shore SA. Obesity and asthma: possible mechanisms. J Allergy Clin Immunol. 2008;121(5):1087-1093.