Probiotics for the Prevention of Gestational Diabetes Mellitus in Overweight and Obese Women: Findings From the SPRING Double-Blind Randomized Controlled Trial

Abstract

OBJECTIVEGiven the role of gut microbiota in regulating metabolism, probiotics administered during pregnancy might prevent gestational diabetes mellitus (GDM). This question has not previously been studied in high-risk overweight and obese pregnant women. We aimed to determine whether probiotics (Lactobacillus rhamnosus and Bifidobacterium animalis subspecies lactis) administered from the second trimester in overweight and obese women prevent GDM as assessed by an oral glucose tolerance test (OGTT) at 28 weeks' gestation. Secondary outcomes included maternal and neonatal complications, maternal blood pressure and BMI, and infant body composition. RESEARCH DESIGN AND METHODSThis was a double-blind randomized controlled trial of probiotic versus placebo in overweight and obese pregnant women in Brisbane, Australia. RESULTSThe study was completed in 411 women. GDM occurred in 12.3% (25 of 204) in the placebo arm and 18.4% (38 of 207) in the probiotics arm (P = 0.10). At OGTT, mean fasting glucose was higher in women randomized to probiotics (79.3 mg/dL) compared with placebo (77.5 mg/dL) (P = 0.049). One-and two-hour glucose measures were similar. Preeclampsia occurred in 9.2% of women randomized to probiotics compared with 4.9% in the placebo arm (P = 0.09). Excessive weight gain occurred in 32.5% of women in the probiotics arm (55 of 169) compared with 46% in the placebo arm (81 of 176) (P = 0.01). Rates of small for gestational age (<10th percentile) were 2.4% in the probiotics arm (5 of 205) and 6.5% in the placebo arm (13 of 199) (P = 0.042). There were no differences in other secondary outcomes. CONCLUSIONSThe probiotics used in this study did not prevent GDM in overweight and obese pregnant women.Clinical trial reg. no. ACTRN12611001208998, www.anzctr.org.au This article is part of a special article collection available at http://care.diabetesjournals.org/ gdm-new-evidence.

Multi-strain Probiotic Increases the Gut Microbiota Diversity in Obese Pregnant Women: Results from a Randomized, Double-blind Placebo-controlled Study

“…Our data on gut microbiota showed a slight increase in α-diversity during the intervention period in (p = 0.01) [21]. An effect of probiotics on body weight has also been described in non-pregnant overweight and obese women [25,26].…”

“…A randomized controlled trial (RCT) showed no effect on either GWG, maternal fasting glucose, infant birthweight, or other metabolic variables after four weeks of probiotic intervention [20]. A recently published RCT including overweight and obese pregnant women showed a significant effect of probiotics in reducing excessive weight gain versus placebo when administrated from the second trimester until delivery [21]. Fasting glucose measurements were, however, significantly higher in the women receiving probiotics.…”

Current Resources for Evidence‐Based Practice, September/October 2020

“…It is a dopamine antagonist and, therefore, is thought to increase prolactin levels. 13 The majority of studies have been carried out among preterm infants whose mothers needed to pump because the infants were unable to breastfeed. However, this meta-analysis restricted to term infants only identified a single study with 45 participants who took 10 mg of domperidone 4 times a day for 4 days.…”

Metformin in pregnancy to avert gestational diabetes in women at high risk: Meta‐analysis of randomized controlled trials

“…GDM affects approximately 12% to 18% of high‐risk pregnancies worldwide, and this number is set to increase with the escalating obesity epidemic . Risk factors for GDM that put women at higher risk include overweight and obesity, advanced maternal age, and a family history of any form of diabetes, history of previous GDM, polycystic ovary syndrome (PCOS), multiparity, and history of preterm delivery …”