Влияние пробиотиков на функциональную активность кишечной микробиоты беременных и микробиом новорожденных

Abstract

UpToDate, the issue of the need for the use of probiotics in pregnant women and newborns, especially in infants born in critical condition, remains relevant. Despite the proven effectiveness in the treatment of antibiotic-associated and nosocomial diarrhea, necrotizing enterocolitis, Helicobacter pylori infection, in some clinical situations, further studies are still often required to confirm the positive effect, determining the type, dose and time of taking probiotics. Objective. To evaluate the effect of probiotics on the metabolic activity of the intestinal microflora of pregnant women and the microbiome of newborns. Patients and methods. 236 women were monitored during single pregnancy from 28 to 42 weeks of gestation. Pregnant women were divided into two groups: the main group, whose patients took the probiotic Lactobacillus reuteri Protectis and the comparison group without probiotitcs. All patients had urgent spontaneous physiological labor. The condition at birth and the period of adaptation of newborns were considered satisfactory, all children were breastfed . The condition of the formed mother–child pair was monitored over the next three months. To determine the functional state of the intestinal microbiome in pregnant women, an assessment of endogenous biomarkers of its metabolic activity – short-chain (SCFAs) fatty acids in coprofiltrates. The gas chromatography-mass spectrometry method was used to separate and quantify short-chain fatty acids in stool. The study of intestinal microflora in newborns was carried out on the 20th–25th day of life using the generally accepted microbiological method, in which a qualitative and quantitative assessment of obligate, conditionally pathogenic and pathogenic microorganisms in stool. The mathematical and statistical processing of the obtained research results was carried out using the TIBCO STATISTICA (USA) application software package for a personal computer. The calculation of the average values of the feature (M), standard errors of the average feature (m), and mean square deviations (σ) was performed. In the analysis of the conjugacy tables, the Pearson criterion χ2 was applied to assess the statistical significance of the differences between the two relative indicators. The data in the groups were regarded as statistically significant at p < 0.05 or statistically highly significant at p < 0.001. Results. The obtained results of the study of SCFAs in stool of pregnant women who received probiotics indicated an increase in the functional activity of the intestinal microbiota, improved utilization of these acids by colonocytes, changes in the composition of anaerobic-aerobic populations of microorganisms, leading to an improvement in the redox potential of the intestinal environment. In women who did not receive probiotics, such dynamics of endogenous biomarkers of the functional activity of the intestinal microbiome was not observed. Conditionally pathogenic microflora, various strains of Escherichia coli, and a decrease in the content of lactic acid flora against the background of a high frequency of functional disorders of the intestinal motility were detected in all 236 newborn children in stool. The analysis of the composition of the intestinal microbiome of infants showed a significantly high incidence of a decrease in the number of lactobacilli and an increase in the content of Staphylococcus aureus, Klebsiella pnemoniae, Enterococcus, E. coli strains with low enzymatic properties and hemolytic E. coli in children of the comparison group. At the same time, there were no differences in the content of bifidobacteria, Candida albicans and strains of lactose-negative E. coli in the microbiome of children of both groups, regardless of the intake of probiotics by women. Conclusions. Thus, the intake of L. reuteri Protectis by pregnant women had a positive effect on the activity of the intestinal microflora, which was expressed by a significant increase in the concentration of acetic acid, the total content of SCFAs and the anaerobic index. Despite the fact that all children had disorders in the composition of the intestinal microflora in the form of the presence of S. aureus, K. pnemoniae, Enterococcus, strains of E. coli with weakly enzymatic properties and hemolytic E. coli – the preventive effectiveness of the use of probiotics during pregnancy of their mothers was confirmed by a decrease in the frequency of functional disorders of intestinal motility and the amount of opportunistic microflora, strains of E. coli in the formation of the intestinal microbiome in newborns. Key words: probiotics, pregnant women, newborns, intestinal microbiome, short-chain fatty acids