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Probiotic supplementation during pregnancy and lactation

may help contribute to a healthy immune system in infants

Pregnant mother and probiotics supplements
Infant health Pregnancy Allergy symptoms LGG® BB-12® LA-5®
5 Min read

Development of an infant’s microbiota is substantially influenced by the maternal microbiota, mode of birth, perinatal antibiotics and breastfeeding. Maternal probiotic intervention during pregnancy and breastfeeding may positively modulate infant microbial colonization. Accordingly, the development and training of the immune system is impacted. Some studies suggest a correlation between probiotic supplementation during pregnancy and incidence of allergies in the children.

Fact
Mothers with a history of allergy symptoms may wish to consider probiotic supplementation during pregnancy and lactation1, 2, 3, 4, 5, 6

Development of the infant immune system 

Shaping of the human immune system begins in utero, and continues to develop and mature during the first 36 months postpartum.7 While it is not yet fully known how the maternal microbiome and prepartum probiotic supplementation influence the infant immune system, it is known that microbes play an immense role in its development. Further, there appears to be a limited window of opportunity during which the innate immune response can be shaped.8 

The maternal microbiota during pregnancy, birth and breastfeeding has an important influence on the infant immune system

A growing body of evidence suggests that cesarean delivery and perinatal antibiotic use are risk factors for eczema and allergies, due to microbial dysbiosis in the infant. Conversely, studies have suggested that maternal supplementation with probiotics has been associated with modulated immune responses, and reduced incidence of allergies and eczema.8 This highlights the importance of the microbiota in immune development.7, 8

There are two main ways by which the maternal gut microbiota affects the infant’s immunity:

  1. Molecular signals derived from the maternal microbiota, including antibodies, cytokines and bacterial metabolites, reach the offspring during development via 
    a. the placenta in the prenatal period9
    b. maternal milk during the postnatal period9

  2. Higher numbers of bifidobacteria in the mother’s gut (e.g. after probiotic supplementation) increases the number of bifidobacteria that are transferred during vaginal birth. This increases the likelihood of successful infant colonization with bifidobacteria.10

Next, we take a closer look at the evidence on how these two natural processes may affect infant immunity.

1. Maternal microbiota influences the development of infant immunity during the prenatal and postnatal period

The infant microbiota is influenced by prenatal external factors, such as maternal stress,11 suggesting the importance of balancing the maternal microbiota during pregnancy.11 Further evidence suggests that manipulation of the maternal microbiota during pregnancy may play a key role in the health of the infant.12, 13

In randomized, blinded and controlled studies, maternal probiotic supplementation has been shown to support a healthy gut and immune system in infants. Mothers with a family history of atopic disease were supplemented with Lactobacillus rhamnosus, LGG® (hereafter referred to by use of the trademark LGG®) during pregnancy and breastfeeding (or given infant formula with the LGG® strain if not breastfeeding). After the intervention the newborns of mothers receiving the LGG® strain had a 50% lower incidence of atopic eczema compared to placebo-treated mothers.1 This effect was sustained in follow-up studies when the infants were 4,1, 2 and 7 years old.1, 3 Similarly, pre- and postnatal maternal supplementation with the LGG® strain, Bifidobacterium, BB-12® (hereafter referred to by use of the trademark BB-12®) and Lactobacillus acidophilus, LA-5® has been associated with a reduced incidence of atopic dermatitis in breastfed infants.4

Breastfeeding in the postnatal period can also impact infant immune development via the maternal microbiota. Selected gut bacteria and metabolites from the maternal gut can access the mammary glands.9, 14 This is further supported by mice models as probiotic bacteria given to the dams have been found in mammary tissue and milk.15 Maternal supplementation with probiotics has been associated with changes to breastmilk.5, 16 In some studies, consumption of the LGG® strain during pregnancy and breastfeeding has been associated with increases in breast milk concentration of TGFβ2, and with a reduced incidence of atopic eczema in the infant.16 TGFβ2 is an important factor for breastmilk-induced immune tolerance,17 since exposure to TGFβ2 stimulates immune maturation in the immature gut.18, 19 The same effect of an increased concentration of TGFβ2 in breastmilk was likewise observed following maternal supplementation with the LGG® and BB-12® strains.5

Breastfed infant and probiotic supplement

2. Vaginal delivery promotes the mother’s bacteria in the babies' gut  

The maternal gut microbiota changes dramatically between trimesters 1 and 3, with a reduced species richness, and an increased abundance of bifidobacteria.20, 21 Progesterone is thought to be an inducer of this natural change in the gut microbiota during late pregnancy.21 These changes in the mother’s microbiome may impact immune development of the infant. 

Modulation of the maternal microbiota may directly impact the infant microbiota during vaginal birth. Specific bifidobacterial strains have been identified in mother-infant pairs following vaginal delivery but not in mother-infant pairs following cesarean delivery. This suggests that an important transmission from the mother to infant occurs in the birth canal.22 In support of this, an investigation of maternal seeding demonstrated that specific bacterial species (essential for the infant microbiome) were nearly always shared between mother and vaginally born infants.23 These persist for at least one year.23 When mothers consumed LGG® in the weeks leading up to birth, their newborns had increased bifidobacterial diversity,6 possibly due to the bifidogenic effect of lactobacilli.24, 25, 26, 27 Therefore, maternal probiotic supplementation can help early colonization of the vaginally born infant.6, 22, 23

Fact
Maternal supplementation with a probiotic may be an important mechanism for immunoregulatory support and maturation in the infant1, 2, 3, 4, 5, 6

Maternal microbiota influences infant immunity during prenatal and postnatal periods

These observations emphasize the prenatal and postnatal interactions between maternal gut microbes and the infant immune system. This suggest an important role for maternal probiotic supplementation during pregnancy and breastfeeding in order to direct the infant’s immune system towards tolerance. 

BB-12®, LA-5® and LGG® are registered trademarks of Chr. Hansen A/S.

The article is provided for informational purposes regarding probiotics and is not meant to suggest that any substance referenced in the article is intended to diagnose, cure, mitigate, treat, or prevent any disease.

Bifidobacterium, BB-12®

The probiotic strain Bifidobacterium, BB-12® is the world’s most documented probiotic bifidobacterium. It has been extensively studied and has been associated with improved outcomes across various health areas.

BB-12® is a trademark of Chr. Hansen A/S

BB-12 consumer logo TM

Reference list

1. Kalliomaki M, et al. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357(9262):1076-9. (PubMed)
2. Kalliomaki M, et al. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet. 2003;361(9372):1869-71. (PubMed)
3. Kalliomaki M, et al. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(4):1019-21. (PubMed)
4. Dotterud CK, et al. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. Br J Dermatol. 2010;163(3):616-23. (PubMed)
5. Huurre A, et al. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double-blind placebo-controlled study. Clin Exp Allergy. 2008;38(8):1342-8.  (PubMed
6. Gueimonde M, et al. Effect of maternal consumption of lactobacillus GG on transfer and establishment of fecal bifidobacterial microbiota in neonates. J Pediatr Gastroenterol Nutr. 2006;42(2):166-70. (PubMed)
7. Walker WA. The importance of appropriate initial bacterial colonization of the intestine in newborn, child, and adult health. Pediatr Res. 2017;82(3):387-95. (PubMed)
8. Rautava S, et al. Microbial contact during pregnancy, intestinal colonization and human disease. Nat Rev Gastroenterol Hepatol. 2012;9(10):565-76. (PubMed)
9. Macpherson AJ, et al. How nutrition and the maternal microbiota shape the neonatal immune system. Nature Reviews Immunology. 2017;17(8):508-17. (PubMed)
10. Mueller NT, et al. The infant microbiome development: mom matters. Trends Mol Med. 2015;21(2):109-17. (PubMed)
11. Zijlmans MA, et al. Maternal prenatal stress is associated with the infant intestinal microbiota. Psychoneuroendocrinology. 2015;53:233-45. (PubMed)
12. Nyangahu DD, et al. Disruption of maternal gut microbiota during gestation alters offspring microbiota and immunity. Microbiome. 2018;6(1):124. (PubMed)
13. Roduit C, et al. Prenatal animal contact and gene expression of innate immunity receptors at birth are associated with atopic dermatitis. J Allergy Clin Immunol. 2011;127(1):179-85, 85.e1. (PubMed)
14. Martı́n Ro, et al. The commensal microflora of human milk: new perspectives for food bacteriotherapy and probiotics. Trends in Food Science & Technology. 2004;15(3-4):121-7. (Source)
15. de Andrés J, et al. Physiological Translocation of Lactic Acid Bacteria during Pregnancy Contributes to the Composition of the Milk Microbiota in Mice. Nutrients. 2017;10(1):14. (PubMed)
16. Rautava S, et al. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol. 2002;109(1):119-21. (PubMed)
17. Verhasselt V, et al. Breast milk-mediated transfer of an antigen induces tolerance and protection from allergic asthma. Nat Med. 2008;14(2):170-5. (PubMed)
18. Rautava S, et al. TGF-beta2 induces maturation of immature human intestinal epithelial cells and inhibits inflammatory cytokine responses induced via the NF-kappaB pathway. J Pediatr Gastroenterol Nutr. 2012;54(5):630-8. (PubMed)
19. Rautava S, et al. Breast Milk-Transforming Growth Factor-β2 Specifically Attenuates IL-1β-Induced Inflammatory Responses in the Immature Human Intestine via an SMAD6- and ERK-Dependent Mechanism. Neonatology. 2011;99(3):192-201. (PubMed)
20. Koren O, et al. Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell. 2012;150(3):470-80. (PubMed)
21. Nuriel-Ohayon M, et al. Progesterone Increases Bifidobacterium Relative Abundance during Late Pregnancy. Cell Rep. 2019;27(3):730-6.e3. (PubMed)
22. Makino H, et al. Mother-to-infant transmission of intestinal bifidobacterial strains has an impact on the early development of vaginally delivered infant's microbiota. PLoS One. 2013;8(11):e78331. (PubMed)
23. Korpela K, et al. Selective maternal seeding and environment shape the human gut microbiome. Genome Res. 2018;28(4):561-8. (PubMed)
24. Tang W, et al. In vitro digestion and fermentation of released exopolysaccharides (r-EPS) from Lactobacillus delbrueckii ssp. bulgaricus SRFM-1. Carbohydr Polym. 2020;230:115593. (PubMed)
25. Russo M, et al. Lactobacillus fermentum CRL1446 Ameliorates Oxidative and Metabolic Parameters by Increasing Intestinal Feruloyl Esterase Activity and Modulating Microbiota in Caloric-Restricted Mice. Nutrients. 2016;8(7). (PubMed)
26. Bello FD, et al. In vitro study of Prebiotic Properties of Levan-type Exopolysaccharides from Lactobacilli and Non-digestible Carbohydrates Using Denaturing Gradient Gel Electrophoresis. Syst Appl Microbiol. 2001;24(2):232-7. (PubMed)
27. Kang J-E, et al. A Novel Lactobacillus casei LP1 Producing 1,4-Dihydroxy-2-Naphthoic Acid, a Bifidogenic Growth Stimulator. Prev Nutr Food Sci. 2015;20(1):78-81. (PubMed)

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