Effects of Probiotic Supplement in Pregnant Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background. Previous studies showed that probiotics could improve glycemic control and attenuate some of the adverse effects of type 2 diabetes. However, whether the effects are generalizable to gestational diabetes mellitus (GDM) remains uncertain. Objective. We conducted a systematic review and meta-analysis to evaluate the effects of probiotic supplement in GDM. Method. PubMed, EMBASE, the Cochrane Library, and EBSCO were systematically searched for relevant literature published through January 2019. Randomized controlled trials (RCTs) assessing the effects of probiotic supplement on one or more of the following in GDM were included: pregnancy outcome (the primary outcome), glycemic control, blood lipid profile, and inflammation and oxidative stress. Two reviewers independently extracted data and assessed the risk of bias in studies. Meta-analysis was conducted by using the fixed effects model unless substantial heterogeneity was found among studies. Results. Eleven randomized trials involving 719 participants were included for analysis. Eight of the trials were from Iran. Probiotics were given alone in eight trials and synbiotics in three trials. Though the components of probiotics varied, Lactobacillus was included in all trials and Bifidobacterium in all except one. The duration of intervention ranged from 4 to 8 weeks. Almost all trials (10/11) had a low risk of bias. Probiotic supplementation reduced the risk of a newborn’s hyperbilirubinemia by 74% and improved four biomarkers for glycemic control (fasting blood glucose, fasting serum insulin, homeostasis model assessment insulin resistance, and quantitative insulin sensitivity check index), two biomarkers for lipid profile (triglycerides and HDL-cholesterol), and four biomarkers for inflammation and oxidative stress (total glutathione, malondialdehyde, nitric oxide, and total antioxidant capacity). But significant heterogeneity was observed in the meta-analyses on the four biomarkers related to glycemic control and on triglycerides, which could not be explained by prespecified subgroup analyses according to the mean age of participants and intervention type (i.e., probiotics or synbiotics). The effects on the risk of preterm delivery, macrosomia and a newborns’ hypoglycemia, gestational age, total cholesterol, and LDL-cholesterol were not statistically significant. Conclusion. Probiotic supplementation seemed to be able to reduce the risk of a newborn’s hyperbilirubinemia and improve glycemic control, blood lipid profiles and inflammation and oxidative stress in pregnant women with GDM. However, due to the heterogeneity among existing studies, the surrogate nature of outcomes, and/or the fact that most studies were from Iran, the clinical significance and generalizability of the above findings remain uncertain. Further studies are warranted to address the limitations of existing evidence and better inform the management of GDM.

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

“…Probiotic administration resulted in a lower risk of offspring's hyperbilirubinemia. The authors also found the significant improvement of maternal glycemia, lipid profile, inflammation, and oxidative stress (186). In conclusion, inositols, ALA, vitamins, antioxidant supplementation, and multiple combinations of these compounds, associated with diet and lifestyle modifications, can be an important therapeutic option to manage PCOS and pregnancy-related complications.…”

Reporting of Perinatal Outcomes in Probiotic Randomized Controlled Trials. A Systematic Review and Meta-Analysis

“…Mean treatment duration was approximately 9 weeks, ranging from 3 weeks of duration [ 67 ] to 26 weeks [ 56 ]. Women were treated with probiotic/synbiotic preparations during the third trimester of gestation in most of the trials (34 studies, 74%) [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 45 , 46 , 48 , 49 , 52 , 53 , 54 , 55 , 58 ,…”

“…Probiotic microorganisms have been used for a plethora of clinical indications such as lactose malabsorption, diarrhea, bowel syndrome, and infection, among others [ 6 ]. In pregnant women, the administration of these microorganisms has been proposed to alleviate gastrointestinal symptoms, improve glycemic control, reduce oxidative stress, and lower the incidence of asthma, atopic sensitization, and allergic disease in offspring, among other outcomes [ 7 , 8 , 9 ]. However, clinical evidence remains far from conclusive [ 10 ].…”

The effect of probiotic supplementation during pregnancy on the interaction network of vaginal microbiome

“…The probiotic supplementation did not increase the incidence of adverse perinatal outcomes 14,17 . Although the beneficial effects of probiotics on perinatal metabolic diseases and the mental disorders have been described, 8,18–22 the efficiency on the interactions of vaginal microbiome during the pregnancy is yet lacking. The previous study did not support that taking probiotics was significantly beneficial to pregnancy 16 .…”

“…Probiotics were known as the live microorganisms which exert health benefits to the host when administered in adequate amounts 7 . They are readily available for consumption as biological supplements or some components of food such as yogurt 7,8 . The probiotic supplementation has been claimed to be of more significance 7 and it has come to draw public attention.…”