Pregnancy outcome of women exposed to Lactobacillus during early pregnancy

Cheil General Hospital & Women’s Healthcare Center

Resident. Lee Ji Eun

• Definition of Probiotics• Current Use of Probiotics• Purpose of this study• Methods of this study• Results of this study• Discussion

Contents

Live microorganisms that, when administered in adequate amounts,

confer a health benefit on the host

Definition of Probiotics

Current use of Probiotics

:Taking probiotics as dietary supplement without prescription….

:But the safety of probiotics for pregnancy has not been established. Herbal medicins in pregnancy and lactation – an evidence based approach . 2006 Mills EJ, Koren G.

To clarify the risks ass. with exposure to probiotics

in early pregnancy and provide a more solid basis for the future resea

rch efforts on probiotics.

Purpose of this study

Subject: from March 2000 to Sep. 2010 104 pregnancy women who were taking probiotics in early

pregnancy

Study outcome: 1. number of life births and spontaneous abortion, gestat

ional age at birth, birth weight, number of babies born with major birth defect

2. number of babies born with a low birth weight, and chromosomal abnormalities, number of preterm birth.

Methods of this study

• No meaningful correlation between exposure to probiotics during pregnancy and adverse outcomes in infants

Results of this study

Table 1.Characteristics of the participants

Exposed (n=100)

Control (n=200) P-value

Age (years) 30.7±4.1 31.5 ± 3.7 0.09

Gravity (n) 2.0 ±1.37 2.2 ± 1.23 0.25

Exposure to lacto.

G.A. at expo.(weeks) 4.2 (-1.2~17.2) - -

Dose (mg/day) 510 (170~1392) - -

Duration of expo.(days) 4 (1-90) - -

Coexpo. to other med.(n) 12.4 ± 7.5 5.5 ± 4.6 0.0

Other relevant coexpo.

Alcohol 48 (48) 98 (49) 0.87

Cigarette smoking 9 (9) 31 (15.5) 0.20

X-ray 27 (27) 52 (26) 0.57

Exposed (n=100)

Control (n=200)

P-value

Spontaneous Abortion 8 (8%) 21 (10.5%) 0.50

Life births 96 187

G.A. at birth (weeks) 38.9 ± 2.6 38.8 ± 2.9 0.84

Birth weight (g) 3200 ± 609 3191 ± 574 0.73

Low birth weight ( 6 (6.3%) 18 (9.6%) 0.34

Preterm birth 13 (13.5%) 18 (9.6%) 0.32

Major malformations 2 (2.0%) 5 (2.7%) 0.76

Minor malformations 2 (2.0%) 6 (3.2%) 0.59

Chromosomal abnormalities 0 1 0.48

Table 2. Pregnancy outcomes of women inadvertently exposed to lactobacillus in the first trimester of pregnancy

• Probiotics have traditionally been used to treat disease related to the gastrointestinal tract.

• By Avoiding colonization by pathogens and reducing the risk for over growth of potential pathogenic bacteria.

Use of Probiotics

+ Understanding of the effect of the microbial Immune modulation

Observations supporting a role for probiotics in inhibiting allergic responses in early life 1. Epidemiologic links between less exposure to microbe and allergic disease, and protective effect

s of higher microbial burden 2. Intestinal microbiotica are the largest source of microbial exposure through early immune development 3. Intestianl microbiotica appear to bee essential for development of oral tolerance. 4. Changing pattern of microbiotica with progressive Westernization and links with allergic disease 5. Difference in perinatal colonization in children who go on to deveolp allergic disease…..

American Academy of Allergy,Asthma & Immunology 2007;120:255

+ Epidemiologic support

Allergen exposure

Early sensitization

Development of clinical allergy

Atopic eczema

Genetic predisposition

Allergen exposure. Immune modulation

Allergy. 2000 Jan;55(1):2-10 Holloway JA Dose atopic disease start in fetal life?

• Probiotics and allergic disease

Use of Probiotics

1996. suppressive effect on lymphocyte proliferation and IL-4 generation in vitro

2000. Immunoinflammatory responses to dietary antigens in allergic individuals were shown to be alleviated by probiotics

2000.Significant improvement in the course of atopic eczema in infants given probiotics supplemented elimination diets

2001. Kalliomaki M. Probiotics in primary prevention of atopic disease

………..

Probiotics Safety in Pregnancy: A Systematic Review and Meta-analysis of Randomized Controlled Trial of Lactobacillus, Bifidobacterium and Saccharomyces spp.

J Obstet Gynaecol Can 2009;31(6):542-552

: The meta-analysis did not indicate that administering certain strains of Lactobacillus spp. and Bifidobacterium spp. had any effect on Cesarean section rate, birth weight, or gestational age.

: Certain strains of Lactobaciilus sp. And Bifidobacterium sp. may prevent atopic disease in infants when administered to their mothers in pregnancy.

A Cochrane systemic review concluded that, when the results for the different probiotics strains used in clinical trials are pooled, probiotics are not effective for the treatment of eczema.

Probiotics and prebiotics:clinical effects in allergic disease Current opinion in pediatrics 2010

There are fewer studies of prebiotics for the treatment or prevention of allergic disease.

But data suggest that prebiotic-supplemented formulas may be effective for preventing eczema in infants at high risk of developing allergic disease

Probiotics for the prevention or treatment of allergic disease J Allergy clin immunol 2007