The Effects of Probiotics/Synbiotics on Glucose and Lipid Metabolism in Women with Gestational Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Nutrients

Mar 2023

DOI: 10.3390/nu15061375

Citations:39

Influential Citations:1

Systematic Reviews / Meta-Analyses

Enhanced Details

Methods

Pregnant women with gestational diabetes mellitus (GDM); age range around 26–33 years; randomized controlled trials; most used double-blind design with placebo controls; trials conducted mainly in Iran (eight studies) and in Ireland, Thailand, and Turkey; no participants received pharmacologic therapy during the intervention; sample sizes per trial ranged from about 20–60.

Intervention

Probiotic or synbiotic capsules; oral administration; most regimens used 1 capsule daily for 4–8 weeks; one trial used 2 capsules daily; total CFU per capsule ranged from 1×10^9 to 112.5×10^9; some regimens combined probiotics with prebiotics (synbiotics) such as inulin or fructooligosaccharides (FOS).

Results

Probiotic/synbiotic supplementation improved glucose control and certain lipid parameters in GDM. Fasting plasma glucose decreased by about 2.33 mg/dL (p=0.02); fasting serum insulin decreased by about 2.47 mU/L (p=0.0003); HOMA-IR decreased by about 0.40 (p=0.02); total cholesterol decreased by about 6.59 mg/dL (p=0.02). QUICKI, HDL-C, LDL-C, and triglycerides showed no consistent improvements. Weight at end of trial and gestational weight gain were not significantly different. Subgroup analyses suggested the probiotic type influenced outcomes (probiotics more consistently improved FPG/FSI than synbiotics); specific regimens containing Lactobacillus acidophilus and Bifidobacterium bifidum at >1×10^6 CFU/g may be particularly beneficial. However, substantial heterogeneity and limited sample sizes mean further high-quality trials across diverse populations are needed to confirm effects and inform guidelines.

Limitations

Small sample sizes (20–60 per trial); majority of trials from Iran; heterogeneity in probiotic strains, doses, and durations; incomplete reporting across studies; infant outcomes and long-term maternal/offspring effects not assessed; potential publication bias; results may not generalize to non-Iranian populations.

Abstract

Background: Gestational diabetes mellitus (GDM) is prevalent with lasting health implications for the mother and offspring. Medical therapy is the foundation of GDM management, for achieving optimal glycemic control often requires treatment with insulin or metformin. Gut dysbiosis is a feature of GDM pregnancies, therefore, dietary manipulation of the gut microbiota may offer a new avenue for management. Probiotics are a relatively new intervention, which can reduce the mother’s blood sugar levels and, furthermore, adjust glucose and lipid metabolism in both mother and offspring. Objective: The aim of this systematic review and meta-analysis is to explore the effect of probiotics/synbiotics on glucose and lipid metabolism in women with GDM. Methods: A systematic search of the literature was conducted using the electronic databases Cochrane Library, Web of Science, PubMed, and EBOSCO, published between 1 January 2012 and 1 November 2022. A total of 11 randomized controlled clinical trials (RCTs) were analyzed. The indicators included fasting plasma glucose (FPG), fasting serum insulin (FSI), the homoeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), total cholesterol (TC), HDL cholesterol, LDL cholesterol and triglycerides (TG), the mean weight at end of trial, and gestational weight gain (GWG). Results: Compared with the placebo, probiotics/synbiotics were associated with a statistically significant improvement in FPG (MD = −2.33, 95% CI = −4.27, −0.40, p = 0.02), FSI (MD = −2.47 95% CI = −3.82, −1.12, p = 0.0003), HOMA-IR (MD = −0.40, 95% CI = −0.74, −0.06, p = 0.02), and TC (MD = −6.59, 95% CI = −12.23,−−0.95, p = 0.02), while other factors had no significant difference. The subgroup analysis revealed that the kind of supplement led to heterogeneity for FPG and FSI, while heterogeneity was not found for others. Conclusion: Probiotics/synbiotics could control glucose and lipid metabolism in pregnant women with GDM. There was a significant improvement in FPG, FSI, HOMA-IR, and TC. The use of specific probiotic supplementation may be a promising prevention and therapeutic strategy for GDM. However, due to the heterogeneity among existing studies, further studies are warranted to address the limitations of existing evidence and better inform the management of GDM. show less