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Wu R, Luan J, Hu J, Li Z. Effect of probiotics on pregnancy outcomes in gestational diabetes: systematic review and meta-analysis. Arch Gynecol Obstet 2024; 310:769-781. [PMID: 38236281 DOI: 10.1007/s00404-023-07346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a prevalent complication during pregnancy associated with numerous adverse outcomes. There is emerging evidence suggesting the potential of probiotics as a therapeutic measure for GDM; however, existing studies have yielded contradictory results. This meta-analysis assessed the efficacy of probiotics on blood glucose management and pregnancy outcomes in patients with GDM. METHODS A comprehensive search of the PubMed, Embase, and Cochrane databases was conducted up to August 22, 2023, to identify relevant studies. The primary outcomes focused on fasting blood glucose (FBG), fasting serum insulin (FSI), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). The secondary outcomes included various maternal and neonatal outcomes. RESULTS This meta-analysis included 15 randomized controlled trials (RCTs), encompassing 1006 patients with GDM. The results showed that, compared to a placebo, probiotics demonstrated a significant reduction in FBG (MD - 2.58, 95% CI - 4.38 to - 0.79, p < 0.01), FSI (MD - 2.29, 95% CI - 3.40 to - 1.18, p < 0.01), HOMA-IR (MD - 0.56, 95% CI - 0.81 to - 0.32, p < 0.01), and birth weight (MD - 101.20, 95% CI - 184.62 to - 17.77, p = 0.02). Furthermore, it resulted in fewer neonatal intensive care unit (NICU) admissions (RR 0.60, 95% CI 0.40-0.89, p = 0.01), instances of hyperbilirubinemia (RR 0.31, 95% CI 0.16-0.61, p < 0.01), and elevated QUICKI (MD 0.01, 95% CI 0.00-0.01, p < 0.01). No significant impact was observed in the other analyzed outcomes. CONCLUSIONS In conclusion, probiotics improve FBG, FSI, and HOMA-IR, and reduce the occurrence of neonatal hyperbilirubinemia, NICU admissions, and birth weight in the offspring of patients with GDM. However, the quality of the evidence, as per the GRADE approach, varies from high to low, necessitating further studies to consolidate these findings.
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Affiliation(s)
- Rui Wu
- School of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China
| | - Jiasi Luan
- School of Medical Devices, Shenyang Pharmaceutical University, Shenyang, China
| | - Juanjuan Hu
- School of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University, Shenyang, China
| | - Zuojing Li
- School of Medical Devices, Shenyang Pharmaceutical University, Shenyang, China.
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Lan X, Li B, Zhao J, Stanton C, Ross RP, Chen W, Yang B. Probiotic intervention improves metabolic outcomes in gestational diabetes mellitus: A meta-analysis of randomized controlled trials. Clin Nutr 2024; 43:1683-1695. [PMID: 38815494 DOI: 10.1016/j.clnu.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/18/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
AIMS To conduct a randomized controlled trial meta-analysis and provide concise and specific recommendations for clinical practice optimization of gestational diabetes for probiotics. METHODS Up until May 2023, we conducted a thorough, systematic search of PubMed, Cochrane Central Controlled Trials, and Embase. Stata software was used to merge the resulting data from the original studies. Cochran's Q and the I2 statistics were used to evaluate and quantify heterogeneity. The GRADE method was used to evaluate the overall quality of the evidence. Sources of heterogeneity were analyzed through a leave-one-out meta-analysis, a Galbraith plot, and a subgroup analysis. RESULTS A meta-analysis of 11 randomized controlled trials with a total of 713 participants was finally conducted. Our findings indicated the administration of probiotics at a median dosage of 6 × 109 CFU/day led to a substantial improvement in fasting glucose levels (MD: -4.16 mg/dL [95% CI: -6.78, -1.54]; P < 0.001), fasting insulin levels (MD: -3.33 μIU/ml [95% CI: -4.92, -1.74]; P < 0.001), homeostatic model assessment for insulin resistance (HOMA-IR) (MD: -0.71 [95% CI: -0.97, -0.45]; P < 0.001), and quantitative insulin sensitivity check index (QUICKI) (MD: 0.01 [95% CI: 0.01, 0.02]; P < 0.001). Subgroup analysis indicated that probiotic intervention exerted a more significant reduction in fasting blood glucose in patients with higher baseline BMI and glucose levels, and reduced fasting insulin more markedly in those with elevated baseline insulin. According to the GRADE assessment, the quality of evidence for fasting blood glucose and QUICKI was rated as "high", while the quality for fasting insulin and HOMA-IR was rated as "moderate". CONCLUSIONS Probiotic intervention has been shown to significantly decrease levels of fasting blood glucose, fasting insulin, and HOMA-IR, while elevating QUICKI levels in patients with GDM, underscoring the potential utility of probiotics in the adjunctive management of GDM.
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Affiliation(s)
- Xiaowen Lan
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China
| | - Bowen Li
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China
| | - Catherine Stanton
- International Joint Research Center for Probiotics & Gut Health, Jiangnan University, Wuxi 214122, Jiangsu, China; APC Microbiome Ireland, University College Cork, Cork T12 YT20, Ireland; Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork P61 C996, Ireland
| | - R Paul Ross
- International Joint Research Center for Probiotics & Gut Health, Jiangnan University, Wuxi 214122, Jiangsu, China; APC Microbiome Ireland, University College Cork, Cork T12 YT20, Ireland
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China; National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, Jiangsu, China
| | - Bo Yang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China; International Joint Research Center for Probiotics & Gut Health, Jiangnan University, Wuxi 214122, Jiangsu, China.
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Li YK, Xiao CL, Ren H, Li WR, Guo Z, Luo JQ. Comparison of the effectiveness of probiotic supplementation in glucose metabolism, lipid profile, inflammation and oxidative stress in pregnant women. Food Funct 2024; 15:3479-3495. [PMID: 38456359 DOI: 10.1039/d3fo04456d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Objective: The optimal probiotic supplementation in pregnant women has not been thoroughly evaluated. By employing a network meta-analysis (NMA) approach, we compared the effectiveness of different probiotic supplementation strategies for pregnant women. Methods: A comprehensive search across multiple databases was performed to identify studies comparing the efficacy of probiotic supplements with each other or the control (placebo) among pregnant women. Results: This NMA, including 32 studies, systematically evaluated 6 probiotic supplement strategies: Lactobacillus, Lacticaseibacillus rhamnosus and Bifidobacterium (LRB), Lactobacillus acidophilus and Bifidobacterium (LABB), Lactobacillus acidophilus, Lacticaseibacillus casei, and Bifidobacterium bifidum (LLB), multi-combination of four probiotics (MP1), and multi-combination of six or more probiotics (MP2). Among these strategies, LLB, MP1, and MP2 all contain LABB. The NMA findings showed that MP1 was the most effective in reducing fasting blood sugar (FBS) (surface under the cumulative ranking curve [SUCRA]: 80.5%). In addition, MP2 was the most efficacious in lowering the homeostasis model assessment of insulin resistance (HOMA-IR) (SUCRA: 89.1%). LABB was ranked as the most effective in decreasing low-density lipoprotein cholesterol (LDLC) (SUCRA: 95.5%), total cholesterol (TC) (SUCRA: 95.5%), and high-sensitivity C-reactive protein (hs-CRP) (SUCRA: 94.8%). Moreover, LLB was ranked as the most effective in raising total antioxidant capacity (TAC) (SUCRA: 98.5%). Conclusion: Multi-combination of probiotic strains, especially those strategies containing LABB, may be more effective than a single probiotic strain in glycolipid metabolism, inflammation, and oxidative stress of pregnant women.
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Affiliation(s)
- Yi-Ke Li
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha 410011, China
- Institute of Clinical Pharmacy, Central South University, Changsha 410011, China.
| | - Chen-Lin Xiao
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha 410011, China
- Institute of Clinical Pharmacy, Central South University, Changsha 410011, China.
| | - Huan Ren
- Department of Pharmacy, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Wen-Ru Li
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha 410011, China
- Institute of Clinical Pharmacy, Central South University, Changsha 410011, China.
| | - Zhen Guo
- Hunan Provincial Key Laboratory of the Fundamental and Clinical Research on Functional Nucleic Acid, Changsha Medical University, Changsha 410219, China
| | - Jian-Quan Luo
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha 410011, China
- Institute of Clinical Pharmacy, Central South University, Changsha 410011, China.
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McDougall A, Nguyen R, Nguyen PY, Allen C, Cheang S, Makama M, Mills K, Hastie R, Ammerdorffer A, Gulmezoglu AM, Vogel JP. The effects of probiotics administration during pregnancy on preeclampsia and associated maternal, fetal, and newborn outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2024; 6:101322. [PMID: 38447676 DOI: 10.1016/j.ajogmf.2024.101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study aimed to synthesize the available evidence on probiotic administration during pregnancy for the prevention of preeclampsia and its effects on related maternal, fetal, and newborn outcomes. DATA SOURCES Six databases were systematically searched for eligible studies, namely Ovid MEDLINE, Embase, CINAHL, Cochrane, Global Index Medicus, and the Maternity and Infant Care Database, from inception to August 2, 2023. STUDY ELIGIBILITY CRITERIA Randomized controlled trials that evaluated the effects of probiotic administration on women during any stage of pregnancy were eligible for inclusion. METHODS The protocol was registered with the International Prospective Register of Systematic Reviews under identifier CRD42023421613. Evaluating study eligibility, extracting data, assessing risk of bias (ROB-2 tool), and rating certainty (Grading of Recommendations, Assessment, Development and Evaluations) were conducted independently by 2 authors. The primary outcomes were incidence of preeclampsia, eclampsia, and maternal mortality. A meta-analysis was performed, and the results were reported as risk ratios with 95% confidence intervals. RESULTS A total of 29 trials (7735 pregnant women) met the eligibility criteria. There was heterogeneity across the trials in the population of enrolled women and the type of probiotic tested (20 different strains), although most used oral administration. Probiotics may make no difference to the risk of preeclampsia (risk ratio, 1.14; 95% confidence interval, 0.84-1.53; 11 trials; 2401 women; low certainty evidence), preterm birth at <37 weeks' gestation (risk ratio, 0.93; 95% confidence interval, 0.66-1.30; 18 trials, 4016 women; low certainty evidence), or gestational age at delivery (mean difference, -0.03 weeks [≈0.2 days]; 95% confidence interval, -0.16 to 0.10 weeks [≈ -1.1 to 0.7 days]; 13 trials, 2194 women; low certainty evidence). It is difficult to assess the effects of probiotics on other secondary outcomes because the evidence was of very low certainty, however, no benefits or harms were observed. CONCLUSION Limited evidence suggests that probiotic supplementation does not affect the risk for preeclampsia. Further high-quality trials are needed to definitively assess the benefits and possible harms of probiotic supplementation during pregnancy. There is also a lack of data from trials that included women who were undernourished or who experienced microbial dysbiosis and for whom probiotic supplementation might be useful.
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Affiliation(s)
- Annie McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel); Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia (Dr McDougall).
| | - Renae Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Phi-Yen Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Connor Allen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Sarah Cheang
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Maureen Makama
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel); School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia (Dr Makama and Prof Vogel)
| | - Kate Mills
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel)
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia (Dr Hastie)
| | - Anne Ammerdorffer
- Concept Foundation, Geneva, Switzerland (Dr Ammerdorffer and Dr Gulmezoglu)
| | - A Metin Gulmezoglu
- Concept Foundation, Geneva, Switzerland (Dr Ammerdorffer and Dr Gulmezoglu)
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia (Dr McDougall, Ms R Nguyen, Ms P Nguyen; Mr Allen, Ms Cheang, Dr Makama, Ms Mills, and Prof Vogel); School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia (Dr Makama and Prof Vogel)
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Tian Z, Zhang X, Yao G, Jin J, Zhang T, Sun C, Wang Z, Zhang Q. Intestinal flora and pregnancy complications: Current insights and future prospects. IMETA 2024; 3:e167. [PMID: 38882493 PMCID: PMC11170975 DOI: 10.1002/imt2.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/27/2023] [Accepted: 12/22/2023] [Indexed: 06/18/2024]
Abstract
Numerous studies have demonstrated the pivotal roles of intestinal microbiota in many physiopathological processes through complex interactions with the host. As a unique period in a woman's lifespan, pregnancy is characterized by changes in hormones, immunity, and metabolism. The gut microbiota also changes during this period and plays a crucial role in maintaining a healthy pregnancy. Consequently, anomalies in the composition and function of the gut microbiota, namely, gut microbiota dysbiosis, can predispose individuals to various pregnancy complications, posing substantial risks to both maternal and neonatal health. However, there are still many controversies in this field, such as "sterile womb" versus "in utero colonization." Therefore, a thorough understanding of the roles and mechanisms of gut microbiota in pregnancy and its complications is essential to safeguard the health of both mother and child. This review provides a comprehensive overview of the changes in gut microbiota during pregnancy, its abnormalities in common pregnancy complications, and potential etiological implications. It also explores the potential of gut microbiota in diagnosing and treating pregnancy complications and examines the possibility of gut-derived bacteria residing in the uterus/placenta. Our aim is to expand knowledge in maternal and infant health from the gut microbiota perspective, aiding in developing new preventive and therapeutic strategies for pregnancy complications based on intestinal microecology.
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Affiliation(s)
- Zhenyu Tian
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University Jinan China
| | - Xinjie Zhang
- Department of Biology University College London London UK
| | - Guixiang Yao
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University Jinan China
| | - Jiajia Jin
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University Jinan China
| | - Tongxue Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University Jinan China
| | - Chunhua Sun
- Department of Health Management Center, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China
| | - Zhe Wang
- Department of Geriatrics Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Qunye Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University Jinan China
- Cardiovascular Disease Research Center of Shandong First Medical University Central Hospital Affiliated to Shandong First Medical University Jinan China
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Poulios E, Pavlidou E, Papadopoulou SK, Rempetsioti K, Migdanis A, Mentzelou M, Chatzidimitriou M, Migdanis I, Androutsos O, Giaginis C. Probiotics Supplementation during Pregnancy: Can They Exert Potential Beneficial Effects against Adverse Pregnancy Outcomes beyond Gestational Diabetes Mellitus? BIOLOGY 2024; 13:158. [PMID: 38534428 DOI: 10.3390/biology13030158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Probiotics, as supplements or food ingredients, are considered to exert promising healthy effects when administered in adequate quantity. Probiotics' healthy effects are related with the prevention of many diseases, as well as decreasing symptom severity. Currently, the most available data concerning their potential health effects are associated with metabolic disorders, including gestational diabetes mellitus. There is also clinical evidence supporting that they may exert beneficial effects against diverse adverse pregnancy outcomes. The purpose of the current narrative study is to extensively review and analyze the current existing clinical studies concerning the probable positive impacts of probiotics supplementation during pregnancy as a protective agent against adverse pregnancy outcomes beyond gestational diabetes mellitus. METHODS a comprehensive and thorough literature search was conducted in the most precise scientific databases, such as PubMed, Scopus, and Web of Sciences, utilizing efficient, representative, and appropriate keywords. RESULTS in the last few years, recent research has been conducted concerning the potential beneficial effects against several adverse pregnancy outcomes such as lipid metabolism dysregulation, gestational hypertensive disorders, preterm birth, excessive gestational weight gain, caesarean risk section, vaginal microbiota impairment, mental health disturbances, and others. CONCLUSION up to the present day, there is only preliminary clinical data and not conclusive results for probiotics' healthy effects during pregnancy, and it remains questionable whether they could be used as supplementary treatment against adverse pregnancy outcomes beyond gestational diabetes mellitus.
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Affiliation(s)
- Efthymios Poulios
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Kalliopi Rempetsioti
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Athanasios Migdanis
- Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Maria Chatzidimitriou
- Department of Biomedical Science, International Hellenic University, 57400 Thessaloniki, Greece
| | - Ioannis Migdanis
- Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
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Suastika AV, Widiana IGR, Fatmawati NND, Suastika K, Paulus IB, Sujaya IN. The role of probiotics and synbiotics on treatment of gestational diabetes: systematic review and meta-analysis. AJOG GLOBAL REPORTS 2024; 4:100285. [PMID: 38322777 PMCID: PMC10844859 DOI: 10.1016/j.xagr.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE This review investigated the efficacy of probiotics and/or synbiotics in gestational diabetes mellitus treatment by targeting insulin resistance, lipid metabolism, and anti-inflammatory effects in an updated trial. DATA SOURCES The literature review was performed using the key words "Probiotics," "Synbiotics," and "Gestational Diabetes" in several databases, including PubMed, ScienceDirect, and the Cochrane Central Register of Controlled Trials. STUDY ELIGIBILITY CRITERIA Eligible publication was screened independently by 2 reviewers. Studies included provided at least 1 of the following outcomes: (1) blood glucose marker, including fasting blood glucose level, fasting serum insulin level, and homeostasis model assessment insulin resistance; (2) blood lipid profiles, including triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol; and (3) nitric oxide and C-reactive protein. METHODS All studies were reviewed using the critical appraisal Cochrane risk-of-bias tool for randomized trials. The descriptions of the extracted data were guided by the Preferred Reporting Items for Systematic Reviews 2020 statement with the Grading of Recommendations Assessment, Development, and Evaluation approach. This study was registered on the International Prospective Register of Systematic Reviews database (identification number: CRD42022375665). RESULTS From 13 randomized controlled trials involving 896 patients, individuals with probiotic had significant reduction on homeostasis model assessment insulin resistance (mean difference, -0.72; 95% confidence interval, -1.07 to -0.38; I2, 96%; P=.00), fasting blood glucose level (mean difference, -3.79; 95% confidence interval, -6.24 to -1.34; I2, 93%; P=.00), and insulin level (mean difference, -2.43 mg/dL; 95% confidence interval, -3.37 to -1.48; I2, 54%; P=.00). Meanwhile for profile lipid, significant reduction of the mean difference was observed in the triglyceride (mean difference, -17.73 mg/dL; 95% confidence interval, -29.55 to - 5.9; P=.003) and C-reactive protein (mean difference, -1.93 dL; 95% confidence interval, -2.3 to -1.56; P=.00). CONCLUSION Probiotic and synbiotic supplementations reduced the risk of insulin resistance and improved glycemic control, blood lipid profiles, and inflammation in women with gestational diabetes mellitus. Probiotics may be a viable option for gestational diabetes mellitus treatment; however, large-scale, well-designed randomized controlled trials with longer follow-up periods are required before they can be recommended to patients.
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Affiliation(s)
| | - I Gde Raka Widiana
- Department of Internal Medicine, Udayana University, Bali, Indonesia (Drs I Widiana and K Suastika)
| | - Ni Nengah Dwi Fatmawati
- Faculty of Medicine, Department of Microbiology, Udayana University, Bali, Indonesia (Dr N Fatmawati)
| | - Ketut Suastika
- Department of Internal Medicine, Udayana University, Bali, Indonesia (Drs I Widiana and K Suastika)
| | | | - I Nengah Sujaya
- Faculty of Medicine, School of Public Health, Udayana University, Bali, Indonesia (N Sujaya PhD)
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Singh P, Elhaj DAI, Ibrahim I, Abdullahi H, Al Khodor S. Maternal microbiota and gestational diabetes: impact on infant health. J Transl Med 2023; 21:364. [PMID: 37280680 PMCID: PMC10246335 DOI: 10.1186/s12967-023-04230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that has been associated with an increased risk of obesity and diabetes in the offspring. Pregnancy is accompanied by tightly regulated changes in the endocrine, metabolic, immune, and microbial systems, and deviations from these changes can alter the mother's metabolism resulting in adverse pregnancy outcomes and a negative impact on the health of her infant. Maternal microbiomes are significant drivers of mother and child health outcomes, and many microbial metabolites are likely to influence the host health. This review discusses the current understanding of how the microbiota and microbial metabolites may contribute to the development of GDM and how GDM-associated changes in the maternal microbiome can affect infant's health. We also describe microbiota-based interventions that aim to improve metabolic health and outline future directions for precision medicine research in this emerging field.
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Affiliation(s)
- Parul Singh
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
- Research Department, Sidra Medicine, Doha, Qatar
| | | | - Ibrahim Ibrahim
- Women's Department, Sidra Medicine, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Hala Abdullahi
- Women's Department, Sidra Medicine, Weill Cornell Medical College-Qatar, Doha, Qatar
| | - Souhaila Al Khodor
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
- Research Department, Sidra Medicine, Doha, Qatar.
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Yefet E, Bar L, Izhaki I, Iskander R, Massalha M, Younis JS, Nachum Z. Effects of Probiotics on Glycemic Control and Metabolic Parameters in Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15071633. [PMID: 37049473 PMCID: PMC10097303 DOI: 10.3390/nu15071633] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Objectives: To assess the effects of probiotic supplements on glycemic control and metabolic parameters in women with gestational diabetes mellitus (GDM) by performing a systematic review and meta-analysis of randomized controlled trials. The primary outcome was glycemic control, i.e., serum glucose and insulin levels. Secondary outcomes were maternal weight gain, neonatal birth weight, and lipid parameters. Weighted mean difference (WMD) was used. Cochrane’s Q test of heterogeneity and I2 were used to assess heterogeneity. Results: Of the 843 papers retrieved, 14 (n = 854 women) met the inclusion criteria and were analyzed. When compared with placebo, women receiving probiotic supplements had significantly lower mean fasting serum glucose, fasting serum insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, and VLDL levels. Decreased neonatal birth weight was witnessed in supplements containing Lactobacillus acidophilus. Conclusion: Probiotic supplements may improve glycemic control and lipid profile and reduce neonatal birth weight in women with GDM.
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Wang YH, Zhou HH, Nie Z, Tan J, Yang Z, Zou S, Zhang Z, Zou Y. Lifestyle intervention during pregnancy in patients with gestational diabetes mellitus and the risk of neonatal hypoglycemia: A systematic review and meta-analysis. Front Nutr 2022; 9:962151. [PMID: 35978965 PMCID: PMC9376328 DOI: 10.3389/fnut.2022.962151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Neonatal hypoglycemia is a severe adverse consequence of infants born to mothers with gestational diabetes mellitus (GDM), which can lead to neonatal mortality, permanent neurological consequences, and epilepsy. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to explore the effect of lifestyle intervention during pregnancy in women with GDM on the risk of neonatal hypoglycemia. Methods PubMed, Web of Science, Cochrane Library, CINAHL, and SPORTDiscus databases were searched by 1st April 2022. Data were pooled as the risk ratio (RR) with 95% CIs of neonatal hypoglycemia. Random-effects, subgroup analyses, meta-regression analysis, and leave-one-out analysis were conducted, involving 18 RCTs. Results Prenatal lifestyle intervention could significantly reduce the risk of neonatal hypoglycemia (RR: 0.73, 95% CI: 0.54–0.98, P = 0.037). Subgroup analysis further demonstrated that the reduced risk of neonatal hypoglycemia was observed only when subjects were younger than 30 years, initiated before the third trimester, and with dietary intervention. Meta-regression analysis revealed that the risk of neonatal hypoglycemia post lifestyle intervention was lower in mothers with lower fasting glucose levels at trial entry. Conclusion We found that prenatal lifestyle intervention in women with GDM significantly reduced the risk of neonatal hypoglycemia. Only lifestyle intervention before the third trimester of pregnancy, or dietary intervention only could effectively reduce the risk of neonatal hypoglycemia. Future studies are required to explore the best pattern of lifestyle intervention and to determine the proper diagnostic criteria of GDM in the first/second trimester of pregnancy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#myprospero, PROSPERO, identifier: CRD42021272985.
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Affiliation(s)
- Ya-Hai Wang
- School of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Huan-Huan Zhou
- Hubei Key Laboratory of Food Nutrition and Safety, Department of Nutrition and Food Hygiene, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhibin Nie
- School of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Jingwang Tan
- Department of Sport and Exercise Science, College of Education, Zhejiang University, Hangzhou, China
| | - Zicheng Yang
- School of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Shengliang Zou
- School of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Zheng Zhang
- Center of Child Health Management, Children's Hospital of Soochow University, Suzhou, China
| | - Yu Zou
- Department of Sport and Exercise Science, College of Education, Zhejiang University, Hangzhou, China
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11
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Gorczyca K, Obuchowska A, Kimber-Trojnar Ż, Wierzchowska-Opoka M, Leszczyńska-Gorzelak B. Changes in the Gut Microbiome and Pathologies in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169961. [PMID: 36011603 PMCID: PMC9408136 DOI: 10.3390/ijerph19169961] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 05/08/2023]
Abstract
Pregnancy is a special period in a woman's life when her organism undergoes multiple physiological changes so that the fetus has optimal conditions for growth and development. These include modifications in the composition of the microbiome that occur between the first and third trimesters of pregnancy. There is an increase in Akkermansia, Bifidobacterium, and Firmicutes, which have been associated with an increase in the need for energy storage. The growth in Proteobacteria and Actinobacteria levels has a protective effect on both the mother and the fetus via proinflammatory mechanisms. The aim of the study is to review the research on the relationship between the mother's intestinal microbiome and gestational pathologies. Changes in the maternal gut microbiome is probably one of the mechanisms that occurs in various pregnancy diseases such as preeclampsia, fetal growth restriction, gestational diabetes mellitus, excessive gestational weight gain, and premature birth. For this reason, it seems vital to pay attention to certain interventions that can benefit the affected patients both in the short term, by preventing complications during pregnancy, and in the long term, as one of the mechanisms occurring in various gestational diseases is dysbiosis of the maternal intestinal flora.
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12
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Mahdizade Ari M, Teymouri S, Fazlalian T, Asadollahi P, Afifirad R, Sabaghan M, Valizadeh F, Ghanavati R, Darbandi A. The effect of probiotics on gestational diabetes and its complications in pregnant mother and newborn: A systematic review and meta-analysis during 2010-2020. J Clin Lab Anal 2022; 36:e24326. [PMID: 35243684 PMCID: PMC8993604 DOI: 10.1002/jcla.24326] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/17/2022] Open
Abstract
This study was aimed to evaluate the effect of probiotics consumption on gestational diabetes (GD) and its complications in pregnant mother and newborn. The study was registered on PROSPERO (CRD42021243409) and all the enrolled articles were collected from four databases (Medline, Scopus, Embase, and Google Scholar) as randomized controlled trials (RCTs) from 2010 to 2020. A total of 4865 study participants from 28 selected studies were included in this review. The present meta‐analysis showed that the consumption of probiotics supplementation has the potential to decrease GD‐predisposing metabolic parameters such as blood glucose level, lipid profile, inflammation, and oxidative markers which may reduce GD occurrence among pregnant women.
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Affiliation(s)
- Marzie Mahdizade Ari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Samane Teymouri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Fazlalian
- Department of Microbial Biotechnology, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Parisa Asadollahi
- Department of Microbiology, Faculty of medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Roghayeh Afifirad
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fateme Valizadeh
- Department of Endodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Atieh Darbandi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Centre, Iran University of Medical Sciences, Tehran, Iran
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13
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de Mendonça ELSS, Fragoso MBT, de Oliveira JM, Xavier JA, Goulart MOF, de Oliveira ACM. Gestational Diabetes Mellitus: The Crosslink among Inflammation, Nitroxidative Stress, Intestinal Microbiota and Alternative Therapies. Antioxidants (Basel) 2022; 11:129. [PMID: 35052633 PMCID: PMC8773111 DOI: 10.3390/antiox11010129] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 01/09/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is characterized by a set of metabolic complications arising from adaptive failures to the pregnancy period. Estimates point to a prevalence of 3 to 15% of pregnancies. Its etiology includes intrinsic and extrinsic aspects of the progenitress, which may contribute to the pathophysiogenesis of GDM. Recently, researchers have identified that inflammation, oxidative stress, and the gut microbiota participate in the development of the disease, with potentially harmful effects on the health of the maternal-fetal binomial, in the short and long terms. In this context, alternative therapies were investigated from two perspectives: the modulation of the intestinal microbiota, with probiotics and prebiotics, and the use of natural products with antioxidant and anti-inflammatory properties, which may mitigate the endogenous processes of the GDM, favoring the health of the mother and her offspring, and in a future perspective, alleviating this critical public health problem.
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Affiliation(s)
- Elaine Luiza Santos Soares de Mendonça
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Marilene Brandão Tenório Fragoso
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Jerusa Maria de Oliveira
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Jadriane Almeida Xavier
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
| | - Marília Oliveira Fonseca Goulart
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceio 57072-970, Alagoas, Brazil; (E.L.S.S.d.M.); (M.B.T.F.); (J.M.d.O.); (J.A.X.)
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14
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Zhang Y, Wei X, Sun Q, Qian W, Liu X, Li J, Long Y, Wan X. Different Types and Functional Effects of Probiotics on Human Health through Regulating Glucose Homeostasis. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:14781-14791. [PMID: 34855398 DOI: 10.1021/acs.jafc.1c04291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With the increasing improvement of people's living standards, hyperglycemia has become one of the most frequent diseases in the world. The current drug therapy may have some negative effects and even cause some complications. As one of the most popular functional ingredients, probiotic bacteria have been proven to play important roles in balancing the glucose homeostasis level in animal and human clinic trials. In this perspective, we sorted three types of probiotics, discussed probiotic safety evaluation, and listed the known probiotic functional foods that assist to control glucose homeostasis. Then, the further summarization of the mechanisms on how probiotic bacteria could regulate glucose homeostasis and the developing trend of probiotic functional foods were discussed.
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Affiliation(s)
- Yong Zhang
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Xun Wei
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Qian Sun
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
| | - Weiyi Qian
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
| | - Xinjie Liu
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Jinping Li
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Yan Long
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
| | - Xiangyuan Wan
- Zhongzhi International Institute of Agricultural Biosciences, Shunde Graduate School, Research Center of Biology and Agriculture, University of Science and Technology Beijing (USTB), Beijing 100024, People's Republic of China
- Beijing Beike Institute of Precision Medicine and Health Technology, Beijing 100192, People's Republic of China
- Beijing Engineering Laboratory of Main Crop Bio-Tech Breeding, Beijing International Science and Technology Cooperation Base of Bio-Tech Breeding, Beijing Solidwill Sci-Tech Company, Limited, Beijing 100192, People's Republic of China
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15
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Zhou L, Ding C, Wu J, Chen X, Ng DM, Wang H, Zhang Y, Shi N. Probiotics and synbiotics show clinical efficacy in treating gestational diabetes mellitus: A meta-analysis. Prim Care Diabetes 2021; 15:937-947. [PMID: 34417122 DOI: 10.1016/j.pcd.2021.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND This study performed a systematic and meta-analysis of randomized controlled trials (RCTs) to explore the efficacy of probiotic- and symbiotic-based supplements in the treatment of gestational diabetes mellitus (GDM). METHODS We performed a meta-analysis to evaluate the efficacy of probiotics/synbiotics in GDM treatment, following a systematic search in Web of Science, PubMed, Cochrane Library, and EBSCO databases for articles published up to July 2020. RESULTS In total, 12 RCTs comprising 894 participants, were analyzed. Compared to the placebo, patients administered with probiotic and synbiotic supplements benefited more with regards to glucose and lipid metabolism as well as anti-inflammation and antioxidant capacity including insulin of change (WMD: 3.57, 95%CI: -5.26, -1.88), very-low-density lipoprotein (VLDL) (WMD: -5.03, 95%CI: -8.26, -1.79), nitric oxide (NO) at the end of trial (WMD: 2.31, 95%CI: 0.91, 3.70), total antioxidant capacity (TAC) at the end of trial (SMD: 0.74, 95%CI: 0.21, 1.27), high-sensitivity C-reactive protein (hsCRP) at the end of trial (SMD: -1.23, 95%CI: -1.97, -0.49). Besides, probiotic and synbiotic supplements improved outcomes on fetal hyperbilirubinemia risk (RR: 0.26, 95%CI: 0.12, 0.55), fetal macrosomia risk (RR: 0.47, 95%CI: 0.27, 0.83) and newborn weight (SMD: -0.29, 95%CI: -0.50, -0.09). CONCLUSIONS Findings from this work demonstrate that probiotic/symbiotic-based interventions improve glucose and lipid metabolism, anti-inflammatory and antioxidant ability in diet-controlled GDM patients, and exert beneficial outcomes on fetal hyperbilirubinemia, fetal macrosomia, and newborn weight.
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Affiliation(s)
- Lushan Zhou
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Caifei Ding
- Department of Reproductive Medicine, Zhejiang Provincial Integrated Chinese and Western Medicine Hospital, Hangzhou, China
| | - Ji Wu
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaoling Chen
- The College of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Derry Minyao Ng
- Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Hezhenrong Wang
- Surgery Department, Fenghua Hospital of Traditional Chinese Medicine, Ningbo, Zhejiang, China
| | - Yingying Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Nanjing Shi
- Department of Endocrinology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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16
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Ghavami A, Khorvash F, Khalesi S, Heidari Z, Askari G. The effects of synbiotic supplementation on oxidative stress and clinical symptoms in women with migraine: A double‐blind, placebo‐controlled, randomized trial. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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17
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Tsarna E, Christopoulos P. The role of gut microbiome in prevention, diagnosis and treatment of gestational diabetes mellitus. J OBSTET GYNAECOL 2021; 42:719-725. [PMID: 34693846 DOI: 10.1080/01443615.2021.1959534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Gestational diabetes mellitus (GDM) is a common metabolic disease associated with maternal and foetal complications; gut microbiome might participate in GDM pathogenesis. Possible biological links include short chain fatty acids, incretin hormones, bile acids homeostasis and peroxisome proliferator-activated receptor gamma deficiency. Gut microbiome differs in patients with GDM even in early pregnancy, but no differences are observed five years postpartum. Patients have enriched Verrucomicrobia phylum, Christensenellaceae and Lachnospiraceae families, Haemophilus, Prevotella, Actinomyces, Collinsella and Ruminococcus genera during pregnancy. Clostridiales order, Alistipes, Faecalibacterium, Blautia, Eubacterium and Roseburia genera are depleted. However, there is great heterogeneity in the reviewed studies and scientific data on the use of gut microbiome characteristics and related biomarkers in GDM risk stratification and diagnosis are scarce. Probiotics and synbiotics have been tested for prevention and treatment for GDM with limited efficacy. Future studies should explore the effect of probiotics administration at first trimester of pregnancy and their value as adjuvant therapy.
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Affiliation(s)
- Ermioni Tsarna
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Athens, Greece
| | - Panagiotis Christopoulos
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Athens, Greece
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18
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Sililas P, Huang L, Thonusin C, Luewan S, Chattipakorn N, Chattipakorn S, Tongsong T. Association between Gut Microbiota and Development of Gestational Diabetes Mellitus. Microorganisms 2021; 9:microorganisms9081686. [PMID: 34442765 PMCID: PMC8400162 DOI: 10.3390/microorganisms9081686] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
Background: It is well known that women with gestational diabetes mellitus (GDM) have gut dysbiosis. However, the dynamic alterations of gut microbiota in GDM are unclear. Additionally, the effects of maternal gut microbiota on the gut microbiota of their newborns remains controversial. The primary objective of this study is to determine the association between types and amounts of gut microbiota and development of gestational diabetes mellitus (GDM). Methods: Eighty-eight pregnant women, including 39 non-GDM and 49 GDM, and their 88 offspring were enrolled. Maternal feces were collected at the time of GDM diagnosis (24–28 weeks of gestation) and at before delivery (≥37 weeks of gestation). Meconium and the first feces of their newborns were also obtained. Results: from quantitative polymerase chain reaction (qPCR) showed that maternal Lactobacillales was decreased from baseline to the time before delivery in both non-GDM and GDM. Firmicutes/Bacteroidetes (F/B) ratio at before delivery was higher in the GDM group. However, there was no difference of neonatal gut microbiota between groups. Conclusions: Although we found only few gut microbiota that demonstrated the difference between GDM and non-GDM, gut microbiota may play a more important role in the development of severer GDM. Therefore, a further study comparing the gut microbiota composition among non-GDM, GDM with diet modification only, GDM with insulin therapy, GDM with successful treatment, and GDM with failure of treatment is needed.
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Affiliation(s)
- Palin Sililas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (T.T.)
| | - Lingling Huang
- Neuroelectrophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.H.); (C.T.); (N.C.)
- Center of Excellence in Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chanisa Thonusin
- Neuroelectrophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.H.); (C.T.); (N.C.)
- Center of Excellence in Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (T.T.)
- Correspondence: (S.L.); (S.C.)
| | - Nipon Chattipakorn
- Neuroelectrophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.H.); (C.T.); (N.C.)
- Center of Excellence in Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siriporn Chattipakorn
- Neuroelectrophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (L.H.); (C.T.); (N.C.)
- Center of Excellence in Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: (S.L.); (S.C.)
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (T.T.)
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The Effect of Dietary Supplements on Oxidative Stress in Pregnant Women with Gestational Diabetes Mellitus: A Network Meta-Analysis. Nutrients 2021; 13:nu13072284. [PMID: 34209454 PMCID: PMC8308478 DOI: 10.3390/nu13072284] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) exacerbates the oxidative stress status of the pregnant women. Τo improve the oxidative stress status, several therapeutic interventions have been suggested. The aim of this network meta-analysis is to assess the effect of different dietary supplements on the oxidative stress status in pregnant women with GDM. METHODS A network meta-analysis of randomized control trials was performed comparing the changes delta (Δ) in total antioxidant capacity (TAC) and concentration of malondialdehyde (MDA) as primary outcomes, following different therapeutic interventions with dietary supplements in pregnant women with GDM. Four electronic databases and grey literature sources were searched. The secondary outcomes were other markers of oxidative stress. RESULTS The meta-analysis included 16 studies of 1173 women with GDM. Regarding ΔTAC: probiotics and omega-3 with vitamin E were superior to placebo/no intervention. Regarding ΔMDA: vitamin D with calcium, omega-3, vitamin D, omega-3 with vitamin E, magnesium with zinc and calcium, and probiotics were superior to placebo/no intervention. CONCLUSIONS Administration of dietary supplements in women with GDM can be helpful in limiting the oxidative stress which develop in these pregnancies.
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Kwoji ID, Aiyegoro OA, Okpeku M, Adeleke MA. Multi-Strain Probiotics: Synergy among Isolates Enhances Biological Activities. BIOLOGY 2021; 10:322. [PMID: 33924344 PMCID: PMC8070017 DOI: 10.3390/biology10040322] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
The use of probiotics for health benefits is becoming popular because of the quest for safer products with protective and therapeutic effects against diseases and infectious agents. The emergence and spread of antimicrobial resistance among pathogens had prompted restrictions over the non-therapeutic use of antibiotics for prophylaxis and growth promotion, especially in animal husbandry. While single-strain probiotics are beneficial to health, multi-strain probiotics might be more helpful because of synergy and additive effects among the individual isolates. This article documents the mechanisms by which multi-strain probiotics exert their effects in managing infectious and non-infectious diseases, inhibiting antibiotic-resistant pathogens and health improvement. The administration of multi-strain probiotics was revealed to effectively alleviate bowel tract conditions, such as irritable bowel syndrome, inhibition of pathogens and modulation of the immune system and gut microbiota. Finally, while most of the current research focuses on comparing the effects of multi-strain and single-strain probiotics, there is a dearth of information on the molecular mechanisms of synergy among multi-strain probiotics isolates. This forms a basis for future research in the development of multi-strain probiotics for enhanced health benefits.
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Affiliation(s)
- Iliya D. Kwoji
- Discipline of Genetics, School of Life Sciences, Westville Campus, University of KwaZulu-Natal, Durban 4000, South Africa; (I.D.K.); (M.O.)
| | - Olayinka A. Aiyegoro
- Gastrointestinal Microbiology and Biotechnology Unit, Agricultural Research Council-Animal Production, Irene 0062, South Africa;
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom 2520, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, Westville Campus, University of KwaZulu-Natal, Durban 4000, South Africa; (I.D.K.); (M.O.)
| | - Matthew A. Adeleke
- Discipline of Genetics, School of Life Sciences, Westville Campus, University of KwaZulu-Natal, Durban 4000, South Africa; (I.D.K.); (M.O.)
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21
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Luo C, Wan J, Rao Z, Zhang Y. Synbiotic supplementation for glycemic status in pregnant women: a meta-analysis of randomized clinical trials. Gynecol Endocrinol 2021; 37:146-151. [PMID: 33356677 DOI: 10.1080/09513590.2020.1853696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The effect of synbiotic supplementation on glycemic status in pregnant women remained controversial and this meta-analysis aimed to explore the efficacy of synbiotic supplementation on glycemic status in pregnant women. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases and randomized controlled trials (RCTs) assessing the effect of synbiotic on glycemic status in pregnant women were included. The meta-analysis was performed using the random-effect model. RESULTS Four RCTs were included in the meta-analysis. Overall, compared with control intervention in pregnant women, synbiotic supplementation was associated with significantly reduced serum insulin (SMD = -0.69; 95%CI = -1.06 to -0.32; p = .0002) and homoeostasis model assessment of insulin resistance (HOMA-IR, SMD = -0.53; 95%CI = -0.87 to -0.18; p = .003), but had no significant effect on fasting plasma glucose (FPG, SMD = -0.16; 95%CI = -0.43 to 0.11; p = .24), quantitative insulin sensitivity check index (QUICKI, SMD = 0.54; 95%CI = -0.10 to 1.18; p = .10) or CRP (SMD = -0.29; 95%CI = -1.23 to 0.64; p = .54). CONCLUSIONS Synbiotic supplementation was beneficial to glycemic control in pregnant women.
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Affiliation(s)
- Cheng Luo
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
| | - Jinxing Wan
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
| | - Zichen Rao
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
| | - Yiming Zhang
- Department of Endocrinology, Quzhou People's Hospital, Quzhou, P. R. China
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22
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Impacts of gut microbiota on gestational diabetes mellitus: a comprehensive review. Eur J Nutr 2021; 60:2343-2360. [PMID: 33512587 DOI: 10.1007/s00394-021-02483-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a condition that seriously threatens mother and child health. The incidence of GDM has increased worldwide in the past decades. In addition, the complications of GDM such as type 2 diabetes (T2DM) and neonatal malformations could negatively affect the living quality of mothers and their children. AIM It has been widely known that the imbalance of gut microbiota or called 'gut dysbiosis' plays a key role in the development of insulin resistance and chronic low-grade inflammation in T2DM patients. However, the impacts of gut microbiota on GDM remain controversial. Here, we aim to comprehensively review the alterations of gut microbiota in GDM mothers and their offspring. RESULTS The alterations of Firmicutes/Bacteroidetes (F/B) ratio, short-chain fatty acid (SCFA)-producing bacteria, bacteria with probiotics properties and gram-negative lipopolysaccharide (LPS)-producing bacteria play a vital role in the development of GDM. The beneficial roles of gut microbiota modification (probiotics, synbiotics and lifestyle modification) as a treatment of GDM were found in some, but not all studies. CONCLUSION In the near future, gut microbiota modification may be considered as one of the standard treatments for GDM. Moreover, further studies regarding the specific gut microbiota that are associated with the early development of GDM are required. This may contribute to the novel diagnostic markers for early stages of GDM.
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Pérez-Castillo ÍM, Fernández-Castillo R, Lasserrot-Cuadrado A, Gallo-Vallejo JL, Rojas-Carvajal AM, Aguilar-Cordero MJ. Reporting of Perinatal Outcomes in Probiotic Randomized Controlled Trials. A Systematic Review and Meta-Analysis. Nutrients 2021; 13:256. [PMID: 33477352 PMCID: PMC7830438 DOI: 10.3390/nu13010256] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 12/29/2022] Open
Abstract
The use of probiotic microorganisms in clinical practice has increased in recent years and a significant number of pregnant women are regular consumers of these products. However, probiotics might modulate the immune system, and whether or not this modulation is beneficial for perinatal outcomes is unclear. We performed a systematic review and meta-analysis to evaluate the reporting of perinatal outcomes in randomized controlled trials including women supplemented with probiotic microorganisms during pregnancy. We also analyzed the effects that the administration of probiotic microorganisms exerts on perinatal outcomes. In the review, 46 papers were included and 25 were meta-analyzed. Reporting of perinatal outcomes was highly inconsistent across the studies. Only birth weight, cesarean section, and weeks of gestation were reported in more than 50% of the studies. Random effects meta-analysis results showed that the administration of probiotic microorganisms during pregnancy did not have any a positive or negative impact on the perinatal outcomes evaluated. Subgroup analysis results at the strain level were not significantly different from main analysis results. The administration of probiotic microorganisms does not appear to influence perinatal outcomes. Nonetheless, future probiotic studies conducted in pregnant women should report probiotic strains and perinatal outcomes in order to shed light upon probiotics' effects on pregnancy outcomes.
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Affiliation(s)
- Íñigo María Pérez-Castillo
- Andalusian Research, Development and Innovation Plan, CTS 367, University of Granada, 18001 Granada, Spain; (Í.M.P.-C.); (A.L.-C.); (A.M.R.-C.); (M.J.A.-C.)
| | | | - Agustín Lasserrot-Cuadrado
- Andalusian Research, Development and Innovation Plan, CTS 367, University of Granada, 18001 Granada, Spain; (Í.M.P.-C.); (A.L.-C.); (A.M.R.-C.); (M.J.A.-C.)
| | - José Luís Gallo-Vallejo
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - Ana María Rojas-Carvajal
- Andalusian Research, Development and Innovation Plan, CTS 367, University of Granada, 18001 Granada, Spain; (Í.M.P.-C.); (A.L.-C.); (A.M.R.-C.); (M.J.A.-C.)
| | - María José Aguilar-Cordero
- Andalusian Research, Development and Innovation Plan, CTS 367, University of Granada, 18001 Granada, Spain; (Í.M.P.-C.); (A.L.-C.); (A.M.R.-C.); (M.J.A.-C.)
- Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
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24
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Houttu N, Mokkala K, Koivuniemi E, Pellonperä O, Juhila J, Sorsa T, Laitinen K. The Impacts of Fish Oil and/or Probiotic Intervention on Low-Grade Inflammation, IGFBP-1 and MMP-8 in Pregnancy: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial. Biomolecules 2020; 11:biom11010005. [PMID: 33375174 PMCID: PMC7822218 DOI: 10.3390/biom11010005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background: We investigated the impact of fish oil and/or probiotics on serum and vaginal inflammatory and metabolic proteins and their relation to the onset of gestational diabetes mellitus (GDM). Methods: Overweight/obese pregnant women received fish oil + placebo, probiotics + placebo, fish oil + probiotics or placebo + placebo from early pregnancy until six months postpartum (fish oil: 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid; probiotics: Lactobacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). Serum high sensitivity C-reactive protein (hsCRP) and serum/vaginal (s/v) phosphorylated insulin-like growth factor binding-protein-1 (phIGFBP-1), IGFBP-1 and matrix metalloproteinase 8 (MMP-8) were analyzed. GDM was diagnosed according to 2 h 75 g OGTT. Results: The intervention had no impact on the change in proteins during pregnancy. Nevertheless, s-MMP-8 decreased and s-IGFBP-1 increased more in obese than in overweight women in the fish oil + probiotics group, while a decrease in s-MMP-8 was seen in obese women and an increase was seen in overweight women in the probiotics + placebo group. The late pregnancy s-phIGFBP-1 was higher in women who developed GDM in fish oil + probiotics-group compared to fish oil + placebo-group. The concentrations of s-phIGFBP-1 (635.9 ± 315.3 ng/mL vs. 753.2 ± 335.1 ng/mL, p = 0.005) and s-IGFBP-1 (3.78 ± 0.72 ng/mL vs. 3.96 ± 0.69 ng/mL, p = 0.042) were lower in early pregnancy in women who developed GDM than in women remaining healthy. Conclusions: The intervention per se had no impact on the proteins, but obesity and GDM may modify the effect. IGFBPs may affect the development of GDM.
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Affiliation(s)
- Noora Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
- Correspondence:
| | - Kati Mokkala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
| | - Outi Pellonperä
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, 20520 Turku, Finland;
| | | | - Timo Sorsa
- Department of Oral and Maxillofacial Disease, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland;
- Department of Oral Diseases, Karolinska Institutet, 141 04 Huddinge, Sweden
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
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Wang CC, Tung YT, Chang HC, Lin CH, Chen YC. Effect of Probiotic Supplementation on Newborn Birth Weight for Mother with Gestational Diabetes Mellitus or Overweight/Obesity: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12113477. [PMID: 33198366 PMCID: PMC7696869 DOI: 10.3390/nu12113477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
High birth weight indicates the future risk of obesity and increased fat mass in childhood. Maternal gestational diabetes mellitus (GDM) or overweight are powerful predictors of high birth weight. Studies on probiotic supplementation during pregnancy have reported its benefits in modulating gut microbiota composition and improving glucose and lipid metabolism in pregnant women. Therefore, probiotic intervention during pregnancy was proposed to interrupt the transmission of obesity from mothers to newborns. Thus, we performed a meta-analysis to investigate the effect of probiotic intervention in pregnant women with GDM or overweight on newborn birth weight. We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases up to 18 December 2019. Randomized controlled trials (RCTs) comparing pregnant women with GDM or overweight who received probiotic intervention during pregnancy with those receiving placebo were eligible for the analysis. Newborn birth weights were pooled to calculate the mean difference with a 95% confidence interval (CI). Two reviewers assessed the trial quality and extracted data independently. Seven RCTs involving 1093 participants were included in the analysis. Compared with the placebo, probiotics had little effect on newborn birth weight of pregnant women with GDM or overweight (mean difference = -10.27, 95% CI = -90.17 to 69.63, p = 0.801). The subgroup analysis revealed that probiotic intake by women with GDM decreased newborn birth weight, whereas probiotic intake by obese pregnant women increased newborn birth weight. Thus, no evidence indicates that probiotic intake by pregnant women with GDM or overweight can control newborn birth weight.
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Affiliation(s)
- Chun-Chi Wang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei City 110, Taiwan; (C.-C.W.); (C.-H.L.)
| | - Yu-Tang Tung
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei City 110, Taiwan;
- Nutrition Research Center, Taipei Medical University Hospital, Taipei City 110, Taiwan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City, 110, Taiwan
| | - Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei City 110, Taiwan;
| | - Chang-Hsien Lin
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei City 110, Taiwan; (C.-C.W.); (C.-H.L.)
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei City 110, Taiwan; (C.-C.W.); (C.-H.L.)
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei City 110, Taiwan;
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei City 110, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Correspondence: ; Tel.: +886-2-2737-2181 (ext. 3032); Fax: +886-2-2738-9804
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Davis DW, Crew J, Planinic P, Alexander JM, Basu A. Associations of Dietary Bioactive Compounds with Maternal Adiposity and Inflammation in Gestational Diabetes: An Update on Observational and Clinical Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7528. [PMID: 33081175 PMCID: PMC7589556 DOI: 10.3390/ijerph17207528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy that adversely affects maternal and offspring health. Maternal obesity, oxidative stress, and inflammation have been implicated in GDM. In non-pregnant adults, intakes of dietary bioactive compounds inversely associate with insulin resistance and inflammation. However, associations of dietary bioactive compounds with biomarkers of adiposity, antioxidant vitamin and mineral status, oxidative stress, and inflammation in GDM have not been fully elucidated. We addressed this gap by conducting a semi-quantitative review of observational studies and randomized controlled trials published between 2010 and 2020 and retrieved from Google Scholar, Medline, and PubMed. Our analysis revealed that women with GDM are more likely to consume a pro-inflammatory diet before pregnancy and tend to consume fewer antioxidant vitamins and minerals during pregnancy than healthy pregnant women. Women with GDM also have lower blood levels of vitamins A, C, and D and certain adipokines. Several dietary bioactive compounds were noted to improve antioxidant status and biomarkers of inflammation. The Dietary Approaches to Stop Hypertension (DASH) diet and soybean oligosaccharides increased antioxidant enzyme levels. Supplementing n-3 fatty acids, probiotics, synbiotics, and trace elements increased antioxidant enzymes and reduced hs-CRP and MDA. Improvements in inflammation by vitamin D may be contingent upon co-supplementation with other dietary bioactive compounds.
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Affiliation(s)
- Dustin W. Davis
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
| | - Jeannette Crew
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
| | - Petar Planinic
- Department of Obstetrics & Gynecology, School of Medicine, University of Nevada at Las Vegas, Las Vegas, NV 89154, USA; (P.P.); (J.M.A.)
| | - James M. Alexander
- Department of Obstetrics & Gynecology, School of Medicine, University of Nevada at Las Vegas, Las Vegas, NV 89154, USA; (P.P.); (J.M.A.)
| | - Arpita Basu
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA; (D.W.D.); (J.C.)
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27
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Pourrajab B, Fatahi S, Sohouli MH, Găman MA, Shidfar F. The effects of probiotic/synbiotic supplementation compared to placebo on biomarkers of oxidative stress in adults: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2020; 62:490-507. [PMID: 33016089 DOI: 10.1080/10408398.2020.1821166] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS During the last decades, there has been a burst of scientific literature hypothesizing the antioxidant effect of probiotics. However, the results of these studies are inconsistent and a final conclusion has yet to be reached. Thus, the aim of this study was to assess the effects of probiotic/synbiotic supplementation on serum total antioxidant capacity (TAC), glutathione (GSH), malondialdehyde (MDA) and nitric oxide (NO) levels in adults. METHODS AND RESULTS The following online databases were searched until August 26th 2020: PubMed/Medline, Scopus, Clarivate Analytics Web of Science, Cochrane Central Register of Controlled Trials, Science Direct, Google Scholar and Igaku Chuo Zasshi. The effect sizes were expressed as the weighted mean difference (WMD) with 95% confidence intervals (CI). A total of 31 eligible trials with 1681 participants (839 cases and 842 controls) were included in this meta-analysis. The results revealed that the supplementation with probiotics/synbiotics, significantly increased serum TAC (WMD: 54.14 mmol/L, 95% CI: 27.87, 80.40, P < 0.001), GSH (WMD: 40.38 μmol/L, 95% CI: 20.72, 60.03, P < 0.001) and NO (WMD: 3.54 μmol/L, 95% CI: 1.73, 5.34, P < 0.001) levels. In addition, MDA levels were significantly reduced (WMD: -0.45 μmol/L, 95% CI: -0.58,-0.32, P < 0.001) following probiotic/synbiotic supplementation. None of the variables showed a significant change in the sensitivity analysis. CONCLUSION Available evidence suggests that probiotic/synbiotic supplementation can significantly increase serum TAC, GSH and NO, as well as reduce MDA levels in adults. Therefore, probiotic/synbiotic supplementation may play a role in improving antioxidant indices and reducing oxidative stress in the body.
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Affiliation(s)
- Behnaz Pourrajab
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran.,Student Research Committee, Faculty of public health branch, Iran University of Medical Sciences, Tehran Iran
| | - Somaye Fatahi
- Student Research Committee, Faculty of public health branch, Iran University of Medical Sciences, Tehran Iran
| | - Mohammad Hassan Sohouli
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran.,Student Research Committee, Faculty of public health branch, Iran University of Medical Sciences, Tehran Iran
| | - Mihnea-Alexandru Găman
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran Iran
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28
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Okesene-Gafa KA, Moore AE, Jordan V, McCowan L, Crowther CA. Probiotic treatment for women with gestational diabetes to improve maternal and infant health and well-being. Cochrane Database Syst Rev 2020; 6:CD012970. [PMID: 32575163 PMCID: PMC7386668 DOI: 10.1002/14651858.cd012970.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is carbohydrate intolerance first recognised during pregnancy and associated with complications for mothers and babies. Probiotics are naturally occurring micro-organisms, which when ingested in adequate amounts, may confer health benefits. Evidence of the role of probiotics as treatment for GDM is limited. OBJECTIVES To evaluate the safety and effectiveness of probiotics in treating women with GDM on maternal and infant outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth's Trials Register ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (24 July 2019), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the use of probiotics versus placebo/standard care for the treatment of GDM. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, checked data accuracy, and assessed risk of bias of included trials. The certainty of evidence for selected maternal and infant/child outcomes was assessed using GRADE. MAIN RESULTS Nine RCTs (695 pregnant women with GDM) comparing probiotics versus placebo were identified. The overall risk of bias in the nine RCTs was low to unclear and the evidence was downgraded for imprecision due to the small numbers of women participating in the trials. The trials were carried out in hospitals and universities in Iran (seven trials), Thailand (one trial) and Ireland (one trial). All trials compared probiotics with placebo. Maternal outcomes We are uncertain if probiotics have any effect compared with placebo on hypertensive disorders of pregnancy, (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.64 to 3.53; participants = 256; studies = 3; low-certainty evidence) and mode of birth as caesareans (average RR 0.64, 95% CI 0.30 to 1.35; participants = 267; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: mode of birth as vaginal/assisted and subsequent development of type 2 diabetes. We are uncertain if probiotics have any effect compared with placebo on induction of labour (RR 1.33, 95% CI 0.74 to 2.37; participants = 127; studies = 1; very low-certainty evidence). For other secondary maternal outcomes, we are uncertain if there are differences between probiotics and placebo for: postpartum haemorrhage; weight gain during pregnancy intervention and total gestational weight gain; fasting plasma glucose and need for extra pharmacotherapy (insulin). Probiotics may be associated with a slight reduction in triglycerides and total cholesterol. In probiotics compared with placebo, there was evidence of reduction in markers for insulin resistance (HOMA-IR) and HOMA-B; and insulin secretion. There was also an increase in quantitative insulin sensitivity check index (QUICKI). Probiotics were associated with minor benefits in relevant bio-markers with evidence of a reduction in inflammatory markers high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and marker of oxidative stress malondialdehyde; and an increase in antioxidant total glutathione, but we are uncertain if there is any difference in total antioxidant capacity. No trials reported secondary outcomes: perineal trauma, postnatal weight retention or return to pre-pregnancy weight and postnatal depression. Infant/child/adult outcomes We are uncertain if probiotics have any effect, compared with placebo, on the risk of large-for-gestational-age babies (RR 0.73, 95% CI 0.35 to 1.52; participants = 174; studies = 2; low-certainty evidence) or infant hypoglycaemia (RR 0.85, 95% CI 0.39 to 1.84; participants = 177; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: perinatal (fetal/neonatal) mortality; or neurosensory disability. For other secondary outcomes, we are uncertain if there is any difference between probiotics and placebo in gestational age at birth, preterm birth, macrosomia, birthweight, head circumference, length, infant hypoglycaemia, and neonatal intensive care unit (NICU) admissions. There was evidence of a reduction in infant hyperbilirubinaemia with probiotics compared with placebo. No trials reported secondary outcomes: infant adiposity, and later childhood adiposity. There were no adverse events reported by any of the trials. AUTHORS' CONCLUSIONS Low-certainty evidence means we are not certain if there is any difference between probiotic and placebo groups in maternal hypertensive disorders of pregnancy, caesareans; and large-for-gestational-age babies. There were no adverse events reported by the trials. Due to the variability of probiotics used and small sample sizes of trials, evidence from this review has limited ability to inform practice. Well-designed adequately-powered trials are needed to identify whether probiotics may improve maternal blood glucose levels and/or infant/child/adult outcomes; and whether they can be used to treat GDM.
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Affiliation(s)
- Karaponi Am Okesene-Gafa
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Abigail E Moore
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Vanessa Jordan
- Cochrane New Zealand, Department Obstetrics and Gynecology, University of Auckland, Auckland, New Zealand
| | - Lesley McCowan
- Department of Obstetrics and Gynaecology, School of Population Health, University of Auckland, Auckland, New Zealand
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Esmaeilinezhad Z, Barati-Boldaji R, Brett NR, de Zepetnek JOT, Bellissimo N, Babajafari S, Sohrabi Z. The effect of synbiotics pomegranate juice on cardiovascular risk factors in PCOS patients: a randomized, triple-blinded, controlled trial. J Endocrinol Invest 2020; 43:539-548. [PMID: 31713129 DOI: 10.1007/s40618-019-01139-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Polycystic ovarian syndrome (PCOS) is one of the most common metabolic and endocrine disorders. Functional foods like pomegranate and probiotics are those that are considered to have beneficial effects on metabolic diseases beyond their basic nutritional value. So, we aimed to evaluate the effect of synbiotic pomegranate juice (SPJ) on cardiovascular risk factors on PCOS patients. METHODS This was a randomized, triple-blinded, 8-week trial. Participants were randomly assigned to receive 300 mL/day of pomegranate juice (PJ), synbiotic beverage (SB), synbiotic pomegranate juice (SPJ), or placebo beverage (PB). Biochemical indices (lipid profile, Total Antioxidant Capacity (TAC), Malondialdehyde (MDA), high sensitive C-Reactive Protein (hs-CRP)) and blood pressure were assessed before and after the intervention. RESULTS Participants in the PJ, SB, and SPJ groups experienced improvement in their lipid profile, oxidative stress, inflammation, and blood pressure during the time. Compared to placebo, Total Cholesterol (TC) was lower in the SB group (P < 0.01), LDL-c was lower in the SPJ and SB groups (P < 0.01), and HDL-c was higher in the SPJ and PJ groups (P < 0.01). With regards to oxidative stress and inflammation, when compared with placebo, MDA was lower in the SPJ, SB, and PJ groups (P < 0.001), TAC was increased in the SPJ and PJ groups (P[Formula: see text] 0.001), and hs-CRP was decreased in the PJ group (P = 0.02). Blood pressure (BP) was lower in the SPJ and PJ groups compared to placebo (P < 0.001; P < 0.01, respectively). CONCLUSIONS Consuming daily SPJ for 8 weeks improved metabolic, oxidative, inflammatory, and BP outcomes in females with PCOS. This trial was registered in the Iranian Registry of Clinical Trials (IRCT20170207032439N2).
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Affiliation(s)
- Z Esmaeilinezhad
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Razi Blvd, Shiraz, Iran
| | - R Barati-Boldaji
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Razi Blvd, Shiraz, Iran
| | - N R Brett
- School of Nutrition, Ryerson University, Toronto, ON, Canada
| | - J O T de Zepetnek
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - N Bellissimo
- School of Nutrition, Ryerson University, Toronto, ON, Canada
| | - S Babajafari
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Razi Blvd, Shiraz, Iran.
| | - Z Sohrabi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Razi Blvd, Shiraz, Iran
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30
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Masulli M, Vitacolonna E, Fraticelli F, Della Pepa G, Mannucci E, Monami M. Effects of probiotic supplementation during pregnancy on metabolic outcomes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2020; 162:108111. [PMID: 32194215 DOI: 10.1016/j.diabres.2020.108111] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 01/06/2023]
Abstract
AIM To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of probiotics in pregnancy on the incidence of gestational diabetes (GDM) and fasting plasma glucose (FPG). METHODS A MEDLINE, EMBASE, Scopus and Cochrane search (up to May 30th, 2019) was performed to identify RCTs of comparison of probiotics with placebo/active comparators in pregnant women. Principal endpoints were the incidence of GDM and the change of FPG. Other maternal and fetal outcomes were secondary endpoints. Mantel-Haenszel Odds Ratio with 95% CI (MH-OR) was calculated for dichotomous outcomes, whereas standardized differences in means was calculated for continuous variables. (PROSPERO registration CRD42019139889). FINDINGS A total of 17 RCTs, all versus placebo, was identified. The overall quality of the trials was satisfactory. No effect of probiotics on incidence of GDM (MH-OR: 0.77[0.51,1.16], p = 0.21,I2:62%) was observed, with a small but significant reduction of FPG (mean difference -1.01 [-1.96, -0.06]mg/dl, p = 0.02, I2:46%). Among secondary endpoints, a significant reduction of maternal insulin (both in women with or without diabetes) was observed in the probiotics group. INTERPRETATION Probiotics during pregnancy do not reduce the incidence of GDM, with a very little (statistically but not clinically significant) reduction of fasting plasma glucose.
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Affiliation(s)
- Maria Masulli
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy.
| | - Ester Vitacolonna
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Pescara, Italy
| | - Federica Fraticelli
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Pescara, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | | | - Matteo Monami
- Diabetology, Careggi Hospital and University of Florence, Italy
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Kumar R, Sood U, Gupta V, Singh M, Scaria J, Lal R. Recent Advancements in the Development of Modern Probiotics for Restoring Human Gut Microbiome Dysbiosis. Indian J Microbiol 2020; 60:12-25. [PMID: 32089570 PMCID: PMC7000592 DOI: 10.1007/s12088-019-00808-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022] Open
Abstract
A healthy gut is predominantly occupied by bacteria which play a vital role in nutrition and health. Any change in normal gut homeostasis imposes gut dysbiosis. So far, efforts have been made to mitigate the gastrointestinal symptoms using modern day probiotics. The majority of the probiotics strains used currently belong to the genera Lactobacillus, Clostridium, Bifidobacterium and Streptococcus. Recent advancements in culturomics by implementing newer techniques coupled with the use of gnotobiotic animal models provide a subtle ground to develop novel host specific probiotics therapies. In this review article, the recent advances in the development of microbe-based therapies which can now be implemented to treat a wide spectrum of diseases have been discussed. However, these probiotics are not classified as drugs and there is a lack of stringent law enforcement to protect the end users against the pseudo-probiotic products. While modern probiotics hold strong promise for the future, more rigorous regulations are needed to develop genuine probiotic products and characterize novel probiotics using the latest research and technology. This article also highlights the possibility of reducing antibiotic usage by utilizing probiotics developed using the latest concepts of syn and ecobiotics.
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Affiliation(s)
- Roshan Kumar
- PhiXGen Private Limited, Gurugram, Haryana 122001 India
- Department of Veterinary and Biomedical Sciences, South Dakota State University, Brookings, SD USA
- South Dakota Centre for Biologics Research and Commercialization, Brookings, SD USA
| | - Utkarsh Sood
- PhiXGen Private Limited, Gurugram, Haryana 122001 India
- Department of Zoology, University of Delhi, Delhi, 110007 India
| | - Vipin Gupta
- PhiXGen Private Limited, Gurugram, Haryana 122001 India
- Department of Zoology, University of Delhi, Delhi, 110007 India
| | - Mona Singh
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, Delhi 110067 India
| | - Joy Scaria
- Department of Veterinary and Biomedical Sciences, South Dakota State University, Brookings, SD USA
- South Dakota Centre for Biologics Research and Commercialization, Brookings, SD USA
| | - Rup Lal
- PhiXGen Private Limited, Gurugram, Haryana 122001 India
- Department of Zoology, University of Delhi, Delhi, 110007 India
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Jamilian M, Amirani E, Asemi Z. The effects of vitamin D and probiotic co-supplementation on glucose homeostasis, inflammation, oxidative stress and pregnancy outcomes in gestational diabetes: A randomized, double-blind, placebo-controlled trial. Clin Nutr 2019; 38:2098-2105. [DOI: 10.1016/j.clnu.2018.10.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 12/17/2022]
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Zhang J, Ma S, Wu S, Guo C, Long S, Tan H. Effects of Probiotic Supplement in Pregnant Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Diabetes Res 2019; 2019:5364730. [PMID: 31583250 PMCID: PMC6748202 DOI: 10.1155/2019/5364730] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/11/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous studies showed that probiotics could improve glycemic control and attenuate some of the adverse effects of type 2 diabetes. However, whether the effects are generalizable to gestational diabetes mellitus (GDM) remains uncertain. OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the effects of probiotic supplement in GDM. METHOD PubMed, EMBASE, the Cochrane Library, and EBSCO were systematically searched for relevant literature published through January 2019. Randomized controlled trials (RCTs) assessing the effects of probiotic supplement on one or more of the following in GDM were included: pregnancy outcome (the primary outcome), glycemic control, blood lipid profile, and inflammation and oxidative stress. Two reviewers independently extracted data and assessed the risk of bias in studies. Meta-analysis was conducted by using the fixed effects model unless substantial heterogeneity was found among studies. RESULTS Eleven randomized trials involving 719 participants were included for analysis. Eight of the trials were from Iran. Probiotics were given alone in eight trials and synbiotics in three trials. Though the components of probiotics varied, Lactobacillus was included in all trials and Bifidobacterium in all except one. The duration of intervention ranged from 4 to 8 weeks. Almost all trials (10/11) had a low risk of bias. Probiotic supplementation reduced the risk of a newborn's hyperbilirubinemia by 74% and improved four biomarkers for glycemic control (fasting blood glucose, fasting serum insulin, homeostasis model assessment insulin resistance, and quantitative insulin sensitivity check index), two biomarkers for lipid profile (triglycerides and HDL-cholesterol), and four biomarkers for inflammation and oxidative stress (total glutathione, malondialdehyde, nitric oxide, and total antioxidant capacity). But significant heterogeneity was observed in the meta-analyses on the four biomarkers related to glycemic control and on triglycerides, which could not be explained by prespecified subgroup analyses according to the mean age of participants and intervention type (i.e., probiotics or synbiotics). The effects on the risk of preterm delivery, macrosomia and a newborns' hypoglycemia, gestational age, total cholesterol, and LDL-cholesterol were not statistically significant. CONCLUSION Probiotic supplementation seemed to be able to reduce the risk of a newborn's hyperbilirubinemia and improve glycemic control, blood lipid profiles and inflammation and oxidative stress in pregnant women with GDM. However, due to the heterogeneity among existing studies, the surrogate nature of outcomes, and/or the fact that most studies were from Iran, the clinical significance and generalizability of the above findings remain uncertain. Further studies are warranted to address the limitations of existing evidence and better inform the management of GDM.
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Affiliation(s)
- Jiayue Zhang
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shujuan Ma
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shilan Wu
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Chuhao Guo
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Sisi Long
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hongzhuan Tan
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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Kintiraki E, Goulis DG. Gestational diabetes mellitus: Multi-disciplinary treatment approaches. Metabolism 2018; 86:91-101. [PMID: 29627447 DOI: 10.1016/j.metabol.2018.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy, associated with several perinatal complications. Adequate glycemic control has been proved to decrease risk of GDM-related complications. Several studies have shown the beneficial effect of exercise and medical nutrition treatment on glycemic and weight control in GDM-affected women. Moreover, pharmacological agents, such as insulin and specific oral anti-diabetic agents can be prescribed safely during pregnancy, decreasing maternal blood glucose and, thus, perinatal adverse outcomes. Multi-disciplinary treatment approaches that include both lifestyle modifications (medical nutritional therapy and daily physical exercise) and pharmacological treatment, in cases of failure of the former, constitute the most effective approach. Insulin is the gold standard pharmacological agent for GDM treatment. Metformin and glyburide are two oral anti-diabetic agents that could serve as alternative, although not equal in terms of effectiveness and safety, treatment for GDM. As studies on short-term safety of metformin are reassuring, in some countries it is considered as first-line treatment for GDM management. More studies are needed to investigate the long-term effects on offspring. As safety issues have been raised on the use of glyburide during pregnancy, it must be used only when benefits surpass possible risks.
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Affiliation(s)
- Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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