ESPE Yearbook of Paediatric Endocrinology

Cochrane Database Syst Rev. 2021 Apr 19;4:CD009951. doi: 10.1002/14651858.CD009951.pub3. PMID: 33870484.

In summary, this review did not find certain evidence to support the use of probiotics to reduce the risk of GDM. Only 2 studies suggested a possible reduction in the risk of GDM with probiotics. More importantly, and of concern, the review found a high degree of certainty that the use of probiotics increases the risk of developing pre-eclampsia. This observation suggests that great care needs to be taken in future studies involving the use of probiotics in pregnancy.

As gestational diabetes mellitus (GDM) is associated with adverse outcomes for both the mother and the child it is important to identify intervention strategies. During normal pregnancy there are increases in body fat content and a reduction in insulin sensitivity and this seems to be linked to changes in the gut microbiome. The gut microbiome is altered in women with GDM as compared to normal pregnancy and may resemble that of non-pregnant women with type 2 diabetes mellitus (1). As the gut microbiome plays an important role in host glucose and lipid metabolism, probiotics have been suggested as a possible intervention for improving glucose control in diabetes and GDM by helping to restore the imbalance in the species of microbiome in the gut. Previously published studies have shown mixed results in terms of using probiotics to prevent GDM.

Therefore, this systematic Cochrane review was conducted to collate and synthesize all the available evidence (comparing probiotics with placebo) for and against the use of probiotics for preventing GDM in pregnancy. Further studies need to be conducted to understand the physiological and biochemical mechanisms of the pre-eclampsia associated with the use of probiotics.

Reference: 1. Crusell MKW, Hansen TH, Nielsen T, Allin KH, Rühlemann MC, Damm P, Vestergaard H, Rørbye C, Jørgensen NR, Christiansen OB, Heinsen FA, Franke A, Hansen T, Lauenborg J, Pedersen O. Gestational diabetes is associated with change in the gut microbiota composition in third trimester of pregnancy and postpartum. Microbiome. 2018 May 15;6(1):89.