Are probiotics (Probiotic supplements) safe to take during pregnancy?

Safety of Probiotics During Pregnancy

Most probiotics are considered safe for pregnant women, but caution is warranted in certain high-risk situations and with specific probiotic strains. 1

General Safety Profile

• Most probiotics in commercial use are derived from fermented foods with a long history of safe consumption or from microbes that naturally colonize humans 1
• The European Food Safety Authority (EFSA) and the U.S. Food and Drug Administration (FDA) consider common probiotic species safe for the general population 1
• The overwhelming existing evidence suggests that probiotics are safe for healthy individuals, including pregnant women 1
• A systematic review found that probiotic use during pregnancy neither increased nor decreased the risk of preterm birth or other adverse pregnancy outcomes 2

Benefits During Pregnancy

• Probiotic supplementation during pregnancy may help reduce the risk of:
  • Gestational diabetes mellitus 3, 4
  • Pre-eclampsia 3
  • Excessive gestational weight gain 5
  • Inflammatory markers like C-reactive protein 3
• Administration of probiotics before and after birth may reduce the risk of atopy and food hypersensitivity in children 6

Important Considerations and Precautions

• Not all probiotics are created equal - strain specificity is crucial 1, 6
• The safety and efficacy findings associated with specific probiotic formulations should not be generalized to other products 1
• Serious adverse effects from probiotics are rare but have been documented in vulnerable populations 1
• High-risk groups requiring careful evaluation before probiotic use include:
  • Patients with damaged intestinal mucosa 1
  • Immunocompromised individuals 1
  • Patients with central venous catheters 1
  • Those with cardiac valvular disease 1
  • Patients with short-gut syndrome 1

Recommended Probiotic Strains

• Combinations of Lactobacillus spp. and Bifidobacterium spp. have shown particular effectiveness 6
• Specific strains like Lactobacillus rhamnosus (now reclassified as Lacticaseibacillus rhamnosus) have been well-studied and have a good safety profile 1
• Saccharomyces boulardii should be used with caution as it has been associated with fungemia in critically ill and immunocompromised patients 1

Practical Guidance

• Always check the precise identity of the bacteria at the strain level when selecting a probiotic 1
• Be aware that probiotic quality varies - the amount of dead bacteria in a preparation is inversely proportional to the product quality 1
• Consider products that have been deposited at a biodepository such as the American Type Culture Collection (ATCC) for quality assurance 1
• Exercise caution with products containing extremely high concentrations of bacteria (450-900 billion bacteria per dose) 1

In conclusion, while most probiotics are safe during pregnancy for healthy women, it's important to select well-studied strains and be aware of potential risks in vulnerable populations. The evidence supports their safety in pregnancy, with potential benefits for both maternal and infant outcomes.