Probiotic supplementation and associated infant gut microbiome and health: a cautionary retrospective clinical comparison

Abstract

While probiotics are a multi-billion dollar industry, there is little evidence to show that supplementing infants provides any health benefits. We conducted an observational study where 35 of 86 participating mothers self-administered probiotics during breastfeeding, as well as directly to their infants. The primary objective was to determine if probiotic exposure influenced the infants’ fecal microbiome while the secondary objective assessed associated changes to the mothers’ breast milk immunity and infant health. Analysis of infant fecal microbiome throughout the first 6 months of life revealed that probiotics were associated with higher abundances of Bifidobacterium at week 1 only. Short-chain fatty acid production and predicted metagenomic functions of the microbial communities were not altered. While probiotics did not alter breast milk immune markers, fecal sIgA responses were higher among probiotic supplemented infants. Surprisingly, this was not associated with better health outcomes, as the probiotic cohort had higher incidences of mucosal-associated illnesses as toddlers. This retrospective clinical comparison suggests that probiotic exposure during infancy has limited effects on gut microbial composition yet is associated with increased infection later in life. These correlative findings caution against probiotic supplementation during infancy until rigorous controlled follow-up studies determining their safety and efficacy have occurred.

The microbiota and immune‐mediated diseases: Opportunities for therapeutic intervention

“…Indeed, there are conflicting data and concerns around the efficacy, mode of action, and methods for testing the effectiveness of probiotic in preventing or treating allergic and other diseases. One study showed that self-administration of probiotics during breastfeeding and directly to the infants enhanced the abundance of Bifidobacterium in the infant gut microbiota for 1 week only, but did not alter SCFA production or immune markers in breast milk, and surprisingly was associated with a higher incidence of mucosal infections in toddlers [105]. Further rigorous, controlled follow-up studies are required to determine the safety and efficacy of probiotic supplementation, in particular more stringent protocols and documentation are necessary to generate valid and conclusive data on their efficacy.…”

Perspectives on Probiotics and Bronchopulmonary Dysplasia

“…Particularly in infancy, premature babies may become a high-risk group to use probiotics, because of their immature immunity. Previous investigations reported that probiotic supplementation early after birth increases the occurrence of mucosal (oral, respiratory, gastrointestinal) infection diseases (90). Infants taking probiotics have complained of unpleasant taste, dry skin, bloating, vomiting, rash, and other adverse events (91).…”

Human behavior, not race or geography, is the strongest predictor of microbial succession in the gut bacteriome of infants

“…at 1 week of age. 89 However, an inverse correlation between probiotic supplements during infancy and mucosal-associated illness in toddlers was reported. Given this, probiotic supplementation during infancy should be approached cautiously until rigorous controlled follow-up studies determining safety and efficacy have occurred.…”