Summaries for consumers

Probiotics to prevent gestational diabetes mellitus

Gestational diabetes mellitus is a condition where the mother has high blood sugar levels during pregnancy. It is associated with a range of adverse pregnancy outcomes for the mother, such as pre‐eclampsia (high blood pressure with protein in the urine) and instrumental or operative delivery, as well as for the infants who may be born large‐for‐gestational age. Current treatment includes diet with or without medication. Prevention of this condition would be preferable to treatment. Preventative diet and lifestyle interventions are time consuming and do not always reduce the number of women getting gestational diabetes. Probiotics ‐ 'good' bacteria that are usually taken in the form of capsules or drinks ‐ supplement the gut bacteria. They have the potential to change a person's metabolism and so prevent gestational diabetes mellitus. This review was designed to look at whether there is evidence to show if this is true or not. At the moment there is only one randomised controlled study, which involved 256 women. This study does show a lower rate of gestational diabetes mellitus in women who took probiotics from early pregnancy, with the rate of diagnosis of gestational diabetes mellitus being reduced by two‐thirds and their babies on average weighed 127 g less at birth. This study did not find differences in the rates of miscarriage, intrauterine or neonatal death or stillbirth. There was no clear evidence of a change in the proportion of women delivered by caesarean section or in the risk of preterm delivery. The study did not report on how much weight the mothers gained during pregnancy or how many babies were large‐for‐gestational age or that weighed more than 4000 g at birth or on the body composition of the babies. One study is not enough to draw any definite conclusions at the moment. There are other studies underway.

What can help prevent gestational diabetes?

Some women can prevent gestational diabetes (diabetes in pregnancy) by getting enough exercise and changing their diet. But there is no evidence that this also prevents complications during pregnancy and childbirth. Women’s metabolism changes in pregnancy. This can cause their blood sugar levels to increase temporarily. If certain levels are exceeded, the woman is considered to have gestational diabetes. Risk factors include being very overweight, having relatives with diabetes, and having had diabetes in a previous pregnancy.

Treatments for gestational diabetes

The best way of identifying and treating women with abnormal blood glucose tests in pregnancy is not known. Raised blood glucose levels during pregnancy is known as gestational diabetes. This abnormality may be associated with bigger babies, more difficult births and could be associated with higher rates of operative delivery such as caesarean section. The review of eight studies (1418 women) suggests that offering specific treatment for gestational diabetes may be associated with better baby and mother outcomes, but has not found robust evidence on the best choice of treatment which provides the better outcomes for these women and their babies, even if identified correctly. More research is needed to assess long‐term mother and baby outcomes.

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