Are Probiotics Safe During Pregnancy and Breastfeeding?

 

Womens Probiotic

 

What are Probiotics? 

Probiotics are living microorganisms that benefit health. Many of these microorganisms are bacteria, which are often thought of as something we should avoid. While there are “bad” bacteria that can cause illness, probiotics are considered “good” bacteria that are critical for normal digestive functioning. Specifically, they help to break down food and ensure that nutrients are well absorbed.

How do we get Probiotics?

Probiotics are naturally present in healthy individuals, but they can also enter the body through foods or formulations. Yogurt, sauerkraut, tempeh, and buttermilk are rich sources of probiotics. Doctors also frequently prescribe probiotic formulations for those suffering from issues related to the digestive system.


What’s important to know about probiotics during pregnancy?

Probiotic supplementation during pregnancy can offer a number of advantages. To accommodate a growing baby, pregnant women undergo a wide array of physiological changes, including in the types and distributions of microorganisms in their bodies. Scientists have suggested that altering this gut “microflora” in expecting mothers may prevent complications during pregnancy. For instance, using probiotic supplementation may improve outcomes related to mucosal immunity, urogenital infections and intestinal dysbiosis [13].

It is not only the mother who is affected by the changes in microflora. Studies have shown that the mother’s gut during the 3rd trimester can influence the immune system and insulin insensitivity in the fetus, both of which have implications for the developing baby’s health [10]. Studies looking at the impact of probiotic supplementation during pregnancy have shown promising results related to pre-eclampsia [16] and pre-term delivery [17], as well as for the likelihood that the child endures gestational diabetes mellitus [14], abnormal weight gain [15], or necrotizing enterocolitis [18].

The relationship between microorganisms and allergic disease in children has been particularly well studied, and there is good reason to believe that probiotics could also alleviate allergies and atopic diseases in infants [13]. One longitudinal study showed that greater diversity in microflora was associated with lower incidences of eczema in infants and that consumption of probiotic milk during pregnancy reduced the risk of atopic eczema in children at 6 months of age [20], [21]. Other studies have demonstrated that administering Lactobacilli, a common bacteria found in milk, during pregnancy reduces the likelihood of atopic eczema in children aged 2 to 7 years [22].

Are probiotics safe for consumption during pregnancy?
Probiotics are generally regarded as “safe.”. They do not tend to have a significant impact on healthy individuals because they are not usually absorbed in this group of people [23]. Clinical trials conducted during third trimester of pregnancy suggest that there is no increased risk of adverse fetal outcomes associated with probiotic supplements. The studies also show that there is a low risk of of probiotics being transferred to breast milk [23]. In pregnancy, probiotic consumption is unlikely to negatively impact adverse pregnancy outcomes or cause harm to either lactating mothers or the fetus [24]. Nevertheless, immunosuppressed patients and patients with leaky gut or significant gastrointestinal disease have an increased risk of sepsis when using probiotics and so must exercise caution [24].

How do probiotics work?
Though the way that probiotics work is not fully understood, the scientific community generally agrees that probiotics work by crowding out “bad” bacteria with “good bacteria.” Because “good” bacteria multiple much faster than “bad” bacteria and compete for the same resources, adding “good” bacteria to our microflora can help eliminate “bad” bacterial strains from the digestive tract [1]. In addition, because many harmful microorganisms do not survive the harsh acidic environment of the stomach, but some probiotic strains can, probiotics that are swallowed can have a positive impact on gut microflora [2] [3].

What are the other therapeutic benefits of probiotics?
While probiotics may be specifically beneficial during pregnancy, they have also been shown to have a number of other therapeutic effects [6, 7]., particularly related to digestion. For instance, research has shown that probiotics can improve outcomes for conditions such as antibiotic-associated diarrhea in adult patients [5] and irritable bowel disease [8].


References
[1] http://www.gutspace.com/how-long-does-it-take-for-probiotics-to-work/

[2] Alander, M., Korpela, R., Saxelin, M., Vilpponen-Salmela, T., Mattila-Sandholm, T. and Von Wright, A. (1997), Recovery of Lactobacillus rhamnosus GG from human colonic biopsies. Letters in Applied Microbiology, 24: 361–364. doi:10.1046/j.1472-765X.1997.00140.x.

[3] Fujiwara, S., Seto, Y., Kimura, A. and Hashiba, H. (2001), Intestinal transit of an orally administered streptomycin–rifampicin-resistant variant of Bifidobacterium longum SBT2928: its long-term survival and effect on the intestinal microflora and metabolism. Journal of Applied Microbiology, 90: 43–52. doi:10.1046/j.1365-2672.2001.01205.x.

[4] LÜ, M., Yu, S., Deng, J., Yan, Q., Yang, C., Xia, G., & Zhou, X. (2016). Efficacy of Probiotic Supplementation Therapy for Helicobacter pylori Eradication: A Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 11(10), e0163743. http://doi.org/10.1371/journal.pone.0163743.

[5] Hickson, M. (2011). Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection. Therapeutic Advances in Gastroenterology, 4(3), 185–197. http://doi.org/10.1177/1756283X11399115.

[6] Tung, J. M., Dolovich, L. R., & Lee, C. H. (2009). Prevention of Clostridium difficile infection with Saccharomyces boulardii: A systematic review. Canadian Journal of Gastroenterology, 23(12), 817–821.

[7] Kelesidis, T., & Pothoulakis, C. (2012). Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology, 5(2), 111–125. http://doi.org/10.1177/1756283X11428502.

[8] Aragon, G., Graham, D. B., Borum, M., & Doman, D. B. (2010). Probiotic Therapy for Irritable Bowel Syndrome. Gastroenterology & Hepatology, 6(1), 39–44.

[9] Gomez Arango, L.F., Barrett, H.L., Callaway, L.K. et al. Curr Diab Rep (2015) 15: 567. http://doi:10.1007/s11892-014-0567-0.

[10] Koren O, Goodrich Julia K, Cullender Tyler C, Spor A, Laitinen K, Kling Bäckhed H, et al. Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell. 2012; 150(3):470–80. http://doi:10.1016/j.cell.2012.07.008.

[11] Thomas DW, Greer FR. Probiotics and prebiotics in pediatrics. Pediatrics. 2010; 126(6):1217–31. http://doi:10.1542/peds.2010-2548.

[12] Gerritsen J, Smidt H, Rijkers GT, de Vos WM. Intestinal microbiota in human health and disease: the impact of probiotics. Genes Nutr.2011;6(3):209–40. http://doi:10.1007/s12263-011-0229-7.

[13] de Vrese M, Schrezenmeir J. Probiotics, prebiotics, and synbiotics. Adv Biochem Eng Biotechnol. 2008; 111:1–66. http://doi:10.1007/10_2008_097.

[14] Nitert MD, Barrett HL, Foxcroft K, Tremellen A, Wilkinson S, Lingwood B, et al. SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women. BMC Pregnancy Childbirth. 2013; 13:50. http://doi:10.1186/ 1471-2393-13-50.

[15] Ilmonen J, Isolauri E, Poussa T, Laitinen K. Impact of dietary counselling and probiotic intervention on maternal anthropometric measurements during and after pregnancy: a randomized placebocontrolled trial. Clin Nutr (Edinb Scotl). 2011; 30(2):156–64. http://doi: 10.1016/j.clnu.2010.09.009.

[16] Organization WH. WHO recommendations for Prevention and treatment of pre-eclampsia and eclampsia. WHO Library Cataloguing-in-Publication Data. 2011.

[17] Rushing J, Neu J. Probiotics for pregnant women and preterm neonates. Am J Clin Nutr. 2011; 93(1):3–4. http://doi:10.3945/ajcn.110. 006346.

[18] AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. The Cochrane database of systematic reviews. 2014; 4:Cd005496. http://doi:10.1002/14651858. CD005496.pub4.

[19] Critchfield JW, van Hemert S, Ash M, Mulder L, Ashwood P. The potential role of probiotics in the management of childhood autism spectrum disorders. Gastroenterol Res Pract. 2011; 2011:161358. http://doi:10.1155/2011/161358.

[20] Forno E, Onderdonk AB, McCracken J, Litonjua AA, Laskey D, Delaney ML, et al. Diversity of the gut microbiota and eczema in early life. Clin Mol Allergy CMA. 2008; 6:11. http://doi:10.1186/1476- 7961-6-11.

[21] Bertelsen RJ, Brantsaeter AL, Magnus MC, Haugen M, Myhre R, Jacobsson B, et al. Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases. J Allergy Clin Immunol. 2014; 133(1):165–71.e1-8. http://doi:10.1016/j.jaci.2013.07.032.

[22] Doege K, Grajecki D, Zyriax BC, Detinkina E, Zu Eulenburg C, Buhling KJ. Impact of maternal supplementation with probiotics during pregnancy on atopic eczema in childhood—a meta-analysis. Br J Nutr. 2012; 107(1):1–6. http://doi:10.1017/s0007114511003400.

[23] Elias, J., Bozzo, P., & Einarson, A. (2011). Are probiotics safe for use during pregnancy and lactation? Canadian Family Physician, 57(3), 299–301.

[24] Dugoua JJ, Machado M, Zhu X, Chen X, Koren G, Einarson TR. Probiotic safety in pregnancy: a systematic review and meta-analysis of randomized controlled trials of Lactobacillus, Bifidobacterium, and Saccharomyces spp. J Obstet Gynaecol Can. 2009;31(6):542–52.


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