Probiotic treatment for women with gestational diabetes to improve maternal and infant health and well-being

• Published in: Cochrane database of systematic reviews 2020-06, Vol.6 (6), p.CD012970
• Main Authors: Okesene-Gafa, Karaponi Am, Moore, Abigail E, Jordan, Vanessa, McCowan, Lesley, Crowther, Caroline A
• Format: Article
• Language: English
• Subjects: Adult; Child; Child health; Confidence Intervals; Diabetes, Gestational - therapy; Female; Humans; Hypertension, Pregnancy-Induced - epidemiology; Infant, Newborn; Infant, Postmature; Labor, Induced - statistics & numerical data; Medical problems during pregnancy; Odds Ratio; Placebos - therapeutic use; Pregnancy; Pregnancy & childbirth; Probiotics - adverse effects; Probiotics - therapeutic use; Randomized Controlled Trials as Topic
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD012970.pub2

Gestational diabetes mellitus (GDM) is carbohydrate intolerance first recognised during pregnancy and associated with complications for mothers and babies. Probiotics are naturally occurring micro-organisms, which when ingested in adequate amounts, may confer health benefits. Evidence of the role of probiotics as treatment for GDM is limited. To evaluate the safety and effectiveness of probiotics in treating women with GDM on maternal and infant outcomes. We searched the Cochrane Pregnancy and Childbirth's Trials Register ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (24 July 2019), and reference lists of retrieved studies. Randomised controlled trials (RCTs) comparing the use of probiotics versus placebo/standard care for the treatment of GDM. Two review authors independently assessed study eligibility, extracted data, checked data accuracy, and assessed risk of bias of included trials. The certainty of evidence for selected maternal and infant/child outcomes was assessed using GRADE. Nine RCTs (695 pregnant women with GDM) comparing probiotics versus placebo were identified. The overall risk of bias in the nine RCTs was low to unclear and the evidence was downgraded for imprecision due to the small numbers of women participating in the trials. The trials were carried out in hospitals and universities in Iran (seven trials), Thailand (one trial) and Ireland (one trial). All trials compared probiotics with placebo. Maternal outcomes We are uncertain if probiotics have any effect compared with placebo on hypertensive disorders of pregnancy, (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.64 to 3.53; participants = 256; studies = 3; low-certainty evidence) and mode of birth as caesareans (average RR 0.64, 95% CI 0.30 to 1.35; participants = 267; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: mode of birth as vaginal/assisted and subsequent development of type 2 diabetes. We are uncertain if probiotics have any effect compared with placebo on induction of labour (RR 1.33, 95% CI 0.74 to 2.37; participants = 127; studies = 1; very low-certainty evidence). For other secondary maternal outcomes, we are uncertain if there are differences between probiotics and placebo for: postpartum haemorrhage; weight gain during pregnancy intervention and total gestational weight gain; fasting plasma glucose and