Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant.

Double-blind, parallel, randomized, placebo-controlled trial; 241 pregnant women with allergic disease and atopic sensitization intending to breastfeed for at least 2 months; mean age ~30 years (range 22–43); infants followed to 24 months; intention-to-treat analyses.

Daily sachet (7 g) of probiotic powder; three arms: Lactobacillus rhamnosus LPR + Bifidobacterium longum BL999 (LPR1BL999), Lactobacillus paracasei ST11 + Bifidobacterium longum BL999 (ST111BL999), or placebo; started 2 months before delivery and continued through the first 2 months of breastfeeding.

Maternal probiotic supplementation during the last 2 months of pregnancy and the first 2 months of breastfeeding significantly reduced infant eczema risk by age 24 months in high-risk infants. Eczema occurred in placebo infants 44/62 (71%), vs 21/73 (29%) with LPR1BL999 and 20/70 (29%) with ST111BL999 (OR 0.17 [0.08–0.35] and 0.16 [0.08–0.35]; P<0.001). Chronically persistent eczema occurred in 16/62 (26%) placebo vs 7/73 (10%) LPR1BL999 and 4/70 (6%) ST111BL999 (OR 0.30 [0.12–0.80] and 0.17 [0.12–0.80]; P=0.016 and 0.003). Skin-prick test positivity did not differ significantly (placebo 26%, LPR 22%, ST11 26%; P=0.60). No adverse effects reported. Conclusion: A safe maternal probiotic regimen during late pregnancy and early lactation can reduce infant eczema risk in high-risk populations; both probiotic combinations were beneficial.

Loss to follow-up: 205/241 completed follow-up; cesarean section rates differed across groups (placebo 19%, LPR 5%, ST11 12%), though no interaction with effect; study limited to high-risk pregnancies; results may not generalize to low-risk populations; only two probiotic combinations were tested.