|
|
Can Fam Physician. 2005 November 10; 51(11): 1477–1479. | PMCID: PMC1479476 |
Taking probiotics during pregnancy Are they useful therapy for mothers and newborns? Gregor Reid, PHD, MBA and Pirkka Kirjaivanen, PHD QUESTION Recently, several of my pregnant patients have asked me about using
probiotics during pregnancy. Is there any evidence that these innocuous
bacteria work effectively? ANSWER An increasing body of evidence suggests that probiotics are effective for
treating bacterial vaginosis and allergic reactions. Most probiotics
available in Canada, however, are of dubious quality, and, for many claimed
indications, there is no proof of effectiveness yet. QUESTION J’ai reçu récemment de nombreuses questions de patientes enceintes concernant
l’utilisation de probiotiques durant la grossesse. Existe-t-il des données
scientifiques démontrant l’efficacité de ces bactéries inoffensives? RÉPONSE Un nombre grandissant de données scientifiques font valoir que les
probiotiques sont efficaces dans le traitement des vaginoses bactériennes et
des réactions allergiques. Par ailleurs, la majorité des probiotiques sur le
marché au Canada sont de qualité douteuse et, pour de nombreuses autres
indications, aucune donnée ne prouve encore leur efficacité. Probiotics have been described as live microorganisms that, when administered in adequate
amounts, confer a health benefit on the host. In Canada, most so-called probiotic
products have never been clinically tested; only two proven probiotic products are
available: the eight-strain VSL#3 for inflammatory bowel disease and Activia yogurt
containing Bifidobacterium lactis DN 001 for regularity. A number of products seem to be associated with favourable effects, such as
Lactobacillus rhamnosus GG (ConAgra), B lactis
BB12 with Lactobacillus acidophilus La5 (Chr Hansen), and
Lactobacillus reuteri SD2112 (Biogaia), all of which are used to
treat diarrhea. 1-3 These and other strains, such as L rhamnosus GR-1, L
reuteri RC-14 (Chr Hansen), and Saccharomyces boulardii
LYO (Biocudex) for urogenital health, 4
Lactobacillus plantarum 299V (Lallemand) for reducing hospital-acquired
infections, 5 and Lactobacillus casei
Shirota (Yakult) for perhaps reducing recurrence of bladder cancer, 6 are in various stages of entering the market. Studies suggest that good nutrition during pregnancy improves the chances of having a
healthy baby who will be at lower risk of diseases, such as diabetes and heart
disease, later in life. 7 The case for folic
acid supplements emerged from our increased knowledge of fetal development. The case
for consuming live bacteria, although it might not be well received by many women,
also has some scientific merit. Bacterial vaginosis, a condition in which lactobacilli are displaced from the vagina
by inflammation-causing pathogens, 7 has been
suggested as a factor that increases risk of preterm labour, 8 although there is controversy about this. Daily use of oral
gelatin capsules containing dried viable L rhamnosus GR-1 and
L reuteri RC-14 has been shown to decrease risk of bacterial
vaginosis and maintain normal lactobacilli vaginal flora. 9,10 In animal studies,
these strains were found to be safe during pregnancy and to enhance the health of
mothers and newborns. 11 Studies are under way
in Toronto, Ont, to test the effects of these strains on bacterial vaginosis in
pregnant women at risk of preterm labour. These lactobacilli might also have a role in preventing vaginal colonization by group
B streptococci, organisms that can cause serious illness and even death in newborns.
Certain lactobacilli can inhibit growth and adhesion of streptococci in vitro, 12,13
but whether they can do this in vivo is untested. The second promising area of research is use of probiotics to prevent allergic
reactions. Studies using L rhamnosus GG and B lactis
BB12 have shown that atopic dermatitis, a condition that causes severe skin
rashes in up to 15% of babies, can be prevented in 50% of cases if mothers ingest
probiotics during pregnancy and newborns ingest them during the first 6 months of
life. 14,15 This is believed to be due to a reprogramming of the newborn’s immune
system or altered proportions of plasma-neutral lipids and alpha-linolenic
acid. 15
Lactobacillus rhamnosus GG is not available in Canada, however, and
probiotics are not permitted for use in newborns. Also, a few cases of asthma arose
in the Finnish study, 16 suggesting more
studies are needed. Probiotics during pregnancy have an excellent safety record. 17 Some researchers argue that the substantial changes in diet
that have come about in modern times are denying humans natural replenishment of the
beneficial bacteria, that we have been ingesting for ages. 18Currently, few of the world’s proven probiotics are available in Canada. Canadians
buy products of dubious quality. 19 For
consumers to get access to high-quality, clinically proven probiotics, they have to
import them from the United States and Europe. For mothers whose previous babies
suffered from atopic dermatitis, daily use of L rhamnosus GG might
be worth considering. It is important for family physicians to be up-to-date on
advances in probiotics. As with other therapeutics, scientifically proven, active
strains of probiotics should be the only products approved by Health Canada and
should be used only for conditions in which efficacy is achieved. Motherisk questions are prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ont. Dr Reid is a Researcher in the Canadian Research and
Development Centre for Probiotics at the Lawson Health Research Institute and in
the Departments of Microbiology and Immunology and Surgery at the University of
Western Ontario in London. Dr Kirjaivanen is a Researcher in the Canadian
Research and Development Centre for Probiotics at the Lawson Health Research
Institute. |
The Canadian Research and Development Centre for Probiotics was established with a
grant from the Ontario Research and Development Challenge Fund. This research is
supported in part by the Canadian Institutes for Health Research and the Natural
Sciences and Engineering Research Council. 1. Guandalini S, Pensabene L, Zikri MA, Dias JA, Casali LG, Hoekstra H, et al. Lactobacillus GG administered in oral
rehydration solution to children with acute diarrhea: a multicenter European
trial. J Pediatr Gastroenterol Nutr. 2000;30:54–60. [PubMed] 2. Saavedra JM, Bauman NA, Oung I, Perman JA, Yolken RH. Feeding of Bifidobacterium bifidum and
Streptococcus thermophilus to infants in hospital for
prevention of diarrhoea and shedding of rotavirus. Lancet. 1994;344(8929):1046–1049. [PubMed] 3. Shornikova AV, Casas IA, Isolauri E, Mykkanen H, Vesikari T. Lactobacillus reuteri as a therapeutic agent in
acute diarrhea in young children. J Pediatr Gastroenterol Nutr. 1997;24:399–404. [PubMed] 4. Reid G, Burton J, Hammond JA, Bruce AW. Nucleic acid based diagnosis of bacterial vaginosis and improved
management using probiotic lactobacilli. J Med Food. pp. 223–228. 5. Rayes N. John M. Kinney International Award for Nutrition and Metabolism.
Lactobacilli and fibers—a strong couple against bacterial
infections in patients with major abdominal surgery. Nutrition. 2004;20(6):579–580. [PubMed] 6. Aso Y, Akaza H, Kotake T, Tsukamoto T, Imai K, Naito S. Preventive effect of a Lactobacillus casei
preparation on the recurrence of superficial bladder cancer in a
double-blind trial. The BLP Study Group. Eur Urol. 1995;27:104–109. [PubMed] 7. Cauci S, Guaschino S, De Aloysio D, Driussi S, De Santo D, Penacchioni P, et al. Interrelationships of interleukin-8 with interleukin-1beta and
neutrophils in vaginal fluid of healthy and bacterial vaginosis positive
women. Mol Hum Reprod. 2003;9(1):53–58. [PubMed] 8. Jacobsson B, Pernevi P, Chidekel L, Platz-Christensen J. Bacterial vaginosis in early pregnancy may predispose for preterm
birth and postpartum endometritis. Acta Obstet Gynecol Scand. 2002;81(11):1006–1010. [PubMed] 9. Reid G, Beuerman D, Heinemann C, Bruce AW. Probiotic Lactobacillus dose required to restore
and maintain a normal vaginal flora. FEMS Immunol Med Microbiol. 2001;32:37–41. [PubMed] 10. Reid G, Hammond JA, Bruce AW. Effect of lactobacilli oral supplement on the vaginal microflora
of antibiotic treated patients: randomized, placebo-controlled study. Nutraceut Food. 2003;8:145–148. 11. Anukam KC, Osazuwa EO, Reid G. Improved appetite of pregnant rats and increased birth weight of
newborns following feeding with probiotic Lactobacillus
rhamnosus GR-1 and L fermentum RC-14. J Appl Res. 2005;5:46–52. 12. Velraeds MM, van der Belt-Gritter B, van der Mei HC, Reid G, Busscher HJ. Interference in initial adhesion of uropathogenic bacteria and
yeasts to silicone rubber by a Lactobacillus acidophilus
biosurfactant. J Med Microbiol. 1998;47:1081–1085. [PubMed] 13. Reid G, Charbonneau D, Gonzalez S, Gardiner G, Erb J, Bruce AW. Ability of Lactobacillus GR-1 and RC-14 to
stimulate host defences and reduce gut translocation and infectivity of
Salmonella typhimurium. Nutraceut Food. 2002;7:168–173. 14. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised
placebo-controlled trial. Lancet. 2001;357:1076–1079. [PubMed] 15. Kankaanpaa PE, Yang B, Kallio HP, Isolauri E, Salminen SJ. Influence of probiotic supplemented infant formula on composition
of plasma lipids in atopic infants. J Nutr Biochem. 2002;13(6):364–369. [PubMed] 16. Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of
a rancdomised placebo-controlled trial. Lancet. 2003;361(9372):1869–1871. [PubMed] 17. Reid G. Safety of Lactobacillus strains as probiotic
agents [letter]. Clin Infect Dis. 2002;35:349–350. [PubMed] 18. Bengmark S. Prospects for new and rediscovered therapies: probiotics and phage. In:
Andrew PW, Oyston P, Smith GL, Stewart-Tull DE, editors. Fighting infection
in the 21st century. London, Engl: Blackwell Science Ltd; 2000. pp. 97–132. 19. Huff BA. Caveat emptor. “Probiotics” might not be what they seem. Can Fam Physician. 2004;50:583–587. [PubMed]
|
