Are Probiotics Safe During Pregnancy?
Yes, probiotics are safe for healthy pregnant women with no underlying medical conditions, and the overwhelming evidence supports their use without increased risk of adverse pregnancy outcomes. 1, 2
Safety Profile for Healthy Pregnant Women
For healthy pregnant women without risk factors, probiotics pose no significant safety concerns and can be used throughout pregnancy. 1, 3, 2
- Most commercially available probiotics are derived from fermented foods with long histories of safe consumption or from microbes that naturally colonize humans 1
- The European Food Safety Authority (EFSA) and U.S. FDA consider common probiotic species safe for the general population, including pregnant women 1
- A comprehensive systematic review and meta-analysis found no evidence that probiotics increase or decrease the risk of preterm birth (<37 weeks: RR 1.08,95% CI 0.71-1.63) or other adverse pregnancy outcomes 3
- Another systematic review specifically examining adverse effects concluded that probiotics and prebiotics are safe during pregnancy and lactation, with no serious health concerns to mother or infant 2
Potential Benefits
Probiotics administered both prenatally to the mother and postnatally to the child reduce 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) in offspring. 1
- Some evidence suggests probiotics may reduce maternal fasting glucose and potentially lower rates of gestational diabetes mellitus, though results are mixed 4, 5
- Probiotics may reduce C-reactive protein levels and potentially lower pre-eclampsia rates, though more research is needed 4
Recommended Strains for Pregnancy
Choose well-studied strains with established safety profiles, particularly Lactobacillus rhamnosus (now reclassified as Lacticaseibacillus rhamnosus). 1
- The American Gastroenterological Association recommends combinations including Lactobacillus rhamnosus with Bifidobacterium species, or Lactobacillus acidophilus with Bifidobacterium species 1
- Always verify the precise bacterial identity at the strain level when selecting a probiotic product 1
Important Contraindications and Precautions
Even though you are healthy, avoid probiotics if you develop any of these high-risk conditions during pregnancy:
- Immunocompromised state (HIV with low CD4 counts, chemotherapy, immunosuppressive medications) - absolute contraindication due to risk of invasive infections including bacteremia and sepsis 6
- Central venous catheters - increased risk of line-associated infections 1, 6
- Cardiac valvular disease - risk of endocarditis from bacteremia 1, 6
- Damaged intestinal mucosa or short-gut syndrome - increased bacterial translocation risk 1, 6
- Severe acute pancreatitis - multispecies probiotic preparations associated with increased mortality 6
- Critical illness or severe debilitation - documented cases of probiotic-induced sepsis 6
Specific Product Considerations
Exercise caution with Saccharomyces boulardii, as this yeast-based probiotic has been associated with fungemia in vulnerable populations. 1, 7
- While S. boulardii is generally safe for healthy individuals, it should be avoided if you become critically ill or immunocompromised during pregnancy 7
- Avoid products containing extremely high bacterial concentrations (450-900 billion bacteria per dose), as safety becomes more sensitive at these formulations 1, 6
Quality Control Matters
Choose products that have been deposited at a biodepository such as the American Type Culture Collection (ATCC) for quality assurance. 1
- The amount of dead bacteria in a preparation is inversely proportional to product quality 1
- The probiotic market suffers from inadequate regulation, with some products containing contaminants or lacking the stated bacterial strains entirely 6
Minor Side Effects
Expect minor gastrointestinal symptoms such as abdominal cramping, bloating, and changes in stool consistency, which are common but not serious. 6, 2