Can Probiotics Be Given During Pregnancy?
Yes, probiotics can be safely given to pregnant women, as the overwhelming existing evidence suggests they are safe for healthy pregnant individuals and may provide benefits for both maternal and infant outcomes. 1
Safety Profile in Pregnancy
Most probiotics in commercial use are derived from fermented foods with a long history of safe consumption or from microbes that naturally colonize humans, and both the European Food Safety Authority (EFSA) and U.S. Food and Drug Administration (FDA) consider common probiotic species safe for the general population, including pregnant women. 1
Multiple randomized controlled trials conducted with women during the third trimester of pregnancy did not report an increase in adverse fetal outcomes. 2
A comprehensive meta-analysis of 18 randomized controlled trials including 4,356 pregnant women found that probiotic supplementation neither increased nor decreased the risk of preterm birth <37 weeks (RR 1.08,95% CI 0.71-1.63) or preterm birth <34 weeks (RR 1.03,95% CI 0.29-3.64). 3
Documented Benefits During Pregnancy
Infant allergic disease prevention: Administration of probiotics to pregnant mothers and postnatally to children reduces the risk of atopy (RR 0.71,95% CI 0.57-0.89) and food hypersensitivity (RR 0.77,95% CI 0.61-0.98), as recommended by the European Food Safety Authority. 1
Improved neonatal outcomes: Probiotic supplementation during pregnancy was associated with significantly reduced risks of neonatal death (RR 0.34,95% CI 0.13-0.91) and necrotizing enterocolitis (RR 0.38,95% CI 0.18-0.81). 4
Reduced infant eczema: Meta-analysis showed decreased risk of atopic eczema (RR 0.68,95% CI 0.58-0.81) and eczema (RR 0.79,95% CI 0.68-0.91) in infants. 4
Prolonged gestational age: Probiotic supplementation was associated with a modest but statistically significant prolongation of gestational age (WMD 0.09 weeks, 95% CI 0.04-0.15). 4
Recommended Strains and Formulations
Well-studied strains: Lactobacillus rhamnosus (now reclassified as Lacticaseibacillus rhamnosus) has been extensively studied and has a good safety profile. 1
Effective combinations: The combination of Lactobacillus species and Bifidobacterium species has demonstrated particular effectiveness for maternal-infant benefits. 5
For preterm infant NEC prevention: The AGA recommends combinations including Lactobacillus rhamnosus with Bifidobacterium species, or Lactobacillus acidophilus with Bifidobacterium species for preterm, low-birth-weight infants. 6
Important Precautions and Contraindications
High-risk populations requiring careful evaluation before probiotic use:
- 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
Specific product considerations:
Saccharomyces boulardii should be used with caution as it has been associated with fungemia in critically ill and immunocompromised patients. 1
Exercise caution with products containing extremely high concentrations of bacteria (450-900 billion bacteria per dose). 1
Serious adverse effects are rare but have been documented, including cases of bacterial sepsis linked to lactobacilli supplements and death from gastrointestinal mucormycosis in a preterm infant from mold contamination. 1
Practical Selection Guidelines
Always verify strain identity: Check the precise identity of the bacteria at the strain level when selecting a probiotic, as effects are strain-specific. 1, 5
Quality assurance: Consider products that have been deposited at a biodepository such as the American Type Culture Collection (ATCC), as the amount of dead bacteria in a preparation is inversely proportional to product quality. 1
Systemic absorption: Current data suggest that probiotic supplementation is rarely systemically absorbed when used by healthy individuals, and probiotics are unlikely to be transferred into breast milk. 2