Effect of maternal supplement beverage with and without probiotics during pregnancy and lactation on maternal and infant health: a randomized controlled trial in the Philippines

Abstract

BackgroundAdequate nutrition is essential during pregnancy and lactation to provide sufficient energy and nutrients to meet the nutritional requirements of the mother, fetus and infant. The primary objective of this study was to assess the effect of a maternal nutritional supplement enriched with probiotics during pregnancy and early lactation on the incidence of infant diarrhea.MethodsHealthy, pregnant (24–28 weeks gestation) women were randomized 1:1:1 to receive either no supplement or two servings per day of an oral supplement (140 kcal/serving) providing 7.9 g protein, multivitamin/minerals, and enriched or not with the probiotics Lactobacillus rhamnosus and Bifidobacterium lactis, from the third trimester of pregnancy until at least 2 months post-delivery. Incidence of infant diarrhea until 12 months post-delivery was analyzed by Poisson regression. The effect on maternal health, fetal growth, and infant growth and morbidity were also evaluated and analyzed by ANOVA.ResultsA total of 208 mother/infant pairs were included in the analysis. No significant difference in the incidence of infant diarrhea was observed between the three study groups. The mean maternal weight gains at delivery were similar among groups, despite an increase in caloric intake in the supplemented groups. No statistically significant differences between groups were observed in incidence of pregnancy-related or fetal adverse outcomes. Mean weight-, length-, BMI- and head circumference-for-age z-scores were below the WHO median value for all groups. Post-hoc analysis to compare the effect of the combined supplement groups versus the no supplement group on infant growth parameters showed, at 12 months, that the combined supplemented group had gained statistically significant more weight (8.97 vs. 8.61 kg, p = 0.001) and height (74.2 vs. 73.4 cm, p = 0.031), and had a higher weight-for-age z-score (− 0.62 vs. -0.88, p = 0.045) than the no supplement group.ConclusionsMaternal nutritional supplement with or without probiotics given during late pregnancy and early lactation was well tolerated and safe. Even though no difference in incidence of infant diarrhea was observed between the three groups, the analysis of the combined supplemented groups showed beneficial effects of maternal supplementation on infant weight and length gains at 12 months.Trial registrationClinicalTrial.gov: NCT01073033. Registered 17.02.2010.

Probiotic Supplementation during the Perinatal and Infant Period: Effects on gut Dysbiosis and Disease

“…The adverse outcomes evaluated were maternal health in one trial [ 187 ]; pregnancy-related or fetal adverse outcomes in three trials [ 187 , 188 , 189 ]; fetal and/or neonatal anthropometry in 10 trials [ 187 , 188 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 ]; infections, including severe infections in eight trials [ 196 , 198 , 199 , 200 , 201 , 202 , 203 , 204 ]; allergic disorders in three trials [ 203 , 205 , 206 ]; gastrointestinal effects in 10 trials [ 187 , 190 , 191 , 192 , 193 , 196 , 197 , 200 , 203 , 205 ]; and noncommunicable diseases in one trial [ 194 ]. Only five studies evaluated the safety during pregnancy [ 187 , 188 , 189 , 190 , 206 ]. The obstetric variables analyzed by these studies were miscarriage before 22 weeks, caesarean delivery, gestational diabetes, prematurity, fetal growth, Apgar score, birth weight, birth length, head circumference at birth, gestational hypertensive disorders, postpartum hemorrhage, maternal weight gain, and tolerance of the product.…”

“…Nine studies used single-strain probiotics ( Lactobacillus rhamnosus GG, Lactobacillus reuteri DSM 17938, Bifidobacterium lactis CNCM I-3446, Bifidobacterium longum subsp. infantis CECT7210 and EVC001) [ 192 , 193 , 195 , 196 , 197 , 200 , 202 , 203 , 205 ] and nine more used a combination of probiotics [ 187 , 188 , 189 , 190 , 191 , 194 , 201 , 204 , 206 ]. The species of probiotics used most often were Lactobacillus rhamnosus, Bifidobacterium infantis, Lactobacillus reuteri , and Bifidobacterium lactis .…”

Preterm Birth: A Narrative Review of the Current Evidence on Nutritional and Bioactive Solutions for Risk Reduction

“…PTB rates were reported as a secondary outcome in two studies testing different combinations of probiotics. Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 were tested in Finland [146], and Lactobacillus rhamnosus LPR and Bifidobacterium lactis NCC 2818 in the Philippines [147]. Both studies found PTB rates much lower than national averages reported by WHO, 1.7% vs. 5.5% in Finland and 2.4% vs. 15% in the Philippines [8].…”

A life history approach to prenatal supplementation: Building a bridge from biological anthropology to public health and nutrition

“…In some cases, additional energy and nutrients lead to gains in perinatal outcomes across the study sample (eg, Huynh, Tran, Nguyen, Berde, & Low, ). In others, they do not (eg, Mantaring et al, ; Stevens et al, ). Most recent studies in diverse populations, however, point to the importance of maternal and ecological characteristics in mediating the impact of supplementation.…”

“…Just as biological anthropologists are expanding the scope of life history theory to account for the costs and benefits of immune activation (McDade, ; Shattuck‐Heidorn, Reiches, Prentice, Moore, & Ellison, ; Urlacher et al, ), public health and nutrition researchers are pushing the frontiers of supplementation in an attempt to influence maternal immune responses and fetal immune system development through the use of probiotics (Baldassarre et al, ; Cabridain et al, ; Mantaring et al, ). This research program on prenatal interventions in the gut microbiome is in its infancy.…”