Probiotics for preventing gestational diabetes in overweight or obese pregnant women: A review

Table 1 Use of probiotics in the prevention of gestational diabetes and infant outcomes in overweight and obese pregnant women

Ref.	Participant	Strain	Dosage	Administration method	Administration duration	Sample size	Results
Lindsay et al[55], 2014	BMI 30.0-39.9 kg/m2	Lactobacillus salivarius UCC118	109 CFU/d	Probiotic or placebo capsules refrigerated after a meal	24-28 wk gestation	175 (IG: 63; CG: 75)	FPG (probiotic: 4.60 mmol/L; placebo: 4.69 mmol/L, P = 0.391). Insulin (probiotic: 15.63 mU/L; placebo: 16.88 mU/L, P =0.16). HOMA2-IR (probiotic: 3.26; placebo: 3.53, P = 0.16). C-peptide (probiotic: 3.32 ng/mL; placebo: 3.37 ng/mL, P = 0.184). Total cholesterol (probiotic: 6.33 mmol/L; placebo: 6.60 mmol/L, P = 0.571). Total GWG (probiotic: 11.1 ± 6.2 kg vs placebo: 9.4 ± 5.6 kg, P = 0.479). PE (probiotic: 4.8%; placebo: 2.7%, P = 0.09)
Asgharian et al[6], 2020	Pre- or early-pregnancy BMI ≥ 25 kg/m2	Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12	100 g/d (5 × 108 CFU/g)	Probiotic or conventional yoghurt refrigerated	24 wk of gestation until delivery	130 (IG: 64; CG: 64)	FPG (probiotic yoghurt: 74.8 mg/dL; conventional yoghurt: 77.9 mg/dL, P = 0.008). 1 h OGTT (probiotic yoghurt: 128.0 mg/dL; conventional yoghurt: 136.0 mg/dL, P = 0.071). 2 h OGTT (probiotic yoghurt: 103.9 mg/dL; conventional yoghurt: 115.5 mg/dL, P = 0.002). GDM (probiotic yoghurt: 9%; conventional yoghurt: 17%, P = 0.184). Preeclampsia (probiotic yoghurt: 2%; conventional yoghurt: 0, P = 0.997). Preterm birth (probiotic yoghurt: 5%; conventional yoghurt: 13%, P = 0.077). Cesarean delivery (probiotic yoghurt: 52%; conventional yoghurt: 35%, P = 0.695). Total bilirubin on days 3-5 after birth (probiotic yoghurt: 9.1 mg/dL; conventional yoghurt: 11.3 mg/dL, P < 0.001). Treatment for hyperbilirubinemia (probiotic yoghurt: 36%; conventional yoghurt: 59%, P = 0.001). Phototherapy for hyperbilirubinemia (probiotic yoghurt: 16%; conventional yoghurt: 42%, P = 0.001)
Callaway et al[51], 2019	BMI > 25 kg/m2	Lactobacillus rhamnosus (LGG) and Bifidobacterium animalis subsp. lactis(BB-12)	109 CFU/d	Probiotic or placebo capsules	Recruitment (12-20 wk of gestation) until birth	433 (IG: 207; CG: 204)	GDM (probiotic: 18.4%; placebo: 12.3%, P = 0.184). FPG (probiotic: 79.3 mg/dL; placebo: 77.5 mg/dL, P = 0.049). PE (probiotic: 9.2%; placebo: 4.9%, P = 0.09). 28 wk diastolic BP (probiotic: 66.4 mmHg; placebo: 65 mmHg, P = 0.070). Excess weight gain (probiotic: 32.5%; placebo: 46%, P = 0.01). SAG < 10th percentile (probiotic: 2.4%; placebo: 6.5%, P = 0.042)
Pellonperä et al[3], 2019	BMI ≥ 25 kg/m2	Lactobacillus rhamnosus HN001 and Bifidobacterium animalis subsp. lactis 420	1010 CFU/d	Probiotic or placebo capsules refrigerated	13.9 ± 2.1 wk of gestation until 6 mo postpartum	439 (fish oil + placebo: 109; probiotics + placebo: 110; fish oil + probiotics: 109; placebo + placebo: 110)	-GDM (fish oil + placebo: 32.5%; probiotics + placebo: 28.4%; fish oil + probiotics: 36.9%; placebo + placebo: 36.9%, P = 0.59). Insulin (fish oil + placebo: 8.0 mU/L; probiotics + placebo: 5.5 mU/L; fish oil + probiotics: 6.6 mU/L; placebo + placebo: 6.4 mU/L, P = 0.16). HOMA2-IR (fish oil + placebo: 0.98; probiotics + placebo: 0.65; fish oil + probiotics: 0.80; placebo + placebo: 0.75, P = 0.12). SAG < 10th percentile (fish oil + placebo: 7.6%; probiotics + placebo: 7.3%; fish oil + probiotics: 8.7%; placebo + placebo: 9.8%, P = 0.93)
Okesene-Gafa et al[4], 2020	BMI ≥ 30 kg/m2	Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12	6.5 × 109 CFU	Probiotic or placebo capsules	Recruitment (12-17 wk) until birth	230 (IG: 115; CG: 115)	Excess weight gain (probiotic: 82.4%; conventional: 73.4%, P = 0.08). GDM (probiotic: 26.7% vs placebo: 27.5%, P = 0.80). Birthweight (probiotic: 3684 g vs placebo: 3504 g, P = 0.08)
Halkjær et al[41], 2020	BMI ≥ 30 and < 35 kg/m2	Probiotic mixture Vivomixx® (Streptococcus thermophilus DSM 24731, bifidobacteria and lactobacilli)	450 × 109 CFU/d	Probiotic or placebo capsules refrigerated	14-20 wk of gestation until delivery	50 (IG: 25; CG: 24)	Total GWG (probiotic: 12.7 ± 5.3 kg vs placebo: 13.1 ± 5.8 kg, P = 0.82). Intervention period weight gain (probiotic: 10.2 ± 3.4 vs placebo: 10.0 ± 4.2, P = 0.87). Birthweight (probiotic: 3608 g vs placebo: 3640 g, P = 0.82). GDM (probiotic: 16% vs placebo: 8%, P = 0.67)
Shahriar et al[7], 2021	High-risk pregnant women for GDM including BMI > 25 kg/m2	Mixture of Lactobacillus acidophilus LA1, Bifidobacterium longum sp54 cs, and Bifidobacterium bifidum sp9 cs	500 mg/d, 9.6 × 109 CFU	Probiotic or placebo capsules with a glass of water or milk (acidic or hot drinks were avoided)	14 wk of pregnancy up to 24 wk	542 (IG: 241; CG: 266)	GDM (probiotic: 41.9% vs placebo: 40.2%, P = 0.780). PE (probiotic: 17.8%; placebo: 17.3%, P = 0.87)

BMI: Body mass index; CFU: Colony forming unit; CG: Control group; FPG: Fasting plasma glucose; GDM: Gestational diabetes mellitus; GWG: Gestational weight gain; HOMA-IR: Homeostasis model assessment of insulin resistance; IG: Intervention group; OGTT: Oral glucose tolerance test; PE: Preeclampsia; SGA: Small for gestation age.