Effects of maternal probiotic supplementation on breast milk microbiome and infant gut microbiome and health: a systematic review and meta-analysis of randomized controlled trials

Alemu, Bekalu Kassie; Azeze, Getnet Gedefaw; Wu, Ling; Lau, So Ling; Wang, Chi Chiu; Wang, Yao

doi:10.1016/j.ajogmf.2023.101148

Cited by 5 publications

(3 citation statements)

References 67 publications

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“…Of note, lines of evidence suggest maternal probiotic supplementation not only positively influences the breast milk and infant’s gut microbiome but also enhances maternal health during pregnancy. 26 Importantly, no adverse effects from these supplements during pregnancy have been reported to date. Previous studies showed that directly administering probiotics to neonates enables them to treat and prevent neonatal jaundice.…”

Section: Discussionmentioning

confidence: 99%

“…Our systematic review and meta-analysis proved this innovative approach. 26 The way for this modulation of breast milk is the enteromammary pathway/gut-breast axis, where intestinal dendritic cells and CD18 + cells play an important role in helping beneficial bacteria translocate from the maternal gut to the mammary system. 27–29 The infant gut microbiota is the collection of germs colonising the newborn’s intestine.…”

Section: Introductionmentioning

confidence: 99%

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Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial

Alemu,

Lee,

Leung

et al. 2024

BMJ Open

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IntroductionNeonatal jaundice is a common and life-threatening health problem in neonates due to overaccumulation of circulating unconjugated bilirubin. Gut flora has a potential influence on bilirubin metabolism. The infant gut microbiome is commonly copied from the maternal gut. During pregnancy, due to changes in dietary habits, hormones and body weight, maternal gut dysbiosis is common, which can be stabilised by probiotics supplementation. However, whether probiotic supplements can reach the baby through the mother and reduce the incidence of neonatal jaundice has not been studied yet. Therefore, we aim to evaluate the effect of prenatal maternal probiotic supplementation on the incidence of neonatal jaundice.Methods and analysisThis is a randomised double-blind placebo-controlled clinical trial among 94 pregnant women (47 in each group) in a tertiary hospital in Hong Kong. Voluntary eligible participants will be recruited between 28 and 35 weeks of gestation. Computer-generated randomisation and allocation to either the intervention or control group will be carried out. Participants will take either one sachet of Vivomixx (450 billion colony-forming units per sachet) or a placebo per day until 1 week post partum. Neither the study participants nor researchers will know the randomisation and allocation. The intervention will be initiated at 36 weeks of gestation. Neonatal bilirubin level will be measured to determine the primary outcome (hyperbilirubinaemia) while the metagenomic microbiome profile of breast milk and maternal and infant stool samples as well as pregnancy outcomes will be secondary outcomes. Binary logistic and linear regressions will be carried out to assess the association of the microbiome data with different clinical outcomes.Ethics and disseminationEthics approval is obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee, Hong Kong (CREC Ref: 2023.100-T). Findings will be published in peer-reviewed journals and presented at international conferences.Trial registration numberNCT06087874.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial

Alemu,

Lee,

Leung

et al. 2024

BMJ Open

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“…Multiple combinations of probiotics were used * [138] Studies were reviewed where probiotics were given to pregnant or post-partum women to see the effect on their infants. Durable reduction in atopic eczema for up to 7 years in the infant was seen in one study; other studies either showed mixed results in reducing eczema; additional findings of the studies included reduced blood glucose and increased glucose tolerance during pregnancy, and immunologic findings suggested a positive effect including increasing the amount of anti-inflammatory cytokine transforming growth factor β2 in lactating mother's milk, likely with immunoprotective effects.…”

Section: Study Outline Probiotics Used Referencesmentioning

confidence: 99%

The Importance of a Healthy Microbiome in Pregnancy and Infancy and Microbiota Treatment to Reverse Dysbiosis for Improved Health

DuPont,

Salge

2023

Antibiotics

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Background: The microbiome of newborn infants during the first 1000 days, influenced early on by their mothers’ microbiome health, mode of delivery and breast feeding, orchestrates the education and programming of the infant’s immune system and determines in large part the general health of the infant for years. Methods: PubMed was reviewed for maternal infant microbiome health and microbiota therapy in this setting with prebiotics, probiotics, vaginal seeding and fecal microbiota transplantation (FMT). Results: A healthy nonobese mother, vaginal delivery and strict breast feeding contribute to microbiome health in a newborn and young infant. With reduced microbiome diversity (dysbiosis) during pregnancy, cesarean delivery, prematurity, and formula feeding contribute to dysbiosis in the newborn. Microbiota therapy is an important approach to repair dysbiosis in pregnant women and their infants. Currently available probiotics can have favorable metabolic effects on mothers and infants, but these effects are variable. In research settings, reversal of infant dysbiosis can be achieved via vaginal seeding or FMT. Next generation probiotics in development should replace current probiotics and FMT. Conclusions: The most critical phase of human microbiome development is in the first 2–3 years of life. Preventing and treating dysbiosis during pregnancy and early life can have a profound effect on an infant’s later health.

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Maternal oral probiotic use is associated with decreased breastmilk inflammatory markers, infant fecal microbiome variation, and altered recognition memory responses in infants—a pilot observational study

Gonia,

Heisel,

Miller

et al. 2024

Front. Nutr.

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IntroductionEarly life gut microbiomes are important for brain and immune system development in animal models. Probiotic use has been proposed as a strategy to promote health via modulation of microbiomes. In this observational study, we explore if early life exposure to probiotics via the mother during pregnancy and lactation, is associated with decreased inflammation in breastmilk, maternal and infant microbiome variation, and altered infant neurodevelopmental features.MethodsExclusively breastfeeding mother-infant dyads were recruited as part of the “Mothers and Infants Linked for Healthy Growth (MILk) Study.” Probiotic comparison groups were defined by exposure to maternal probiotics (NO/YES) and by timing of probiotic exposure (prenatal, postnatal, total). C-reactive protein (CRP) and IL-6 levels were determined in breastmilk by immunoassays, and microbiomes were characterized from 1-month milk and from 1- and 6-month infant feces by 16S rDNA sequencing. Infant brain function was profiled via electroencephalogram (EEG); we assessed recognition memory using event-related potential (ERP) responses to familiar and novel auditory (1 month) and visual (6 months) stimuli. Statistical comparisons of study outcomes between probiotic groups were performed using permutational analysis of variance (PERMANOVA) (microbiome) and linear models (all other study outcomes), including relevant covariables as indicated.ResultsWe observed associations between probiotic exposure and lower breastmilk CRP and IL-6 levels, and infant gut microbiome variation at 1- and 6-months of age (including higher abundances of Bifidobacteria and Lactobacillus). In addition, maternal probiotic exposure was associated with differences in infant ERP features at 6-months of age. Specifically, infants who were exposed to postnatal maternal probiotics (between the 1- and 6-month study visits) via breastfeeding/breastmilk, had larger differential responses between familiar and novel visual stimuli with respect to the late slow wave component of the EEG, which may indicate greater memory updating potential. The milk of mothers of this subgroup of infants had lower IL-6 levels and infants had different 6-month fecal microbiomes as compared to those in the “NO” maternal probiotics group.DiscussionThese results support continued research into “Microbiota-Gut-Brain” connections during early life and the role of pre- and postnatal probiotics in mothers to promote healthy microbiome-associated outcomes in infants.

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Effects of maternal probiotic supplementation on breast milk microbiome and infant gut microbiome and health: a systematic review and meta-analysis of randomized controlled trials

Cited by 5 publications

References 67 publications

Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial

Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial

The Importance of a Healthy Microbiome in Pregnancy and Infancy and Microbiota Treatment to Reverse Dysbiosis for Improved Health

Maternal oral probiotic use is associated with decreased breastmilk inflammatory markers, infant fecal microbiome variation, and altered recognition memory responses in infants—a pilot observational study

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