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Can probiotics be used to reduce complications during pregnancy? MP




INTRODUCTION


Complications during pregnancy  

The majority of pregnancies are not associated with any health problems. However, some women can experience health complications during pregnancy including high blood pressure, gestational diabetes mellitus (GDM), infections, preeclampsia, preterm birth, miscarriage and stillbirth. These complications can affect the mothers and/or the foetuses health and may even affect survival (1). 


GDM is associated with foetal macrosomia (new-born with excessive weight) and also increases the risk of obesity and diabetes later in life for the infant (2). Additionally, preeclampsia can increase the risk of developing cardiovascular conditions and diabetes mellitus later in life in both the infant and the mother (3). Preeclampsia has also been shown to be a risk factor for the development of asthma, eczema and allergy in childhood (4) Preterm birth has been associated with higher rates of cardiovascular disorders, neurodevelopmental disabilities and learning difficulties later in life, alongside an increased risk of asthma and atopic dermatitis (5,6) It has been suggested that bacterial infections may be associated with pregnancy complications and may even induce some of these conditions (7). 


Probiotics during pregnancy – the evidence  

A number of large observational studies have investigated if the consumption of certain probiotics could help in maintaining a normal pregnancy and avoid the complications above. More specifically, the probiotics examined was Lactobacillus (L.) acidophilus BIFOLACTM5, L. rhamnosus BIFOLACTMGG, and Bifidobacterium animalis ssp. lactis BIFOLACTM12. The study described in the following was a part of the Norwegian Mother and Child Cohort Study, where several thousand women were provided with two questionnaires during the first 4-5 months of pregnancy. The questionnaires were designed to provide insight on the mother ́s health and dietary patterns, specifically in relation to the consumption of probiotics. When comparing women with a daily intake of probiotics to women not consuming probiotics, in relation to the likelihood of preterm birth, it was shown that the daily intake of probiotics reduced the probability of preterm birth by 18% (fig. 1) (8).  

Figure 1. Pregnant women taking probiotics to reduce the risk of preterm delivery.The diagram illustrates the likelihood of preterm birth (Odds ratio) in women with no intake of probiotics and in women with daily intake of probiotics. The daily intake of probiotics reduced the likelihood of preterm birth by 18% .



The observations from Norway have been further corroborated by a number of intervention studies, using a combination of the same strains as those previously investigated. In addition to outcomes of the studies in Norway, the effect of probiotics on the mother ́s metabolism has also been examined. In a study from Finland, a combination of L. rhamnosus BIFOLACTMGG, and Bifidobacterium animalis ssp. lactis BIFOLACTM12 was tested. Here 256 pregnant women were divided among three groups: a control group receiving placebo, a group receiving dietary counselling and placebo, and a group receiving dietary counselling and probiotics. The mothers consumed the placebo or probiotics daily for approximately 12 months (first trimester to end of exclusive breastfeeding). The results of the study showed that consumption of probiotics led to a significant reduction in the frequency of women with gestational diabetes mellitus (GDM) (figure 2) (9).




Figure 2. Frequency of gestational diabetes mellitus reduced in pregnant women taking probiotics.  The illustration depicts the difference in the frequency of gestational diabetes mellitus in the study groups. The consumption of probiotics was shown to reduce the frequency of gestational diabetes mellitus (probiotics:13% vs. control:34% vs. diet/placebo 36%) (9). 


Besides providing support for the mother during pregnancy, maternal consumption of probiotics has also been shown to affect the infant health. A study investigating the effect of consuming L. rhamnosus BIFOLACTMGG on infant immune maturation included 62 mother-infant pairs. The mothers consumed either probiotics or placebo from 4 weeks before giving birth through the breastfeeding period. The study showed that probiotic consumption resulted in a significant reduction in the prevalence of chronic relapsing atopic eczema (probiotic group: 15% vs. placebo group: 47%) (figure 3). This was further associated with a significantly reduced risk of acquiring atopic eczema (10)



Figure 3 - Pregnant women taking probiotics to reduce the development of atopic eczema in their babies. The diagram shows the number of infants experiencing chronic relapsing atopic eczema. Chronic relapsing atopic eczema occurred in 15% of infants in the probiotics and in 47% of infants in the placebo group, which was a significant reduction (10).  


Probiotics have been shown to be safe to take during pregnancy, especially Lactobacilli and Bifidobacterium. They have shown to be well tolerated and have a low risk of side effects (11,12). Additionally, the evidence has shown that the consumption of probiotics should be encouraged amongst pregnant women to decrease the risk of complications during pregnancy and reduce the incidence of adverse health effects in infancy and into adulthood.


Folic acid during pregnancy 

Neural tube defects (NTDs) is one of the most common serious birth defects throughout the world, affecting 1 in every 1000 pregnancies. NTDs can result in termination of foetus or fatal or severe disabilities of an infant (13). 


NTDs can be prevented by the consumption of folic acid during pregnancy. Folic acid is the man-made version of the vitamin folate. Folic acid is essential for normal and maternal tissue growth and development during pregnancy in order to meet the rapid growth and nutrient demands for the placenta and foetus. It is recommended that all women who are trying to get pregnant and during the first 12 weeks of pregnancy should consume at least 400ug of folic acid per day (14).  


SOURCES  

  1. https://gem-3910432.netWhat are some common complications of pregnancy? [Internet]. http://www.nichd.nih.gov/. 2017 [cited 18 June 2019]. Available from: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/complications 
  2. Coustan DR. Gestational Diabetes Mellitus. Clin Chem. 2013;59(9):1310-1321. doi:10.1373/clinchem.2013.203331 
  3. Gathiram P, Moodley J. Pre-eclampsia: its pathogenesis and pathophysiolgy. Cardiovasc J Afr. 2016;27(2):71-78. doi:10.5830/CVJA-2016-009 
  4. Stokholm J, Sevelsted A, Anderson UD, Bisgaard H. Preeclampsia associates with asthma, allergy, and eczema in childhood. Am J Respir Crit Care Med. 2017;195(5):614-621. doi:10.1164/rccm.201604-0806OC 
  5. Freitas AC, Bocking A, Hill JE, Money DM. Increased richness and diversity of the vaginal microbiota and spontaneous preterm birth. Microbiome. 2018;6(1):1-15. doi:10.1186/s40168-018-0502- 
  6. Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Why focus on preterm birth and stillbirth? Global report on preterm birth and stillbirth (1 of 7): defi nitions, description of the burden and opportunities to improve data R E V I E W BMC Pregnancy and Childbirth. BMC Pregnancy Childbirth. 2010;10(1):1. http://www.biomedcentral.com/1471- 2393/10/S1/S1     
  7. Seong H, Lee S, Kang J, Romero R, Yoon B. The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact 

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