Efficacy of Direct or Indirect Use of Probiotics for the Improvement of Maternal Depression during Pregnancy and in the Postnatal Period: A Systematic Review and Meta-Analysis

Abstract

The mother and infant form a unique bond, with maternal mental health affecting the interactions with the infant and infant behaviours impacting maternal mental health. One of the possible mechanisms influencing maternal mental health is the manipulation of the gut-brain axis by consuming probiotic supplements. Probiotics can also have an indirect influence on maternal mental health via the modulation of the infant microbiome and consequently improving the infant’s health and thus, indirectly leading to an improvement in maternal mood. This systematic review evaluated the efficacy of probiotics on maternal mental health by searching for randomised controlled trials via international databases: Cochrane Library, PubMed, Scopus, ScienceDirect, and Web of Science until January 2022. A meta-analysis was performed using the Cochrane Collaboration methodology where possible. We found seven clinical trials that included the word probiotics and addressed maternal depression and/or anxiety. Of these, five trials investigated the influence of maternal probiotic supplementation on the gut-brain axis. Two trials investigated the indirect influence of probiotics on maternal depression via supplementation of probiotics by infants and subsequent influence on the crying of colicky infants. Meta-analysis of two studies of pregnant and postnatal women and two studies of infants consuming probiotics on the outcome of the Edinburgh Postnatal Depression Scale for mothers showed no statistical difference. The findings indicate that maternal depression is very complex and is influenced by various bidirectional factors. One of the factors that can improve maternal mental health is probiotics, however, careful consideration must be given to correct strain selection as strain-specific effectiveness was observed. Further well-designed, robust clinical studies are warranted.

Impact of probiotic on anxiety and depression symptoms in pregnant and lactating women and microbiota of infants: A systematic review and meta-analysis

“…This systematic review and meta-analysis evaluated the efficiency of probiotic supplementations for pregnant and lactating women and infant's microbiota. Supplementation of probiotics in pregnant women has improved mental health [ 19 , 39 ]. There is strong evidence that probiotics benefit the gut and nervous systems, known as the “gut-brain axis” [ 40 , 41 ].…”

“…However, only a few systematic reviews and meta-analyses were conducted to evaluate probiotics’ effect on depression symptoms in adults [ 17 , 18 ], prenatal women [ 19 ] and perinatal and postnatal mothers. In addition, pooled the data from previous reviews unclear and retrieved from both randomized control trials (RCTs) and quasi-experimental studies.…”

Inflammatory pathophysiological mechanisms implicated in postpartum depression

“…preterm birth), are potential predictors for PPD (Yim et al, 2010;Sylven et al, 2013;Corwin et al, 2015;Guintivano et al, 2018a;Guintivano et al, 2018b;Osborne et al, 2019a;Bauer et al, 2019;Cao and Wei, 2020;Cevik and Alan, 2021;Grippi, 2021;Lapato et al, 2021;Nelson et al, 2022). In terms of inflammatory Probiotics regulate microbiome-gut-brain axis (Desai et al, 2021;Trifkovic et al, 2022) PPD, postpartum depression; Treg cells, regulatory T cells; Th17, T helper cell 17; IL, interleukin; TNF-α, tumor necrosis factor-α; CXCR2, C-X-C motif chemokine receptor 2; 1-MT, 1methyltryptophan; IDO, indoleamine 2,3-dioxygenase; TDO, tryptophan 2,3-dioxygenase; NLRP3, nod-like receptor protein 3; NSAIDs, non-steroidal anti-inflammatory drugs; TLR4, toll-like receptor 4…”

“…In addition, microbiome-gut-brain axis shows correlation to depression ( Carlessi et al, 2021 ; Donoso et al, 2022 ). Though recent systematic reviews ( Desai et al, 2021 ; Trifkovic et al, 2022 ) demonstrated that there was limited evidence about the effectiveness of probiotics on PPD, probiotics is a promising therapeutical alternative. Correct strain selection should be taken into consideration.…”

PRO-DEMET Randomized Controlled Trial on Probiotics in Depression—Pilot Study Results

“…Hence, there is a need to identify specific conditions, including features in the clinical population, that may support the curative action of probiotics. For example, there is limited but promising evidence with regard to the effectiveness of probiotics regarding the risk of depressiveness or anxiety in the perinatal period [ 44 , 45 ], and probiotics may have a favorable effect on overweight-induced cognitive impairment and anxiety [ 46 ]. More specifically, little is known whether probiotic mixtures have favorable effects on psychometric, metabolic and inflammation measures in a population with depression, with or without MetS as a comorbidity [ 47 ].…”