The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review
2. What Are Prebiotics and What Types Are There?
3. Prebiotics for Healthy Pregnant Women
4. Prebiotics for Pregnancy Complications
4.1. Obese Pregnancy
4.2. Gestational Diabetes
4.3. Hypertension and Preeclampsia
4.4. Bacterial Vaginosis
4.5. Perinatal Mental Health
5. Prevention of Pediatric Disorders
5.1. Prebiotics in the Window of Opportunity
5.2. Caesarean Delivery
5.3. Preterm Labor
5.4. Asthma and Allergy
5.5. Skin Maladies
5.6. Protection against SARS-CoV-2
6. Conclusions, Limitations, and Reflections
7. Methods of Searching
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Condition||Evidence from Clinical Trials||References|
|Pregnancy and its complications||Healthy pregnancy||In maternal intake of FOS during the third trimester, there was a significant increase in fecal Bifidobacterium spp. and Bifidobacterium longum in the intervention group at the end of pregnancy.|
Administration of milk fortified with prebiotic, probiotic, DHA and micronutrients, observing notable increases in fecal concentration of the organism used as probiotic, alleging that probiotic colonization is successful when combined with prebiotics and other micronutrients.
Comparing pregnant women for 9 weeks, synbiotics containing Lactobacillus sporogenes and inulin showed significant differences with lower serum insulin levels in the intervention group versus the control group.
Regarding safety of pro- and prebiotics use in pregnancy and lactation, although only in some cases were changes in stool consistency noticed, but did not have serious effects for the mother or the infant’s health.
|Gestational diabetes (GDM)||Intervention with synbiotics has shown significant improvements on glucose and lipid metabolism, insulin resistance, as well as anti-inflammatory and antioxidant ability in diet controlled GDM patients, reducing the risk of fetal hyperbilirubinemia, fetal macrosomia, and limiting newborn weight. However, to optimize the results, more characterization about combinations with certain probiotics strains should be considered.||[29,30,31]|
|Hypertension and preeclampsia||The safety of pro- and prebiotic use stimulates gut-derived metabolites, such as butyrate, that attenuate inflammation.|
There were no notable benefits from the administration of probiotics or synbiotics in women with hypertensive disorders or GDM, although due to the limited number of studies available, additional efforts are required.
|Bacterial vaginosis||Synbiotics consumption seems to effectively prevent recurrent urinary tract infections in women. In the case of bacterial vaginosis, they suggest that a combo of probiotics and prebiotics should be applied instead of using antibiotics, which is risky for a pregnant woman. Furthermore, pre/probiotic regimens seem to have even higher cure rates than antibiotics.||[35,36]|
|Perinatal mental health||Limited evidence of a lower incidence of anxiety and depressive symptoms in the perinatal period has been reported when supplementing with pro-, pre- and synbiotics during pregnancy.||[37,38]|
|Fortified formula milk and breastfeeding)||Prevention in the window of opportunity||There are significant increases in fecal Bifidobacterium spp. when treating mothers with FOS, but no difference was observed in neonates aged 1 month. Longer term studies need to be undertaken.|
Short-term studies have observed reduced daily crying time when administering probiotics compared to placebo. The same studies defend the application of oligosaccharide prebiotics to promote the growth of beneficial bacteria as treatments for allergy or intolerance and for crying in babies with colic that are on formula.
A premise from ecological theory says that microbial community development is affected by priority effects that determine species arrival and their behavior, which can be favorably modulated by pro- and prebiotics, so therapies targeting the gut microbiota are a potential choice.
Different formulas of milk have reported an increase in bifidogenic bacteria and a decrease in opportunistic pathogens, in addition to a reduction of fecal pH, an increase in alpha diversity, and optimized calcium absorption.
Human milk composition in prebiotics stimulate Bifidobacteria and Lactobacilli as well. However, when breast milk is not available or adequate, HMO fortified formulas seem to be the best option.
A randomized controlled trial studied the effect of a specific prebiotic mixture administered from the day of birth on bifidobacterial and lactobacilli counts. An examination was performed at 3, 6 and 12 months of age, finding that the supplemented group had more fecal bifidobacterial and lactobacilli compared to placebo, these differences being maintained six months later without further supplementation. This kind of explorative study shows that prebiotics, even in the first days of life, are effective in establishing a competent gut immune system.
|Pediatric disorders||Caesarean delivery||Stool samples from supplemented babies are softer and seem to be related to a lower level of pathogens. Nevertheless, the duration of supplementation to ensure a lasting beneficial effect is yet unknown, and another gap to close in clinical studies.|
A recent systematic review noted that the sooner the intervention during pregnancy and lactation after cesarean delivery, the better the effects that are achieved, especially Bifidobacterium colonization. Results were even more favorable in breastfed infants from supplemented mothers. The utilized formulas included GOS, FOS, or bovine milk-derived oligosaccharides, combined with probiotics from the genera Lactobacillus, Bifidobacterium, Propionibacterium, and Streptococcus.
|Asthma and allergy||The use of a formula milk containing a mixture of prebiotic oligosaccharides was associated with the lower incidence for recurrent wheezing in 132 infants at risk of atopy, although supplementation of non-human neutral and acidic oligosaccharides during the neonatal period did not reduce the incidence of allergies, bronchial hyper-reactivity, or respiratory infections in 113 preterm infants.|
They found a meta-analysis of two studies with 249 infants, reporting a reduction in infant asthma or recurrent wheezing in prebiotic-treated infants, and a single study reporting a significant reduction of the risk of developing food allergies by the use of prebiotics.
These results are due to their ability to induce the production of short-chain fatty acids, especially dietary fiber and oligosaccharides, leading to the activation of T regulatory cells and tolerance mechanisms.
Despite these potential benefits, the available literature seems to indicate that the evidence for the supplementation of prebiotics for the prevention of allergies are not yet strong enough to make any clear recommendations.
|Skin maladies||Synbiotics consumption during pregnancy and lactation seems to decrease eczema incidence in offspring. Few clinical trials have noticed lower eczema and atopic dermatitis severity in unweaned babies.|
Studies related to maternal supplement intake while lactating compared to using prebiotic-enriched formula milk, seem to be a more proper approach to reduce eczema in ≤4 year-aged babies.
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García-Montero, C.; Fraile-Martinez, O.; Rodriguez-Martín, S.; Saz, J.V.; Rodriguez, R.A.; Moreno, J.M.P.; Labarta, J.R.; García-Honduvilla, N.; Alvarez-Mon, M.; Bravo, C.; De Leon-Luis, J.A.; Ortega, M.A. The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review. Foods 2023, 12, 1148. https://doi.org/10.3390/foods12061148
García-Montero C, Fraile-Martinez O, Rodriguez-Martín S, Saz JV, Rodriguez RA, Moreno JMP, Labarta JR, García-Honduvilla N, Alvarez-Mon M, Bravo C, De Leon-Luis JA, Ortega MA. The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review. Foods. 2023; 12(6):1148. https://doi.org/10.3390/foods12061148Chicago/Turabian Style
García-Montero, Cielo, Oscar Fraile-Martinez, Sonia Rodriguez-Martín, Jose V. Saz, Rocio Aracil Rodriguez, Juan Manuel Pina Moreno, Javier Ruiz Labarta, Natalio García-Honduvilla, Melchor Alvarez-Mon, Coral Bravo, Juan A. De Leon-Luis, and Miguel A. Ortega. 2023. "The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review" Foods 12, no. 6: 1148. https://doi.org/10.3390/foods12061148