Improvement of glucose metabolism in pregnant women through probiotic supplementation depends on gestational diabetes status: meta-analysis

Abstract

The aim of this study was to assess the effects of probiotic and synbiotic supplementation on glucose metabolism in pregnant women using data from randomized controlled trials. Furthermore, this meta-analysis examines whether the observed effects depend on the presence or absence of gestational diabetes mellitus (GDM), and if the effect is dependent on the type of supplement used (probiotic or synbiotic). We performed a literature search of databases (Medline, Scopus, Web of Knowledge, and Cochrane Library) and identified all relevant randomized controlled trials (RCTs) published prior to May 2019. We compared the effects of probiotic supplementation with the administration of placebos in pregnant women with and without GDM. The systematic review and meta-analysis protocol were registered in the International Prospective Register of Systematic Reviews as number CRD 42019111467. 1119 study participants from 15 selected studies were included. The participants in four studies did not have GDM (being recruited to the study before week 20 of pregnancy) and the participants in the rest of the studies were diagnosed with GDM between weeks 24 and 28 of gestation. The meta-analysis showed that supplementation lowers serum glucose, insulin levels, and HOMA-IR index, but only in pregnant women with GDM. Moreover, both probiotics and synbiotics lower serum insulin level and HOMA-IR index, but the glucose lowering effect is specific only to probiotics and not synbiotics. Probiotic supplementation may improve glucose metabolism in pregnant women with GDM. There is a need for more RCT studies with larger groups to better estimate this effect.

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 ].…”

Effects of probiotic and synbiotic supplementation on insulin resistance in women with polycystic ovary syndrome: a meta-analysis

“…For example, a previous meta-analysis of 1119 participants from 15 studies reported that probiotics and synbiotics could decrease HOMA-IR and serum insulin levels and improve glucose metabolism in patients with gestational diabetes mellitus. 25 A randomized placebo-controlled clinical trial in patients with diabetic nephropathy indicated that 8 × 10 9 CFU per day probiotic supplementation for 12 weeks helped control glycaemic metabolism. 26 Compared with placebo, probiotic supplementation resulted in a significant reduction in FPG, serum insulin and HOMA-IR.…”

Diet and Pre-Intervention Washout Modifies the Effects of Probiotics on Gestational Diabetes Mellitus: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Previous meta-analyses explored the effects of probiotic intervention on glycemic control [35][36][37][38][39][40][41][42], and limited meta-analyses analyzed lipid metabolism [39,40,43,44], inflammatory [27,44], oxidative stress [27,44], and pregnancy outcomes in pregnant women with GDM [41,43,44]. The majority of these reviews suggested that probiotic supplementation has beneficial effects on glycemic outcomes.…”

“…However, other glycemic control parameters, namely fasting serum insulin, homeostasis model assessment index (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI), were not assessed. Through meta-analysis, Łagowska et al [ 37 ] observed that improvement in FPG was dependent on GDM status and women with GDM showed a significant reduction in FPG compared with women without GDM (standardized mean difference (SMD), −0.46 mg/dL; 95% CI = −0.89, −0.03; p = 0.034). However, the reduction in FPG in this meta-analysis may not reflect the true effects of probiotics because of the high heterogeneity (I 2 = 90.24%), which may be caused by the inclusion of studies that used synbiotics [ 37 ].…”