In overweight and obese women, administering probiotics during the second trimester of pregnancy did not reduce the risk of gestational diabetes mellitus (GDM), according to a study published in Diabetes Care.
Researchers conducted the Study of Probiotics In Gestation (SPRING), a prospective,double-blind, randomized controlled trial of probiotics vs placebo, to analyze whether probiotics prevented GDM in overweight and obese women. Participants were aged >18 years, had a singleton pregnancy at <20 weeks’ gestation, and had a body mass index (BMI) >25 kg/m2. All women underwent random venous plasma glucose level assessment prior to enrollment; those with levels ≥8.0mmol/L proceeded to a 75-g oral glucose tolerance test (OGTT). Participants were randomly assigned to probiotics (Lactobacillus rhamnosus and Bifidobacterium animalis subspecies lactis; n=207)or placebo (microcrystalline cellulose and dextrose anhydrate capsules; n=204).
The primary outcome measure was the frequency of GDM at 28 weeks’ gestation as determined by 75-g OGTT. Maternal secondary outcomes included gestational weight gain, preeclampsia, hypertensive disorders of pregnancy, cesarean delivery, and gestational age at delivery. Neonatal secondary outcomes included premature birth, neonatal special care admission, jaundice, hypoglycemia, birth weight, small for gestational age (SGA), large for gestational age, stillbirth,birth injury, congenital anomaly, fat-free mass, and percentage of fat.
Rates of GDM were 25 of 204 (12.3%) in the placebo group and 38 of 207 (18.4%) in the probiotics group; mean fasting glucose was higher in those receiving probiotics(79.3 mg/dL) compared with placebo (77.5 mg/dL). Of the women taking probiotics,9.2% developed preeclampsia compared with 4.9% in the placebo group. Excessive weight gain occurred in 32.5% of women taking probiotics compared with 46%taking placebo, but no difference was found in mean weight gain between the groups.
Neonatal outcomes did not differ between the probiotic and placebo groups; the only statistically significant difference was found in relation to SGA, which occurred in 13 of 199 infants in the placebo arm (6.5%) and 5 of 205 infants in the probiotics arm (2.4%).
“Based on the findings of this double-blind, randomized placebo-controlled trial, we conclude that probiotics administered from the second trimester of pregnancy do not prevent GDM, or improve secondary outcomes, in overweight and obese pregnant women,” stated the authors.
CallawayLK, McIntyre HD, Barrett HL, et al. Probiotics for the prevention of gestational diabetes mellitus in overweight and obese women:findings from the SPRING double-blind randomized controlled trial [published online January 18, 2019]. Diabetes Care. doi: 10.2337/dc18-2248