Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: a systematic review and meta-analysis
Bibliographic record
Abstract
Often preceded by early-life wheezing, asthma is the most common chronic disease of childhood. In view of the emerging microflora hypothesis of allergic disease, probiotics have been proposed for the prevention and treatment of allergic disorders including asthma, but clinical studies have yielded conflicting results. We undertook a systematic review and meta-analysis of randomized controlled trials to evaluate the association of probiotic use during pregnancy or infancy with childhood asthma and wheeze. Following a registered protocol (PROSPERO CRD42013004385), we searched MEDLINE, EMBASE, and CENTRAL from inception to February 2013, plus the World Health Organization's International Clinical Trials Registry Platform and relevant conference proceedings for the preceding 5 years. Included trials and relevant reviews were forward searched in Web of Science. Two reviewers independently identified randomized controlled trials evaluating probiotics administered during pregnancy or the first year of life. The primary outcome was clinician-diagnosed asthma; secondary outcomes included wheeze and lower respiratory tract infection. We identified 20 eligible trials involving 4866 children. Studies were heterogeneous in the type and duration of probiotic supplementation, and duration of follow up. Two trials conducted follow-up at or beyond 6 years of age, and no trials were powered for asthma detection. We adjudicated most trials (16/20) to be of unclear or high risk of bias. Among 2781 infants enrolled in 8 studies contributing asthma data, the risk ratio of clinician-diagnosed asthma in participants randomized to receive probiotics was 0.96 (95% confidence interval [CI] 0.71 to 1.29, I = 13%). The risk ratio of incident wheeze was 0.95 (95%CI 0.85 to 1.07, I = 0%, 8 trials, 1770 infants). Among 1364 infants enrolled in 6 trials, the risk ratio of lower respiratory tract infection following probiotic use was 1.26 (95%CI 0.99 to 1.61, I = 0%). We found no evidence to support a protective association between perinatal administration of probiotics and clinician-diagnosed asthma or childhood wheeze. There is currently insufficient evidence from randomized controlled trials to recommend probiotics for the primary prevention of these disorders. Extended follow up of existing trials, along with further clinical and basic research, are required to accurately define the role of probiotics in the prevention of childhood asthma.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.021 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".