Probiotics during Pregnancy & Breastfeeding Safety & Benefits

How effective are probiotics during pregnancy? Are probiotic preparations such kefir, yogurt, Lactobacillus Acidophilus safe? What about when breastfeeding? Read on to find out more about probiotics and pregnancy and lactation, benefits, side effects and tips on  optimal use.

Probiotics and Pregnancy-Safety

The biggest question asked is whether probiotics are safe for use during pregnancy and lactation. Which is good since you may end up risking the welfare of the baby if you do not seek medical assistance.

Probiotics are safe for use. The worry most people have is whether probiotics can cause systemic infections which may be conversantly transmitted to the baby. Despite limited research done on this, the few that exist do not express mixed results.

There are several randomized clinical trials that have been conducted in expectant mothers in their third stage of pregnancy. The study focused on the strains Lactobacillus spp  and Bifidobacterium spp  which are the most widely used strains in probiotic formulations. The research was however not able to evaluate pregnancy outcomes by design, and therefore did not propose a side effect that is related to probiotics. Two observational studies focusing on Lactobacilli in the first stage of pregnancy fortunately reported negative risk of malformations[i].

Oral or vaginal administration of probiotics are rendered safe. There is a trace in the ability of probiotics to cause systemic infections though rare. In some instance probiotic-induced bacteremia and fungemia have resulted and reported. It is worthwhile to note that this blood infection lies at a probability of less than 1 per 1, 000, 000 users. The ratio is five times larger with fungemia caused by Saccharomyces boulardii. Note that the prevalence varies with individuals. A healthy individual will have less susceptibility to these kinds of infection while immune-compromised are at a higher risk.

Other causes that may lead to infection in the blood that may be passed on to the baby are:

1. Critical and terminal illnesses
2. Breach of the intestinal epithelium
3. Drugs that may cause immunosuppression

According to the National Institute of Health, probiotics are safe due to their low absorption through the epithelial wall of the gut. The conclusion made is that probiotics are safe in both pregnancy and lactating mothers[ii].

In a randomized control trial Lactobacillus reuteri levels were analyzed in 74 colostrum samples. This test was done after the mother had consumed an oral supplement of probiotic with the strain. A placebo was also administered and the results were that there was a higher amount of the bacteria in those who took the supplement. The prevalence was however clinically insignificant therefore not raising any eyebrows in matters adverse effects.

A meta-analysis of researchers in Canada also found no connection between probiotic use and low birth weight, miscarriages or birth in need of Caesarean section.

Benefits of Probiotics during Pregnancy

1. Reduced risk for allergies such as asthma and eczema which are inflammatory diseases.
2. Reduced post-partum depression – according to a preliminary research, probiotics can alter the enteric (gut) neurotransmitters and allowing the body deal with anxiety and depression.
3. Colicky behavior – probiotics help maintain the normal intestinal flora, allowing proper digestion and preservation of the integrity of intestinal walls. This reduces gas, bloating and constipation.
4. Reduced risk of pre-eclampsia – a study published in the American Journal of Epidemiology showed that out of more than 33,000 women in Norway, those who consumed fermented milk products during the first trimester and half of the second, had reduced risk of pre-eclampsia. This has been linked to its anti-inflammatory properties in the intestines that in turn prevent build-up of blood pressure. In addition, probiotics with Lactobacillus and Bifidobacterium taken during the first trimester until 6 months after birth reduced central obesity. This prevents the occurrence of pre-eclampsia in subsequent pregnancies.
5. Preventing antibiotic-induced diarrhea during pregnancy

Side effects of Probiotics in Pregnancy

Probiotics are safe for use and side effects should be reported by the patient. These may include causing an infection. This is a rare occurrence when taken in regulated amounts and if you are not immune-compromised.

Yogurt, Kefir & Acidophilus Probiotics during Pregnancy

Yogurt

Yogurt is not only loaded with calcium for your healthy bones and the baby’s but also packed with beneficial bacteria. You might already know this. The big question is, is it a safe product for use during pregnancy?

Yes it is! Yogurt might not be the only way to get your probiotics, but in terms of accessibility, they might as well be. By accessibility, you will well refer to its physical availability and affordability. Dairy products are considered the best way to get the beneficial bacteria into your system.

In vitro studies have shown that lactoferrin in dairy foods may enhance Bifidobacteria growth which is one of the friendly bacteria. L. acidophilus, which is used in the fermentation of milk is also present. The active friendly bacteria can also help combat stomach discomforts as well as yeast infections. Yeast infections are more common in pregnancy since the mother’s immune system has been a bit suppressed to accommodate the baby.

While yogurt is safe for use in pregnancy, its benefits will be highly reaped if the organisms in it are well preserved and active. This means that you need to refrigerate and store it within the acceptable conditions according to label. While pasteurization and sterilized milk will likely contain little microorganisms unlike organic yogurts, stick to this regime.

Pasteurized or ultra-heated (UHT) milk should be used in the preparation of home-made yogurt and this should be your first concern. If not, just avoid it so as to prevent any kind of infections arising. Note that listeria bacteria which may be harmful to your fetus is most prevalent in untreated dairy products. One other important item to check for is the use-by-date. You are at liberty to choose from all types of yogurt including low-fat, live and bio.

Kefir

Relatively new in in most stores as compared to yogurt, kefir has grown fast from the Eastern European Caucasus Mountains. Some people prefer kefir to yogurt for their probiotics. It contains many strains of beneficial bacteria including the Leuconostac, Acetobacter and Lactobacillus caucasus. Apart from these, kefir also has some beneficial yeast that will help outcompete pathogenic bacteria too.

Some brands of kefir have as much as 12 species of beneficial bacteria. Back to the big question; is kefir safe and efficient for use in pregnancy?

In countries with National Kefir Associations (NKA), kefir has been considered a safe probiotic and even recommends that pregnant women take it regularly. Some of the benefits of kefir include:

1. Flushes out pathogenic bacteria from the intestines
2. Regulates digestion allowing proper absorption of nutrients that are needed by both you and your baby.
3. It is used in the treatment and relief of diarrhea, leaky gut syndrome and skin conditions. Diarrhea may result in you losing excess water and causing dehydration which is not what you want during your trimesters.
4. Regulation of your immune system preventing any kind of inflammation both in the gut and along the gut-skin axis.
5. Kefir contains lactose and sugar utilizing bacteria which is more beneficial to those mothers who are lactose intolerant and diabetics. Though it contains lactose, the live strains present help predigest sugar.

Lactobacillus acidophilus

This strain of bacteria has been successfully used in the last trimester within the last 2-4 weeks before childbirth. It has also been implicated to have beneficial effects during lactation for up to 6 months.

According to a systematic review of scientific and peer-reviewed literature in the Natural Standard Research Collaboration, L. acidophilus tablets are indicated for a variety of diseases and conditions. Such includes, bacteria vaginosis, inflammations and premature childbirth.

Tablets of this strain are therefore beneficial in pregnancy but care should be taken with drug interactions. According to Mayo Clinic, L. acidophilus may affect insulin sensitivity and therefore should be contraindicated in diabetics. In case of administration, a qualified healthcare professional especially a pharmacist should make necessary adjustments to therapy[iii].

Culturelle

This probiotic contains Lactobacillus rhamnosus  GG and is therefore generally safe and effective to take during pregnancy. Its benefits elicited are in a similar manner to other strains of friendly bacteria.

How Helpful are Probiotics while Breastfeeding?

Probiotics are particularly helpful in the gut of the baby in a direct fashion. The Australian Healthy Eating Guidelines for breastfeeding women recommends 2 servings of dairy including yogurt each day.

A study has been done to investigate whether strains of gut-associated anaerobes are shared between the mother and neonate gut through breastfeeding. The results were positive with similar strains found in the mother’s feces and breast milk[iv].

You and your baby will benefit from the friendly probiotic bacteria if taken during this time. More emphasis is placed on:

1. Nutrients are leached from the mother during this time and the immune system may be lowered. Probiotics regulate the immune system.
2. Strengthens the infants immune system
3. Reduction of acid reflux symptoms. In a 2011 publication in the European Journal of Clinical Investigation, babies on Lactobacillus reuterii showed reduced reflux symptoms.
4. Control of diaper rash and oral thrush. The friendly bacteria in probiotics suppress the growth of yeast and therefore outcompete it. Some probiotics contain yeast in them and introducing infants to it makes them immune-competent against yeast infections.

Tips on how to get best results out of probiotics while Pregnant & Breastfeeding

1. Seek professional healthcare advice – if you are in a dilemma, make sure that you see a healthcare professional including a pharmacist, physician or nutritionist.
2. Learn when to take them – when to take a probiotic is important to ensure that all the beneficial bacteria are delivered to the intestines. A study published in the Journal of Beneficial Microbes showed that optimal absorption is evident when taken before a meal. This is because they are not exposed to too much acid that would kill all the bacteria.
3. Read the labels on your probiotic products – it is important to note whether the expiry date has passed and whether the product, if a dairy product has been treated appropriately.

Sources and References

1. [i] Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Luoto R, Laitinen K, Nermes M, Isolauri E, Br J Nutr. 2010 Jun; 103(12):1792-9.
2. [ii] Are probiotics safe for use during pregnancy and lactation? Jackie Elias, RPh, Pina Bozzo, and Adrienne Einarson, RN
3. [iii] Ringel-Kulka T, Palsson OS, Maier D, et al. Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. J.Clin.Gastroenterol. 2011; 45(6):518-525.
4. [iv] Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland.