Effectiveness of Probiotic, Prebiotic, and Synbiotic Supplementation to Improve Perinatal Mental Health in Mothers: A Systematic Review and Meta-Analysis

Frontiers in Psychiatry

Apr 2021

DOI: 10.3389/fpsyt.2021.622181

Citations:39

Influential Citations:5

Systematic Reviews / Meta-Analyses

Enhanced Details

Methods

Three randomized, double-blind, placebo-controlled trials evaluating probiotic supplementation during pregnancy. Participants were pregnant women (mean age ~28.6–33.5 years) from New Zealand (two trials) and Iran (one trial), including healthy, obese (BMI ≥30), and constipated pregnant women. Total participants: 713.

Intervention

Probiotic regimens: 1) Lactobacillus rhamnosus HN001, 6 × 10^9 CFU daily, from enrollment until 6 months after birth if breastfeeding, or until birth if not breastfeeding; 2) Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, 6.5 × 10^9 CFU daily, from enrollment until birth; 3) Probiotic yogurt: 300 g, enriched with Lactobacillus acidophilus and Bifidobacterium lactis, containing 4.8 × 10^10 CFU per serving, given 3 times daily for 4 weeks.

Results

Anxiety symptoms (STAI-6) were significantly reduced with probiotic use during pregnancy (MD −0.99; 95% CI −1.80 to −0.18; I^2 = 0%; n = 543). Depression symptoms showed no significant change (MD −0.46; 95% CI −2.16 to 1.25). The proportion scoring above the depression cut-off favored probiotics but was not statistically significant (OR 0.68; 95% CI 0.43 to 1.07). Global mental health (SF-36) showed no difference (MD 1.09; 95% CI −2.04 to 4.22). Conclusion: Evidence is limited but promising that probiotics during pregnancy may reduce anxiety symptoms; no trials on prebiotics or synbiotics; more robust randomized trials are needed before clinical recommendations.

Limitations

Small number of trials (3) with 713 participants; varied populations and probiotic strains; overall moderate-to-low quality of evidence; some risk of bias from other sources and allocation concealment in at least one trial; industry involvement in some trials; heterogeneity in depression outcomes; no data on prebiotics or synbiotics.

Abstract

Introduction: There is an emerging interest in modulating the gut microbiota to target the gut-brain axis and improve maternal mental health in the perinatal period. This systematic review evaluated the effectiveness of prebiotics, probiotics, and synbiotics supplementation during pregnancy to reduce the risk of maternal mental health problems in the perinatal period. Methods: Electronic biomedical databases and clinical trial registries were searched from database inception through August 2020 to identify randomized controlled clinical trials (RCTs) evaluating the effect of probiotic, prebiotic, or synbiotic supplements administered to women during pregnancy on measures of perinatal depression, anxiety, and other mental health outcomes. Study selection, risk of bias appraisal, and data extraction were independently performed by two reviewers. Pooled mean differences (MD) and odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for the outcomes of interest in the review. Results: From 3,868 studies identified through the search strategy, three RCTs of low risk of bias involving 713 participants were included, all three testing probiotics. There were no differences between probiotics and control groups in the mean depression scores (MD −0.46; 95% CI −2.16, 1.25) at end of follow-up. Although statistical significance was not achieved, probiotics showed an advantage in the proportion of participants scoring below an established cut-off for depression (pOR 0.68; 95% CI 0.43, 1.07). Compared to placebo, probiotics in pregnancy reduced anxiety symptoms (MD −0.99; 95% CI −1.80, −0.18); however, this advantage was not translated in a reduction in the proportion of participants scoring above an established cut-off for anxiety (pOR 0.65; 95% CI 0.23, 1.85). There were no differences between probiotics and control groups in global mental health scores at end of follow-up (MD 1.09; 95% CI −2.04, 4.22). Conclusion: There is limited but promising evidence about the effectiveness of probiotics during pregnancy to reduce anxiety symptoms and reduce the proportion of women scoring ABOVE a cut-off depression score. There is a lack of RCT evidence supporting prebiotics and synbiotics supplementation for similar purposes in the perinatal period. More research is needed before prebiotics, probiotics, and synbiotics are recommended to support maternal mental health and well-being in the perinatal period. Systematic Review Registration: PROSPERO, CRD42019137158. show less