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Grand Rounds

Cochrane Update 2021: Probiotics Use in Pregnancy for the Prevention of Gestational Diabetes

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BACKGROUND AND PURPOSE:

  • WHO probiotics definition: “live microorganisms which when administered in adequate amounts confer a health benefit on the host”
  • There are various probiotics with specific species and strains
  • Most common probiotics used are members of Lactobacillus,  Bifidobacterium, and Enterococcus genera
  • In an update to a 2014 review, Davidson et al. (Cochrane Database for Systematic Reviews, 2021) assessed the effects of probiotic supplements used either alone or in combination with pharmacological and non-pharmacological interventions on the prevention of GDM

METHODS:

  • Systematic review and meta-analysis
  • Data sources
    • Cochrane Pregnancy and Childbirth’s Trials Register | ClinicalTrials.gov | WHO International Clinical Trials Registry Platform (ICTRP)
    • References of studies also reviewed  
    • Through to March 2020
  • Study inclusion criteria
    • Randomized and cluster‐randomized trials
    • Studies that compared the use of probiotic supplementation with either placebo or diet for the prevention of GDM
  • Study design
    • Two independent review authors: Assessed study eligibility, extracted data and assessed risk of bias of included studies
  • Primary outcomes
    • GDM diagnosis
    • Hypertensive disorders of pregnancy
    • Cesarean delivery
    • Large for gestational age (LGA) neonate
    • Mortality or morbidity composite

RESULTS:

  • 7 trials | 1647 participants
    • Some variability in studies based on inclusion related to maternal weight
    • All studies compared probiotics with placebo
  • Risk of bias
    • Generally low risk of bias | One study had an unclear risk of bias

Probiotics and Maternal Outcomes Including Risk Of GDM, Hypertensive Disorders of Pregnancy, and Cesarean Delivery

  • GDM: Uncertain if probiotics have any effect
    • Mean risk ratio (RR) 0.80 (95% CI, 0.54 to 1.20)
    • 6 studies | 1440 participants
    • Low‐certainty evidence
  • Preeclampsia: Probiotics increase risk
    • RR 1.85 (95% CI, 1.04 to 3.29)
    • 4 studies | 955 women
    • High‐certainty evidence
  • Hypertensive disorders of pregnancy: Probiotics may increase risk  
    • RR 1.39 (95% CI, 0.96 to 2.01)
    • 4 studies | 955 women
    • However, wide CI indicates that probiotics may have no effect
  • Cesarean: Probiotics make little to no difference
    • RR 1.00 (95% CI, 0.86 to 1.17)
    • 6 studies | 1520 women
    • High‐certainty evidence
  • Maternal weight gain during pregnancy: Probiotics make little to no difference
    • MD 0.30 kg (95% CI, –0.67 to 1.26)
    • 4 studies | 853 women
    • Moderate‐certainty evidence

Probiotics and Neonatal Outcomes Including Risk of LGA, Mortality and Morbidity

  • LGA incidence: Probiotics probably make little to no difference   
    • RR 0.99 (95% CI, 0.72 to 1.36)
    • 4 studies | 919 infants
    • Moderate‐certainty evidence
  • Neonatal adiposity: Probiotics may make little to no difference
    • Adiposity as fat mass: MD –0.04 kg (95% CI, –0.12 to 0.04)
    • 2 studies | 320 infants
    • Data not pooled; low‐certainty evidence

Additional Outcomes

  • Probiotics have an unknown effect on
    • Perinatal mortality 
    • A composite measure of neonatal morbidity 
    • Neonatal hypoglycemia 
  • No included studies reported on perineal trauma, postnatal depression, maternal and infant development of diabetes or neurosensory disability

CONCLUSION:

  • There was no clear effect of probiotics on GDM risk (low-certainty evidence)
  • However, there was a clear link between probiotics and an increased risk for preeclampsia (high-certainty evidence)
  • The authors suggest caution in taking probiotics in pregnancy, due to the risk of harm and limited evidence of benefit

Learn More – Primary Sources:

Probiotics for preventing gestational diabetes

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Related ObG Topics:

Does Probiotic Use Reduce Risk of GDM in Obese Pregnant Women?
Could Probiotic Milk Reduce Pregnancy Risks?
Does Folic Acid Supplementation Before Pregnancy Reduce Risk of Gestational Diabetes?

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