Can Vizylac (Lactobacillus acidophilus) be given in pregnancy with a previous history of Preterm Premature Rupture of Membranes (PPROM)?

Vizylac (Lactobacillus acidophilus) in Pregnancy with Previous History of PPROM

Vizylac (Lactobacillus acidophilus) can be given in pregnancy with a previous history of PPROM as it may help maintain a healthy vaginal microbiome, but it is not specifically recommended as a standard preventive intervention for PPROM recurrence.

Understanding PPROM and Previous History

A history of preterm premature rupture of membranes (PPROM) is a significant risk factor for recurrence in subsequent pregnancies. According to the Society for Maternal-Fetal Medicine (SMFM), women with a previous history of PPROM should be managed following guidelines for pregnant persons with previous spontaneous preterm birth 1, 2.

Role of Probiotics in PPROM Prevention

Current Evidence:

• Research has shown an association between vaginal microbiota dysbiosis (reduced Lactobacillus abundance) and PPROM 3, 4
• Cervical microbiota dominated by non-Lactobacillus bacteria is associated with stronger cervical inflammatory response and higher rates of microbial invasion of the amniotic cavity 4
• Some studies suggest probiotics might be beneficial:
  • A 2022 study found that Ampicillin + Lactobacillus casei rhamnosus treatment was effective in PPROM cases and positively affected perinatal outcomes 5
  • The Pro-PPROM trial is currently evaluating whether oral probiotic therapy (Lactobacillus fermentum) can prolong pregnancy duration in women with PPROM 6

Clinical Application:

• While probiotics like Vizylac may help maintain a healthy vaginal microbiome, there is insufficient evidence to recommend them specifically for PPROM prevention
• Standard management for women with previous PPROM focuses on:
  1. Screening and treating bacterial vaginosis at the first prenatal visit (13-20 weeks) if there's a history of preterm birth 2
  2. Following guidelines for management of pregnant persons with previous spontaneous preterm birth 1

Management Algorithm for Pregnancy with Previous PPROM

1. Risk Assessment:

   • Evaluate additional risk factors beyond previous PPROM: second-trimester loss, uterine anomalies, maternal medical conditions, advanced maternal age 2

2. Monitoring and Prevention:

   • Provide detailed instructions about monitoring for signs and symptoms of PPROM 2
   • Consider Vizylac (Lactobacillus acidophilus) as a supplementary intervention to maintain healthy vaginal flora
   • Screen for bacterial vaginosis at first prenatal visit if there's a history of preterm birth 2

3. Activity Recommendations:

   • Women with a history of PPROM can engage in low-intensity physical activity and maintain activities of daily living 1
   • No evidence supports avoiding intercourse as a strategy to reduce PPROM rates 2

Important Considerations and Caveats

• Vizylac is not a replacement for standard preventive measures for recurrent preterm birth
• The optimal probiotic strain, dose, and timing for PPROM prevention remain undetermined
• Current standard of care for PPROM management includes antibiotics (typically ampicillin and erythromycin or azithromycin) 7, but these are for active PPROM, not prevention
• Be cautious with antibiotic use in pregnancy with previous PPROM as erythromycin may damage a healthy microbiome by targeting Lactobacillus species 3

While Vizylac can be safely used in pregnancy with previous PPROM, it should be considered as part of a comprehensive approach to preterm birth prevention rather than as a specific PPROM preventive measure.