Oral Probiotics for Maternal and Newborn Health

The recent papers by Nishijima et al1 and Morelli et al2 not only confirmed our previous studies that orally administered lactobacilli can confer benefits on vaginal health but also began to uncover new concepts of disease prevention. Each day, more than 7,000 women acquire HIV, a disease whose prevalence is significantly raised by absence of lactobacilli from the vagina.3 In addition, more than 23,000 babies (conservative 7% estimate) are born premature each day; and although it is difficult to know how many are associated with bacterial vaginosis, it could represent more than 2,000 babies per day. The use by Nishijima et al1 of culture and failure to perform Gram stain Nugent studies likely underestimated the presence of pathogens. Nevertheless, the ability to displace pathogens from the vagina confirms our human studies with Lactobacillus rhamnosus GR-1 and L. reuteri (formerly L. fermentum) RC-14.4 The mechanisms of action could in part be due to killing effects of bacteriocins, hydrogen peroxide, and acids produced by GR-1, RC-14, and L. johnsonii La1, but bacterial vaginosis organisms mostly exist in dense biofilms not easily eradicated by antimicrobials. Using in vitro studies, we have now shown that Lactobacillus GR-1 can penetrate urogenital pathogen biofilms within 1 hour,5 and a biosurfactant mixture produced by Lactobacillus RC14 can inhibit growth and adhesion of a range of urogenital pathogens. Furthermore, parallel flow cell studies, set at 2 mL per minute urine for 1 hour, have shown that a lactobacilli byproduct, 0.19 mmol/L lactic acid, can detach 30% fimbriated Escherichia coli 67 biofilms at pH 3 and 15% at pH 4. Such probiotic effects not only appear to be safe for mothers and help to prevent preterm delivery, as suggested by Nishijima et al,1 but they may also enhance the mother's appetite and heath of the newborn as shown when 75 200 g to 250-g Sprague-Dawley albino rats were fed 2 mL of placebo or 1 × 109 CFU/mL Lactobacillus GR-1 and RC-14 in drinking water for 30 days. The net effect was increased birth weight (6.5 ± 0.7 g vs. 4.58 ± 0.6 g; P < 0.01). In summary, we agree with the call by Nishijima et al1 for more support for the application of probiotics for women, including during pregnancy. There is a good rationale for their efficacy and large numbers of women and newborns who could potentially benefit from this approach. While use of live bacterial therapies is not without risk, pregnant women are often treated with antibiotics, anti-retrovirals, and other chemicals, some possessing potentially serious side effects. As mechanisms of action of probiotics become more understood, the arguments against supporting studies using well-characterized strains in pregnancy become less easy to justify.

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