Effectiveness of Probiotic, Prebiotic, and Synbiotic Supplementation to Improve Perinatal Mental Health in Mothers: A Systematic Review and Meta-Analysis

Abstract

Introduction: There is an emerging interest in modulating the gut microbiota to target the gut-brain axis and improve maternal mental health in the perinatal period. This systematic review evaluated the effectiveness of prebiotics, probiotics, and synbiotics supplementation during pregnancy to reduce the risk of maternal mental health problems in the perinatal period.Methods: Electronic biomedical databases and clinical trial registries were searched from database inception through August 2020 to identify randomized controlled clinical trials (RCTs) evaluating the effect of probiotic, prebiotic, or synbiotic supplements administered to women during pregnancy on measures of perinatal depression, anxiety, and other mental health outcomes. Study selection, risk of bias appraisal, and data extraction were independently performed by two reviewers. Pooled mean differences (MD) and odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for the outcomes of interest in the review.Results: From 3,868 studies identified through the search strategy, three RCTs of low risk of bias involving 713 participants were included, all three testing probiotics. There were no differences between probiotics and control groups in the mean depression scores (MD −0.46; 95% CI −2.16, 1.25) at end of follow-up. Although statistical significance was not achieved, probiotics showed an advantage in the proportion of participants scoring below an established cut-off for depression (pOR 0.68; 95% CI 0.43, 1.07). Compared to placebo, probiotics in pregnancy reduced anxiety symptoms (MD −0.99; 95% CI −1.80, −0.18); however, this advantage was not translated in a reduction in the proportion of participants scoring above an established cut-off for anxiety (pOR 0.65; 95% CI 0.23, 1.85). There were no differences between probiotics and control groups in global mental health scores at end of follow-up (MD 1.09; 95% CI −2.04, 4.22).Conclusion: There is limited but promising evidence about the effectiveness of probiotics during pregnancy to reduce anxiety symptoms and reduce the proportion of women scoring ABOVE a cut-off depression score. There is a lack of RCT evidence supporting prebiotics and synbiotics supplementation for similar purposes in the perinatal period. More research is needed before prebiotics, probiotics, and synbiotics are recommended to support maternal mental health and well-being in the perinatal period.Systematic Review Registration: PROSPERO, CRD42019137158.

Efficacy of Direct or Indirect Use of Probiotics for the Improvement of Maternal Depression during Pregnancy and in the Postnatal Period: A Systematic Review and Meta-Analysis

“…A similar systematic review and meta-analysis by Desai and co-authors [ 9 ] focused on the effectiveness of probiotic, prebiotic and synbiotic administration on perinatal maternal mental health; however, it focused only on supplementation during pregnancy. It is well known that probiotic supplementation of mothers during breastfeeding or direct supplementation to the infant has several benefits for the infant, including developing a healthy microbiome, reduction in colic and regurgitation, the development of a healthy immune system, and reduction in the risk of atopic eczema [ 73 , 74 , 75 ].…”

“…Assessing the maternal and child’s microbial communities may be an important missing component in mother-infant attachment-based therapies during the treatment of perinatal depression [ 8 ]. One approach to improving maternal mental health in the perinatal period is targeting the gut-brain axis by modulating the gut microbiota [ 9 ].…”

“…A recent review by Desai and co-authors [ 9 ] that included three randomised controlled trials investigated the effectiveness of probiotic, prebiotic, or synbiotic supplementation during pregnancy to improve perinatal maternal health. Desai and co-authors [ 9 ] focused only on probiotic supplementation during pregnancy and found that there is limited but promising evidence regarding the effectiveness of probiotics during pregnancy to reduce anxiety symptoms and reduce the proportion of women scoring above a cut-off depression score.…”

“…A recent review by Desai and co-authors [ 9 ] that included three randomised controlled trials investigated the effectiveness of probiotic, prebiotic, or synbiotic supplementation during pregnancy to improve perinatal maternal health. Desai and co-authors [ 9 ] focused only on probiotic supplementation during pregnancy and found that there is limited but promising evidence regarding the effectiveness of probiotics during pregnancy to reduce anxiety symptoms and reduce the proportion of women scoring above a cut-off depression score. Our review aimed to assess the influence of probiotics on improving maternal depression and anxiety, whether taken directly by pregnant women or after birth, as well as the indirect influence of probiotics on maternal mental health if consumed by infants, as all factors can influence maternal mental health.…”

Mood Disorders Induced by Maternal Overnutrition: The Role of the Gut-Brain Axis on the Development of Depression and Anxiety

“…In an animal model, consumption of probiotics concomitant with an HFD started before pregnancy and continued until lactation was able to protect mice offspring against metabolic disturbances compared to offspring of dams on HFD alone (Guo et al, 2018). On the other hand, its effect in pregnant women is controversial since promising literature (Desai et al, 2021) contrasts with evidence such as a randomized clinical trial that found no benefits with Lactobacillus rhamnosus and Bifidobacterium lactis supplementation in obese pregnant women regarding depression and well-being (Dawe et al, 2020). Therefore, future studies are needed to robustly assert whether probiotic supplementation during pregnancy would be useful to prevent the development of mood disorders such as depression and anxiety in the progeny.…”