Abstract
Probiotic and prebiotic products have shown potential health benefits, including for the prevention of adverse pregnancy outcomes. The incidence of adverse effects in pregnant people and their infants associated with probiotic/prebiotic/synbiotic intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic, and/or synbiotic supplementation during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of this population. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. In total, 11/100 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. One study reported increased risk of vaginal discharge and changes in stool consistency (relative risk [95% CI]: 3.67 [1.04, 13.0]) when administering Lactobacillus rhamnosus and L. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.
Highlights
The use and acceptance of probiotic products is increasing globally due to their documented health benefits [1,2]
While probiotic supplementation in pregnant populations has been associated with several health benefits, there is a lack of information on the health benefits of prebiotics and synbiotics in pregnant and lactating people
All 11 studies included in the Graphical Overview for Evidence Reviews (GOfER) diagram that reported on adverse effects were randomized controlled trials
Summary
The use and acceptance of probiotic products is increasing globally due to their documented health benefits [1,2]. Some probiotic products can alter vaginal and breastmilk microbial composition, and have been used to prevent the recurrence of bacterial vaginosis [15] and support the gut health of newborn infants by influencing the composition of their gut microbiomes [16]. Given their documented and potential therapeutic effects for certain conditions in non-pregnant, pregnant, and lactating people, there may be specific situations for which there is a need for probiotics. The potential benefits of these products in non-pregnant populations include reducing plasma cholesterol and insulin concentrations [17], decreasing body weight in overweight individuals [18], improving stool consistency [19], and treating constipation [20]
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