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Probiotics fail to prevent gestational diabetes in high-risk pregnant women

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January 31, 2019

Administering probiotics in the second trimester of pregnancy is not an effective strategy for preventing gestational diabetes in women with overweight or obesity, according to findings published in Diabetes Care.

“[Gestational diabetes] therapy is currently focused on normalizing glycemia,” Leonie K. Callaway, MBBS, FRACP, PhD, GCELead, the head of the Royal Brisbane Clinical School and a senior specialist in obstetric and internal medicine at the Royal Brisbane and Women’s Hospital in Brisbane, Australia, and colleagues wrote. “While this prevents or reduces the impact of short-term complications, this may not be true for the longer-term complications. Ideally, [gestational diabetes] would be prevented.”

Callaway and colleagues conducted a prospective, double-blind, randomized controlled trial with 411 women recruited from the Royal Brisbane and Women’s Hospital, Radcliffe Hospital and the Mater Mothers’ Hospital in Brisbane, Australia. Participants, who were recruited beginning in November 2012, were required to be older than 18 years with a singleton pregnancy of less than 20 weeks’ gestation and a BMI of more than 25 kg/m2.

Participants were randomly assigned to a probiotic mixture of Lactobacillus rhamnosus and Bifidobacterium animalis subspecies lactis (n = 207; mean age, 31.3 years; mean BMI, 31.9 kg/m2) or placebo capsules (n = 204; mean age, 31.7 years; mean BMI, 31.6 kg/m2), taken daily until birth. At 28 weeks, the frequency of gestational diabetes was assessed with a 75-g oral glucose tolerance test. The researchers also evaluated secondary outcomes, including gestational weight gain, preeclampsia and gestational age at delivery.

More women in the probiotics group developed gestational diabetes (n = 38; 18.4%) than in the placebo group (n = 25; 12.3%), but the difference was not statistically significant. Women in the probiotics group also had higher average fasting glucose levels (79.3 mg/dL) compared with the placebo group (77.5 mg/dL; P = .049). The researchers noted that 1- and 2-hour glucose levels were similar between the two groups.

As for secondary outcomes, a larger percentage of women in the probiotics group developed preeclampsia (9.2%) compared with the placebo group (4.9%; P = .09), whereas women in the placebo group had higher rates of excessive weight gain (46%) than their counterparts in the probiotic group (32.5%; P = .01). The researchers also said the only significant difference in neonatal outcomes occurred in small for gestational age deliveries, with 6.5% in the placebo group compared with 2.4% of the probiotics group (P = .042).

“For many years, there has been widespread speculative commentary regarding the potential for probiotics to be an elegant and easy solution to [gestational diabetes] prevention. They appeared safe and easy to take without any obvious maternal or neonatal side effects,” the researchers wrote. “Despite reassuring safety data, and the logical reasons that probiotics might improve glucose metabolism, our study clearly argues against efficacy of probiotics in [gestational diabetes] prevention.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

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