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Malloy E, Kates AE, Dixon J, Riley C, Safdar N, Hanson L. Vaginal and Rectal microbiome changes following administration of a multi-species antenatal probiotic: A randomized control trial. GUT MICROBES REPORTS 2024; 1:1-10. [PMID: 38708373 PMCID: PMC11065196 DOI: 10.1080/29933935.2024.2334311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/14/2024] [Indexed: 05/07/2024]
Abstract
The gut and vaginal microbiome undergo changes during pregnancy which may be protective or harmful to the birthing person. Probiotics have been found to cause protective changes to the gut and vaginal microbiomes, with the potential to improve perinatal outcomes. This randomized control trial compares the vaginal and rectal microbiomes before and after an antenatal probiotic or placebo intervention, with a diverse group of pregnant people and a special focus on racial disparities. The vaginal and rectal microbiomes reveal non-significant increased Lactobacillus in the probiotics group, with a greater increase in participants who identified as Black. Potential implications and future study are discussed.
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Affiliation(s)
- Emily Malloy
- Aurora UW Medical Group Midwifery & Wellness, Advocate Aurora Healthcare Milwaukee, USA
- College of Nursing, Marquette University, Milwaukee, USA
| | - Ashley E. Kates
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Jonah Dixon
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Colleen Riley
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Lisa Hanson
- College of Nursing, Marquette University, Milwaukee, USA
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Hanson L, VandeVusse L, Malloy E, Garnier-Villarreal M, Watson L, Fial A, Forgie M, Nardini K, Safdar N. Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis. Midwifery 2021; 105:103208. [PMID: 34890880 DOI: 10.1016/j.midw.2021.103208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/21/2021] [Accepted: 11/18/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To systematically review and meta-analyse studies of the efficacy of probiotics to reduce antenatal Group B Streptococcus (GBS) colonisation. PARTICIPANTS Antenatal participants with known positive GBS colonisation or unknown GBS status. INTERVENTION Probiotic interventions containing species of Lactobacillus or Streptococcus. DESIGN Systematic review and meta-analysis. MEASUREMENTS AND FINDINGS The systematic review included 10 studies. Five articles contained in vitro studies of probiotic interventions to determine antagonistic activity against GBS. Six clinical trials of probiotics to reduce antenatal GBS were systematically reviewed and meta-analysed. The meta-analysis revealed that the use of an antenatal probiotic increased the probability of a negative GBS result by 79% (OR = 0.56, 95% CI = 8.7%, 194.1%, p = 0.02) (n = 709). However, only one clinical trial of 6 had a low risk of bias. KEY CONCLUSIONS The probiotic interventions subjected to in vitro testing showed antagonistic activity against GBS through the mechanisms of acidification, immune modulation, and adhesion. The findings of the meta-analysis of the clinical trials revealed that probiotics are a moderately effective intervention to reduce antenatal GBS colonisation. More well-controlled trials with diverse participants and with better elucidation of variables influencing GBS colonisation rates are needed. IMPLICATIONS FOR PRACTICE Probiotic interventions appear to be a safe and effective primary prevention strategy for antenatal GBS colonisation. Application of this low-risk intervention needs more study but may reduce the need for intrapartum antibiotic prophylaxis in countries or regions where antenatal GBS screening is used. Midwives can be instrumental in conducting and supporting larger well-controlled clinical trials.
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Affiliation(s)
- Lisa Hanson
- Klein Endowed Professor and Associate Director, Marquette University College of Nursing, Midwifery Program, Milwaukee, WI USA.
| | - Leona VandeVusse
- Associate Professor Emerita, Marquette University College of Nursing Milwaukee, WI USA
| | - Emily Malloy
- PhD student, Marquette University College of Nursing; Nurse-Midwife, Midwifery and Wellness Center, Department of Obstetrics and Gynecology, Advocate Aurora Health Care, Milwaukee, WI, USA
| | | | - Lauren Watson
- Laboratory Manager, UW Madison School of Medicine and Infectious Disease, Madison, WI, USA
| | - Alissa Fial
- Research & Instruction Services, Associate Librarian, Raynor Memorial Libraries, Marquette University, Milwaukee, WI, USA
| | - Marie Forgie
- Physician, Department of Obstetrics and Gynecology, Advocate Aurora Women's Health Care, Milwaukee, WI, USA
| | - Katrina Nardini
- Associate Chief, Midwifery Division, University of New Mexico Health Sciences Center, Department of Obstetrics and Gynecology, Albuquerque, New Mexico, USA
| | - Nasia Safdar
- Professor, Infectious Disease, UW Madison School of Medicine. Madison WI, USA
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Distribution of Streptococcus agalactiae Among Iranian Women from 1992 to 2018: A Systematic Review and Meta-Analysis. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.102314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Group B Streptococcus has the capacity of being colonized in the rectovaginal organ of women and causes infections in a mother and her fetus, thereby leading to neonatal diseases. Evidence Acquisition: The aim of this review was to summarize all of the relevant articles published to highlight the prevalence of group B Streptococcus colonization or infection in different regions of Iran. A systematic literature review was conducted by searching PubMed, Scopus, Web of Science (ISI), ScienceDirect, Google Scholar, and domestic databases for papers published in English or Persian from 1992 up to July 2019, concerning the prevalence of group B Streptococcus among Iranian women. All information regarding year, location of cases, frequency, author’s name, date of publication, participants, pregnancy period, sampling, and quality assessment were recorded. Summary effects were derived using the random effects model. Results: Among 61 suitable papers, data revealed that 36,807 cases of pregnant and non-pregnant women had been tested for group B Streptococcus during 1992-2018. Overall, 11.9% of pregnant and 5.3% of non-pregnant women were positive. Further results were as follows: vaginal, recto-vaginal, rectal, and endocervical colonization rates were 12.9%, 9.7%, 18.5%, and 3.7%, respectively. Group B Streptococcus incidence was the highest in Sanandaj (61.5%), and the lowest in Tabriz (1.8%). Conclusions: Although the prevalence distribution in Iran seems to be acceptable, more investigations are needed to represent the real incidence of group B Streptococcus around the country. In addition, a program with a standard lab technique is needed to screen pregnant women for further treatment before birth.
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Emaneini M, Jabalameli F, van Leeuwen WB, Beigverdi R. Prevalence of Group B Streptococcus in Pregnant Women in Iran: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2018; 37:186-190. [PMID: 28767617 DOI: 10.1097/inf.0000000000001713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group B Streptococcus (GBS or S. agalactiae) is a major cause of severe disease in neonates. In perinatal infections or early-onset disease, GBS is transmitted vertically to the newborn from the birth canal during labor and delivery. Limited information is available on the prevalence of GBS recto-vaginal colonization among pregnant women in Iran. METHODS We performed a systematic search by using different electronic databases including Medline (via Pubmed), Embase, Web of Science and Iranian Database. Meta-analysis was performed by Comprehensive Meta-Analysis (Biostat V2.2) software. RESULTS Of 250 articles published from January 2000 to September 2016, 25 studies that reported incidence of GBS colonization in pregnant women were included in this review. The meta-analyses showed that the prevalence of GBS colonization among Iranian pregnant women was 9.8% (95% confidence interval, 7.9-12). CONCLUSIONS The results of this study indicate that GBS screening measures and chemoprophylaxis guidelines concerning GBS infections must be established for pregnant women in Iran, and these guidelines must provide guidance for obstetricians, midwives and neonatologists on the prevention of GBS infections.
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Kwatra G, Cunnington MC, Merrall E, Adrian PV, Ip M, Klugman KP, Tam WH, Madhi SA. Prevalence of maternal colonisation with group B streptococcus: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:1076-1084. [PMID: 27236858 DOI: 10.1016/s1473-3099(16)30055-x] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND The most important risk factor for early-onset (babies younger than 7 days) invasive group B streptococcal disease is rectovaginal colonisation of the mother at delivery. We aimed to assess whether differences in colonisation drive regional differences in the incidence of early-onset invasive disease. METHODS We did a systematic review of maternal group B streptococcus colonisation studies by searching MEDLINE, Embase, Pascal Biomed, WHOLIS, and African Index Medicus databases for studies published between January, 1997, and March 31, 2015, that reported the prevalence of group B streptococcus colonisation in pregnant women. We also reviewed reference lists of selected studies and contacted experts to identify additional studies. Prospective studies in which swabs were collected from pregnant women according to US Centers for Disease Control and Prevention guidelines that used selective culture methods were included in the analyses. We calculated mean prevalence estimates (with 95% CIs) of maternal colonisation across studies, by WHO region. We assessed heterogeneity using the I(2) statistic and the Cochran Q test. FINDINGS 221 full-text articles were assessed, of which 78 studies that included 73 791 pregnant women across 37 countries met prespecified inclusion criteria. The estimated mean prevalence of rectovaginal group B streptococcus colonisation was 17·9% (95% CI 16·2-19·7) overall and was highest in Africa (22·4, 18·1-26·7) followed by the Americas (19·7, 16·7-22·7) and Europe (19·0, 16·1-22·0). Studies from southeast Asia had the lowest estimated mean prevalence (11·1%, 95% CI 6·8-15·3). Significant heterogeneity was noted across and within regions (all p≤0·005). Differences in the timing of specimen collection in pregnancy, selective culture methods, and study sample size did not explain the heterogeneity. INTERPRETATION The country and regional heterogeneity in maternal group B streptococcus colonisation is unlikely to completely explain geographical variation in early-onset invasive disease incidence. The contribution of sociodemographic, clinical risk factor, and population differences in natural immunity need further investigation to understand these regional differences in group B streptococcus maternal colonisation and early-onset disease. FUNDING None.
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Affiliation(s)
- Gaurav Kwatra
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Research Foundation, Vaccine Preventable Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Elizabeth Merrall
- Biostatistics and Statistical Programming, GlaxoSmithKline, Amsterdam, Netherlands
| | - Peter V Adrian
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Research Foundation, Vaccine Preventable Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Ip
- Department of Microbiology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Keith P Klugman
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Global Health, Emory University, Atlanta, GA, USA; Pneumonia Program, Bill & Melinda Gates Foundation, Washington, DC, USA
| | - Wing Hung Tam
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Research Foundation, Vaccine Preventable Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
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Barthow C, Wickens K, Stanley T, Mitchell EA, Maude R, Abels P, Purdie G, Murphy R, Stone P, Kang J, Hood F, Rowden J, Barnes P, Fitzharris P, Craig J, Slykerman RF, Crane J. The Probiotics in Pregnancy Study (PiP Study): rationale and design of a double-blind randomised controlled trial to improve maternal health during pregnancy and prevent infant eczema and allergy. BMC Pregnancy Childbirth 2016; 16:133. [PMID: 27255079 PMCID: PMC4891898 DOI: 10.1186/s12884-016-0923-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 05/26/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Worldwide there is increasing interest in the manipulation of human gut microbiota by the use of probiotic supplements to modify or prevent a range of communicable and non-communicable diseases. Probiotic interventions administered during pregnancy and breastfeeding offer a unique opportunity to influence a range of important maternal and infant outcomes. The aim of the Probiotics in Pregnancy Study (PiP Study) is to assess if supplementation by the probiotic Lactobacillus rhamnosus HN001 administered to women from early pregnancy and while breastfeeding can reduce the rates of infant eczema and atopic sensitisation at 1 year, and maternal gestational diabetes mellitus, bacterial vaginosis and Group B Streptococcal vaginal colonisation before birth, and depression and anxiety postpartum. METHODS/DESIGN The PiP Study is a two-centre, randomised, double-blind placebo-controlled trial in Wellington and Auckland, New Zealand. Four hundred pregnant women expecting infants at high risk of allergic disease will be enrolled in the study at 14-16 weeks gestation and randomised to receive either Lactobacillus rhamnosus HN001 (6 × 10(9) colony-forming units per day (cfu/day)) or placebo until delivery and then continuing until 6 months post-partum, if breastfeeding. Primary infant outcomes are the development and severity of eczema and atopic sensitisation in the first year of life. Secondary outcomes are diagnosis of maternal gestational diabetes mellitus, presence of bacterial vaginosis and vaginal carriage of Group B Streptococcus (at 35-37 weeks gestation). Other outcome measures include maternal weight gain, maternal postpartum depression and anxiety, infant birth weight, preterm birth, and rate of caesarean sections. A range of samples including maternal and infant faecal samples, maternal blood samples, cord blood and infant cord tissue samples, breast milk, infant skin swabs and infant buccal swabs will be collected for the investigation of the mechanisms of probiotic action. DISCUSSION The study will investigate if mother-only supplementation with Lactobacillus rhamnosus HN001 in pregnancy and while breastfeeding can reduce rates of eczema and atopic sensitisation in infants by 1 year, and reduce maternal rates of gestational diabetes mellitus, bacterial vaginosis, vaginal carriage of Group B Streptococcus before birth and maternal depression and anxiety postpartum. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registration: ACTRN12612000196842. Date Registered: 15/02/12.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand.
| | - Kristin Wickens
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Robyn Maude
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, P O Box 7625, Newtown, Wellington, 6242, New Zealand
| | - Peter Abels
- Department of Obstetrics and Gynaecology, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Gordon Purdie
- Dean's Department, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Janice Kang
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Fiona Hood
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Judy Rowden
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Phillipa Barnes
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Penny Fitzharris
- Immunology Department, Auckland Hospital, Private Bag 92024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Jeffrey Craig
- Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia
| | - Rebecca F Slykerman
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
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De Gregorio PR, Juárez Tomás MS, Nader-Macías MEF. Immunomodulation of Lactobacillus reuteri CRL1324 on Group B Streptococcus Vaginal Colonization in a Murine Experimental Model. Am J Reprod Immunol 2015; 75:23-35. [PMID: 26547516 DOI: 10.1111/aji.12445] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 12/26/2022] Open
Abstract
PROBLEM Maternal Group B Streptococcus (GBS) colonization is a risk factor for infectious disease in newborns. One promising strategy is the modulation of vaginal defense to increase the host's ability to combat infection. METHOD OF STUDY The effect of intravaginal (i.va.) Lactobacillus reuteri CRL1324 inoculation on different immune cell populations, cytokines, and immunoglobulin isotypes in a murine model of GBS vaginal colonization was evaluated. RESULTS Seven i.va. inoculations of L. reuteri CRL1324 previous to GBS challenge showed an immunomodulatory effect on the cells and mediators of innate immunity, decreasing the number of neutrophils induced by the pathogen and increasing the activated macrophage population. Moreover, increases in B lymphocytes and IgA and IgG subclasses were observed in mice inoculated with L. reuteri CRL1324 and then challenged with GBS. CONCLUSION Lactobacillus reuteri CRL1324 shows a protective effect against GBS colonization that could be mediated by the modulation of the immune response.
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Griffin C. Probiotics in obstetrics and gynaecology. Aust N Z J Obstet Gynaecol 2015; 55:201-9. [PMID: 26052924 DOI: 10.1111/ajo.12303] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/22/2014] [Indexed: 12/11/2022]
Abstract
Despite the great advances in modern medicine, our understanding of the most basic function of our complete genetic makeup is extremely poor. Our complete genetic make up is complemented by 100 trillion cells living within or on our body and is called the microbiome. Manipulation of the microbiome is in the embryological stages of investigation but promises great hope in targeting both pregnancy specific and general medical / gynaecological conditions. This review presents an undertanding of the microbiome manipulation with probiotics in women's health in 2015.
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Affiliation(s)
- Christopher Griffin
- School of Women's and Infants' Health, The University of Western Australia and King Edward Memorial Hospital, Subiaco, WA, Australia
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Hanson L, Vande Vusse L, Duster M, Warrack S, Safdar N. Feasibility of Oral Prenatal Probiotics against Maternal Group B Streptococcus Vaginal and Rectal Colonization. J Obstet Gynecol Neonatal Nurs 2014; 43:294-304. [DOI: 10.1111/1552-6909.12308] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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