Probiotic supplementation in pregnancy diabetes

reference

Karamali M., Nasiri N., Shavazi NT, et al. The effects of the synbiotic supplementation on pregnancy results in pregnancy diabetes. Probiotics Antimicrobial proteins (published online before printing on August 7, 2017). DOI: 10.1007/S12602-017-9313-7

draft

randomized, double blind, placebo -controlled clinical study

participant

60 pregnant women in Iran aged 18 to 40 years with pregnancy diabetes who did not receive oral antidiabetics; The exclusion criteria included preeclampsia, eclamps, thyroid diseases, tobacco consumption (smoking), kidney or liver diseases and current use of probiotics (including yoghurt and kefir).

Intervention

The participants were assigned random to consume 1 probiotic capsule or placebo every day for 6 weeks. The probiotic capsule contained the following ingredients:

• lactobacillus acidophilus Stamm T16 (IBRC-M10785), 2 x 10 9 KBE/G
• Lactobacillus casei Stamm T2 (IBRC-M10783), 2 x 10 9 KBE/G
• Bifidobacterium bifidum Stamm T1 (IBRC-M10771), 2 x 10 9 KBE/G
• inulin, 800 mg

All women in the study also took 400 µg folic acid per day from the beginning of pregnancy and from the second trimester 60 mg iron sulfate per day. Compliance and nutrition were monitored.

study parameters evaluated

All women and newborns were weighed and measured at the beginning and at the end of the study (weight, length and head circumference in infants; size and weight in mothers). Sober blood samples were taken at the beginning and end of the treatment to determine the serum levels of inflammatory markers and markers for oxidative stress. Newborns have been examined for hyperbilirubinemia (defined as total serum bilirubin ≥15 mg/dl for infants aged 25–48 hours, ≥18 mg/dl for infants aged 49–72 hours and ≥20 mg/dl for infants that are older than 72 hours). . The accessories of the infants were also recorded.

The women were asked to record their food intake on 3 consecutive days in weeks 1, 3 and 5.

primary result measurements

serum levels of inflammatory markers (C-reactive protein [CRP]) were the primary result parameters; The secondary endpoints included biomarkers for oxidative stress (nitrogen monoxide [NO] total antioxidant capacity [TAC] Total glutathione [GSH] Malonaldehyde [MDA]) and pregnancy results.

important knowledge

After the 6-week treatment, there was no difference between the groups of medium-sized, weight or BMI. When checking the 3-day nutritional diaries, there was no significant difference in relation to the absorption of macronutrients and micronutrients between the groups.

After 6 weeks of intervention, women who received a probiotic supplementation had a significantly reduced CRP value (–1.9 ± 4.2 vs. +1.1 ± 3.5 mg/l; p = 0.004) compared to the placebo group, a marker for inflammation, a marker for oxidative stress (–0.1 ± 0.6 vs. +0.3 ± 0.7 Umol/l; The antioxidant total capacity increased significantly (+70.1 ± 130.9 vs. –19.7 ± 124.6 mmol/l; p = 0.009) as well as GSH (+28.7 ± 61.5 vs. –14.9 ± 85.3 UMOL/L; p = 0.02). There was no verifiable change in the plasma no level in both groups.

This study showed several positive effects of supplementation with a relatively low -dose probiotic in pregnant women with pregnancy diabetes on mother and child.

Women in the supplementing group had a significant fewer caesarean sections (16.7 % vs. 40.0 %; p = 0.04) and a lower incidence of hyperbilirubinemic newborn (3.3 % vs. 30 %; p = 0.006) and hospital stay in newborns (3.3 % vs. 30 %; p = 0.006) compared to the placebo group.

practice implications

This study showed several positive effects of supplementation with a relatively low -dose probiotic in pregnant women with pregnancy diabetes on mother and child. The positive effects on mothers include improvements in biomarkers for inflammation and oxidative stress as well as a lower need for more risky surgical interventions during labor. The positive effects on the babies included lower rates of jaundice and hospital stays.

Earlier studies on probiotics in other population groups have shown positive effects on both inflammatory and oxidative biomarkers. ^{1 and studies on pregnant women with pregnancy diabetes have shown advantages for inflammatory markers. could improve pregnant women.}

pregnancy diabetes is associated with increased oxidative stress due to an increased production of reactive oxygen species and advanced glycosylated end products (AGES).

In addition, it has become clear that the maternal microbial environment is a significant influence on the development of the child's immune system, as studies on the influence of the mother's microbiome on the atopic reaction of the offspring. ⁴

This study and others indicate the relevance of the maternal microbiome for pregnancy results and the health of the descendants. As we begin to understand the positive effects, this is really just the beginning. In a few years in which increasing data is increasingly indicated on clearer stem -specific effects on biomarkers and health parameters, we will probably look back on this time when the prescription of an unspecific probiotic combination formula was rough. Nevertheless, the data clearly show that this prescription can also bring advantages for mother and child.

restrictions

This study had some restrictions that could be relevant. First, there were no fecal measurements of bacterial loads, short -chain fatty acids or microbiological regular analyzes. Since we know that the microbiomas of individuals are unique, a better understanding of the microbiome of each participant could have been helpful before and after the study period and could also confirm compliance with the protocol. Second, although this study is relevant to women with pregnancy diabetes, it would be helpful to understand possible positive effects on the general population through further studies. Finally, in view of contradictory results on the effects on oxidative and inflammatory markers based on the symbiotic bacterial strains used, it will be helpful to examine the trunk -specific effects so that the best probiotic tribes for pregnant women can be used.