10511717_lCommentary by: Matthew Baral, ND

Reference: 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 Feb 4:1-8.

Design: Double-blind, placebo controlled study.

Participants: 256 pregnant women were recruited during their initial visit at a maternal welfare clinic in Turku, Finland. Pregnant women were randomized to three groups: control, dietary intervention (diet), and dietary intervention with probiotic supplementation (diet + probiotics). All groups received basic dietary counseling normally provided by the clinic. However, the dietary intervention group received additional intensive dietary counseling regarding specific fat and fiber recommendations. This group was then further randomized to create the diet + probiotics group. The study period began during the first trimester and ended when exclusive breastfeeding was discontinued. 238 mothers initially started the study, and 191 mother-child pairs followed through to completion. Exclusion criteria included any metabolic diseases, but any history of atopic disease was acceptable. In fact, 79% of them had received a diagnosis of at least one allergic disease (atopic eczema, allergic rhinitis or asthma) in the past.

Study Medication and Dosage: Probiotic treatment included Lactobacillus rhamnosus GG and Bifidobacterium lactis. Each probiotic was taken at 10 billion CFU per day.

Key Findings: The diet + probiotic group had a significantly reduced rate of Gestational Diabetes Mellitus (GDM) when compared to controls; 13% of the diet + probiotic group developed GDM, versus 36% in the diet group and 34% in the control group (P=0.003). All groups breast fed their babies until at least until 6 months of age. GDM was linked to increased infant birth weights and lengths in all the groups, but the correlation was strongest in the control group.

Practice Implications:

This is the first paper to be published on the safety of maternal probiotic supplementation during the first trimester. GDM and maternal obesity are interrelated, and GDM is associated with higher infant birth weight. The unfortunate long-term effects of GDM play a role in both the mother’s and infant’s endocrine and metabolic health: GDM mothers have a very high risk of developing type 2 diabetes later in life, and experience a 3-fold increased risk of developing metabolic syndrome, while their children’s risk of diabetes at 19-27 years increases 8-fold.i

Research clearly shows that larger birth weight babies are at higher risk for becoming obese later in life.iiiiiiv This paper is quite interesting in that it demonstrates the benefits of a nutritional supplement not previously assumed to have a metabolic impact of this scale. Other important research reinforces the connection of probiotic supplementation and obesity. Specific bacterial ratios will either encourage or discourage obesity later in lifev, and even predict obesity development. High numbers of bifidobacteria and low numbers of S. aureus in infancy can help protect against overweight and obesity in children,vi possibly revealing a key reason that breast-fed infants enjoy a healthier metabolic outcome. Not surprisingly, several studies show that breastfeeding is inversely related to childhood obesity.viiviiiix We do know that probiotics help modulate the immune system and therefore inflammation.x Obesity can lead to a state of low-grade systemic inflammation, possibly explaining the increased incidence of asthma in obese patients.xi Since obesity and inflammation are related, it can be postulated that the probiotic control of inflammation plays a role in obesity prevention. Since 79% of the participants did have a history of allergic disease, it is understandable that probiotic supplementation would have a strong effect on this population and their offspring. This study strengthens support of probiotic use as a pre and perinatal treatment. Previous research shows prenatal intake will benefit the child in preventing atopy. However, this recent discovery of how beneficial the use of probiotics is on the health of both the mother and child is exciting, adding an inexpensive, non-invasive treatment to the arsenal of obesity prevention tools.

References:

i Damm P.Future risk of diabetes in mother and child after gestational diabetes mellitus.

Int J Gynaecol Obstet. 2009 Mar;104 Suppl 1:S25-6. Epub 2009 Jan 15.

ii Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law C. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ. 2005 Oct 22;331(7522):929. Epub 2005 Oct 14.

iii Druet C, Ong KK. Early childhood predictors of adult body composition. Best Pract Res Clin Endocrinol Metab. 2008 Jun;22(3):489-502.

iv Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005 Mar;115(3):e290-6.

v Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. 2006 Dec 21;444(7122):1022-3.

vi Kalliomäki M, Collado MC, Salminen S, Isolauri E. Early differences in fecal microbiota composition in children may predict overweight. Am J Clin Nutr. 2008 Mar;87(3):534-8.

vii Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity: a systemic review. Int J Obes Relat Metab Disord 2004; 28:1247–56.

viii Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol 2005;162:397– 403.

ix Owen C, Martin R, Whincup P, Smith D, Cook D. The effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics 2005;115:1367–77.

x Laitinen K, Hoppu U, Ha¨ma¨la¨inen M, Linderborg K, Moilanen E, Isolauri E. Breast milk fatty acids may link innate and adaptive immune response regulation: analysis of soluble CD14, prostaglandin E2, and

fatty acids. Pediatr Res 2006;59:723–7.

xi Shore SA. Obesity and asthma: possible mechanisms. J Allergy Clin Immunol. 2008 May;121(5):1087-93; quiz 1094-5. Epub 2008 Apr 11.

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