Econorm (Saccharomyces boulardii) Safety in Pregnancy
Econorm sachets containing Saccharomyces boulardii can be used during pregnancy when clinically indicated, as available evidence suggests no increased risk of adverse fetal outcomes, though data specific to Saccharomyces species in pregnancy remain limited.
Evidence Base for Safety
Human Pregnancy Data
A systematic review and meta-analysis of probiotic use in pregnancy found that Lactobacillus and Bifidobacterium species showed no effect on Caesarean section rates (OR 0.88; 95% CI 0.65-1.19), birth weight (weighted difference 45g; 95% CI -181 to 271), or gestational age (weighted difference 0.4 weeks; 95% CI -0.4 to 1.2), with no malformations reported in probiotic groups 1
However, this same systematic review explicitly noted that no randomized controlled trials were available for Saccharomyces species during pregnancy, making the safety profile of S. boulardii specifically unknown in pregnant women 1, 2
Systemic Absorption Profile
Current data suggest that probiotic supplementation is rarely systemically absorbed when used by healthy individuals, which supports a favorable theoretical safety profile 2
Probiotics are unlikely to be transferred into breast milk, making breastfeeding compatible with S. boulardii use 2
Clinical Use Considerations
When to Use
S. boulardii is indicated for acute diarrhea, antibiotic-associated diarrhea, and other gastrointestinal conditions where probiotics provide benefit 3
The decision to use should weigh maternal benefit against the limited (but reassuring) safety data available 2
Neonatal Safety Data
Studies in preterm neonates receiving S. boulardii at 250 mg/day showed improved feeding tolerance and reduced clinical sepsis, with no reported adverse effects 4
A meta-analysis of 10 RCTs involving 1264 preterm infants found significant reductions in necrotizing enterocolitis (RR 0.56; 95% CI 0.36-0.89) and feeding intolerance (RR 0.52; 95% CI 0.39-0.68) with no adverse effects reported 5
Practical Recommendations
Dosing and Administration
Standard adult dosing of S. boulardii (typically 250-500 mg daily) can be continued during pregnancy when clinically necessary 3
No dose adjustment is required based on trimester 2
Monitoring
No specific maternal or fetal monitoring is required beyond routine prenatal care 1
Watch for signs of systemic infection only in immunocompromised pregnant women, as fungemia with S. boulardii is theoretically possible but extremely rare 3
Common Pitfalls to Avoid
Do not assume all probiotic safety data applies to S. boulardii—most pregnancy studies used Lactobacillus or Bifidobacterium species, not Saccharomyces 1, 2
Do not use in immunocompromised pregnant women without careful consideration, as fungemia risk exists with any yeast-based probiotic 3
Do not withhold treatment for significant maternal gastrointestinal illness due to theoretical concerns—the risk of untreated maternal illness likely outweighs the minimal theoretical risk of S. boulardii 2