Are Probiotics and Prebiotics Safe for Use during Pregnancy and Lactation? A Systematic Review and Meta-Analysis

Probiotic and prebiotic products have shown potential health benefits, including for the prevention of adverse pregnancy outcomes. The incidence of adverse effects in pregnant people and their infants associated with probiotic/prebiotic/synbiotic intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic, and/or synbiotic supplementation during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of this population. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. In total, 11/100 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. One study reported increased risk of vaginal discharge and changes in stool consistency (relative risk [95% CI]: 3.67 [1.04, 13.0]) when administering Lactobacillus rhamnosus and L. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.

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Are probiotics and prebiotics safe for use during pregnancy and lactation? A systematic review and meta-analysis

10.1101/2021.01.19.21250133 ◽

2021 ◽

Author(s):

Hauna Sheyholislami ◽

Kristin L. Connor

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

English Language ◽

Clinical Decision Making ◽

Meta Analysis ◽

Lactobacillus Rhamnosus ◽

Potential Health ◽

Increased Risk ◽

Pregnancy And Lactation ◽

Synbiotic Supplementation

AbstractProbiotic and prebiotic products are increasingly popular due to their potential health benefits, including in pregnancy where probiotic supplementation has been associated with prevention of gestational diabetes and mastitis. The incidence of adverse effects in pregnant people and their infants associated with probiotic, prebiotic and/or synbiotic product intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic and/or synbiotic supplementation before and during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of pre-pregnant, pregnant and lactating people. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. 11/70 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. Only one study reported increased risk of vaginal discharge and changes in stool consistence (Relative Risk [95% CI]: 3.67 [1.04, 12.2]) when administering Lactobacillus rhamnosus and L. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.

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Effects of interpregnancy interval on pregnancy complications: protocol for systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-025008 ◽

2018 ◽

Vol 8 (8) ◽

pp. e025008 ◽

Cited By ~ 1

Author(s):

Amanuel Tesfay Gebremedhin ◽

Annette K Regan ◽

Eva Malacova ◽

M Luke Marinovich ◽

Stephen Ball ◽

...

Keyword(s):

Systematic Review ◽

Pregnancy Complications ◽

English Language ◽

Human Subjects ◽

Meta Analysis ◽

Primary Data ◽

Interpregnancy Interval ◽

Eligibility Criteria ◽

Increased Risk ◽

Adverse Pregnancy

IntroductionInterpregnancy interval (IPI) is the length of time between a birth and conception of the next pregnancy. Evidence suggests that both short and long IPIs are at increased risk of adverse pregnancy and perinatal outcomes. Relatively less attention has been directed towards investigating the effect of IPI on pregnancy complications, and the studies that have been conducted have shown mixed results.This systematic review will aim to provide an update to the most recent available evidence on the effect of IPI on pregnancy complications.Method and analysisWe will search electronic databases such as Ovid/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and PubMed to identify peer-reviewed articles on the effects of IPI on pregnancy complications. We will include articles published from start of indexing until 12 February 2018 without any restriction to geographic setting. We will limit the search to literature published in English language and human subjects. Two independent reviewers will screen titles and abstracts and select full-text articles that meet the eligibility criteria. The Newcastle-Ottawa tool will be used to assess quality of observational studies. Where data permit, meta-analyses will be performed for individual pregnancy complications. A subgroup analyses by country categories (high-income vs low and middle-income countries) based on World Bank income group will be performed. Where meta-analysis is not possible, we will provide a description of data without further attempt to quantitatively pool results.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be published in peer-reviewed journals and presented at national and international conferences.PROSPERO registration numberCRD42018088578.

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Factors Associated with Disease Severity and Mortality among Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

10.1101/2020.08.07.20166868 ◽

2020 ◽

Author(s):

Vignesh Chidambaram ◽

Nyan Lynn Tun ◽

Waqas Haque ◽

Marie Gilbert Majella ◽

Ranjith Kumar Sivakumar ◽

...

Keyword(s):

Systematic Review ◽

Disease Severity ◽

English Language ◽

Clinical Decision Making ◽

Clinical Laboratory ◽

Data Extraction ◽

Meta Analysis ◽

Severe Disease ◽

Factors Associated ◽

Risk Of Mortality

Background: Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. Methods: We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. Results: Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45; 95%CI 1.23,1.71), dyspnea (RR 2.55; 95%CI 1.88,2.46), diabetes (RR 1.59; 95%CI 1.41,1.78), hypertension (RR 1.90; 95%CI 1.69,2.15). Congestive heart failure (OR 4.76; 95%CI 1.34,16.97), hilar lymphadenopathy (OR 8.34; 95%CI 2.57,27.08), bilateral lung involvement (OR 4.86; 95%CI 3.19,7.39) and reticular pattern (OR 5.54; 95%CI 1.24,24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. Conclusion: Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

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Management of special situations in systemic lupus erythematosus

10.1093/med/9780198739180.003.0009 ◽

2016 ◽

Author(s):

April Jorge ◽

Rosalind Ramsey-Goldman

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Comprehensive Treatment ◽

Systemic Lupus ◽

Risk Factor Modification ◽

Safety Issues ◽

Increased Risk ◽

Treatment Considerations ◽

Pregnancy And Lactation ◽

Adverse Pregnancy

In caring for patients with systemic lupus erythematosus (SLE), there are several important treatment considerations. Since many patients with SLE are female and of childbearing potential, it is important to address conception planning, contraceptive options, and the maternal and fetal risks associated with pregnancy, which are increased when there is higher SLE disease activity. It is also pertinent to address medication safety issues throughout pregnancy and lactation, as some commonly used medications can increase risks of adverse pregnancy outcomes. Additionally, patients with SLE are at higher risk for cardiovascular disease (CVD) than the general population. Therefore, these patients must undergo aggressive risk factor modification. Patients with SLE are also at increased risk for osteoporosis, and bone health is an important treatment consideration. Routine cancer screening and vaccinations are also important elements of the comprehensive treatment of the patient with SLE.

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Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599819832277 ◽

2019 ◽

Vol 161 (1) ◽

pp. 18-27 ◽

Cited By ~ 4

Author(s):

Eric L. Wu ◽

William C. Harris ◽

Casey M. Babcock ◽

Bailin H. Alexander ◽

Charles A. Riley ◽

...

Keyword(s):

Systematic Review ◽

Allergic Rhinitis ◽

Relative Risk ◽

English Language ◽

Meta Analysis ◽

Included Study ◽

Pubmed Central ◽

Intranasal Corticosteroids ◽

Language Studies ◽

Increased Risk

Objective Intranasal corticosteroids (INCSs) are widely utilized for the treatment of allergic rhinitis. Epistaxis is a known adverse effect of INCSs, but it is not known if the risk of epistaxis differs among INCSs. Data Sources Systematic review of primary studies identified through Medline, Embase, Web of Science, PubMed Central, and Cochrane databases. Review Methods Systematic review was conducted according to the PRISMA standard. English-language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta-analysis was performed of the relative risk of epistaxis for each INCS. Results Of 949 identified studies, 72 met the criteria for analysis. Meta-analysis demonstrated an overall relative risk of epistaxis of 1.48 (95% CI, 1.32-1.67) for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis. Conclusions about epistaxis with use of budesonide, triamcinolone, and flunisolide are limited due to the low number of studies and high heterogeneity. Conclusions While a differential effect on epistaxis among INCS agents is not clearly demonstrated, this meta-analysis does confirm an increased risk of epistaxis for patients using INCSs as compared with placebo for treatment of allergic rhinitis.

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Is Gestational Diabetes Mellitus a Risk Factor of Maternal Breast Cancer? A Systematic Review of the Literature

Biomedicines ◽

10.3390/biomedicines9091174 ◽

2021 ◽

Vol 9 (9) ◽

pp. 1174

Author(s):

Julien Simon ◽

Karine Goueslard ◽

Sonia Bechraoui-Quantin ◽

Patrick Arveux ◽

Catherine Quantin

Keyword(s):

Breast Cancer ◽

Diabetes Mellitus ◽

Systematic Review ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

English Language ◽

Low Grade ◽

Hormonal Changes ◽

Review Of The Literature ◽

Increased Risk

The association between gestational diabetes mellitus (GDM) and breast cancer (BC) risk is complex. We aimed to examine this association in a systematic review of the literature. This review was done using the PubMed/Medline and Web of Science databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Newcastle–Ottawa Scale was used for the assessment of bias and quality of studies. Only English-language articles published before 1 June 2021, were included. Fourteen studies were included in this systematic review. Among them, eight did not find statistically significant results. Three studies showed a statistically significant increased risk of BC after GDM, and they explained this potential increased risk by hyperinsulinemia, hyperglycemia, and low-grade inflammation. However, three studies showed a statistically significant decreased risk of BC after GDM, suggesting a possible protective effect of hormonal changes induced by GDM during pregnancy. These controversial results should be interpreted with caution due to both quantitative and qualitative methodological shortcomings. Further investigations are thus needed in order to gain a better understanding of the associations between GDM and BC, and their underlying mechanisms.

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P116 A systematic review of the safety of non-tumour necrosis factor inhibitor and targeted synthetic drugs in rheumatic disease in pregnancy

Rheumatology ◽

10.1093/rheumatology/keaa111.114 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Hanh Nguyen ◽

Kawser Ahmed ◽

Julia Flint ◽

Ian Giles

Keyword(s):

Systematic Review ◽

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Final Analysis ◽

Tumour Necrosis Factor Inhibitor ◽

Increased Risk ◽

Factor Inhibitor ◽

Adverse Pregnancy ◽

Necrosis Factor ◽

In Pregnancy

Abstract Background Despite increasing evidence to support safe use of tumour necrosis factor inhibitor (TNFi) drugs in pregnancy, there remains a paucity of evidence regarding non-TNFi and targeted synthetic disease modifying anti-rheumatic drugs (tsDMARDs) in pregnancy. Therefore, we conducted a systematic review to summarise use of these drugs in pregnancy and breastfeeding. Methods Systematic search of databases including; EMBASE, Pubmed (MEDLINE), and Cochrane up to December 2018 using keywords including; commonly prescribed non-TNFi and tsDMARDs, pregnancy, conception/pre-conception, lactation/breastfeeding, childhood and vaccination/infection. Results From an initial screen of 700 papers, n = 92 full text papers were included in the final analysis. A summary of findings from known outcomes of pregnancy and breastfeeding exposures as well as long-term follow-up of infants where available are shown in Table 1. Overall, this data does not identify an increased risk of adverse pregnancy outcomes with these drugs in this population of patients. Conclusion These findings do not suggest an increased risk of non-TNFi and tsDMARDs in pregnancy. Given that the total number of exposures, however, remain limited these drugs should only be considered in pregnancy if the benefit of maintaining disease control in the mother justifies any potential risk to the fetus. This body of evidence will be useful when counselling women about the potential risks of using these types of drugs during pregnancy and breastfeeding period as well as following accidental exposure to drugs at conception. Disclosures H. Nguyen None. K. Ahmed None. J. Flint None. I. Giles None.

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Nandrolone Decanoate: Use, Abuse and Side Effects

Medicina ◽

10.3390/medicina56110606 ◽

2020 ◽

Vol 56 (11) ◽

pp. 606

Author(s):

Federico Giuseppe Patanè ◽

Aldo Liberto ◽

Andreana Nicoletta Maria Maglitto ◽

Pasquale Malandrino ◽

Massimiliano Esposito ◽

...

Keyword(s):

Systematic Review ◽

Side Effects ◽

Adverse Effects ◽

English Language ◽

Scientific Literature ◽

Reproductive Organs ◽

Nandrolone Decanoate ◽

Inclusion Criteria ◽

Pubmed Database ◽

Study Results

Background and Objectives: Androgens play a significant role in the development of male reproductive organs. The clinical use of synthetic testosterone derivatives, such as nandrolone, is focused on maximizing the anabolic effects and minimizing the androgenic ones. Class II anabolic androgenic steroids (AAS), including nandrolone, are rapidly becoming a widespread group of drugs used both clinically and illicitly. The illicit use of AAS is diffused among adolescent and bodybuilders because of their anabolic proprieties and their capacity to increase tolerance to exercise. This systematic review aims to focus on side effects related to illicit AAS abuse, evaluating the scientific literature in order to underline the most frequent side effects on AAS abusers’ bodies. Materials and Methods: A systematic review of the scientific literature was performed using the PubMed database and the keywords “nandrolone decanoate”. The inclusion criteria for articles or abstracts were English language and the presence of the following words: “abuse” or “adverse effects”. After applying the exclusion and inclusion criteria, from a total of 766 articles, only 148 were considered eligible for the study. Results: The most reported adverse effects (found in more than 5% of the studies) were endocrine effects (18 studies, 42%), such as virilization, gynecomastia, hormonal disorders, dyslipidemia, genital alterations, and infertility; cardiovascular dysfunctions (six studies, 14%) such as vascular damage, coagulation disorders, and arteriosus hypertension; skin disorders (five studies, 12%) such as pricking, acne, and skin spots; psychiatric and mood disorders (four studies, 9%) such as aggressiveness, sleep disorders and anxiety; musculoskeletal disorders (two studies, 5%), excretory disorders (two studies, 5%), and gastrointestinal disorders (two studies, 5%). Conclusions: Based on the result of our study, the most common adverse effects secondary to the abuse of nandrolone decanoate (ND) involve the endocrine, cardiovascular, skin, and psychiatric systems. These data could prove useful to healthcare professionals in both sports and clinical settings.

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Maternal urinary levels of trichloroacetic acid and association with adverse pregnancy outcomes

Journal of Water and Health ◽

10.2166/wh.2019.109 ◽

2019 ◽

Vol 17 (6) ◽

pp. 884-895 ◽

Cited By ~ 1

Author(s):

Funanani Mashau ◽

Esper Jacobeth Ncube ◽

Kuku Voyi

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Premature Birth ◽

Trichloroacetic Acid ◽

Adverse Pregnancy Outcomes ◽

Potential Health ◽

Increased Risk ◽

Adverse Pregnancy

Abstract The current study aimed to determine the association between trichloroacetic acid (TCAA) levels and adverse pregnancy outcomes among third-trimester pregnant women who were exposed to chlorinated drinking water. A total of 205 pregnant women who participated in the disinfection by-products exposure and adverse pregnancy outcome study in South Africa were randomly asked to participate in this study by providing their morning urine sample voids. Samples were analysed for urinary creatinine and TCAA. Furthermore, participants gave individual data using a structured questionnaire. The mean (median) concentration of creatinine-adjusted urinary TCAA was 2.34 (1.95) μg/g creatinine. Elevated levels of creatinine-adjusted TCAA concentrations showed an increased risk of premature birth, small for gestational age (SGA) and low birth weight. There was no significant statistical correlation observed between creatinine-adjusted TCAA concentrations and the total volume of cold water ingested among the study population. No statistically significant association was observed between creatinine-adjusted urinary TCAA and premature birth, SGA and low birth weight newborns among the study subjects. However, the urinary TCAA concentrations identified in this study suggest potential health risks towards women and foetus. Therefore, further studies are warranted to prevent further adverse pregnancy outcomes.

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The influence of disease activity on pregnancy outcomes in women with inflammatory bowel disease: A systematic review and meta-analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa225 ◽

2020 ◽

Author(s):

Min-A Kim ◽

Young-Han Kim ◽

Jaeyoung Chun ◽

Hye Sun Lee ◽

Soo Jung Park ◽

...

Keyword(s):

Systematic Review ◽

Preterm Birth ◽

Disease Activity ◽

Spontaneous Abortion ◽

Pregnancy Outcomes ◽

Meta Analysis ◽

Cochrane Library ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Impact

Abstract Background & Aims Robust evidence regarding the impact of disease activity on pregnancy outcomes in women with IBD is crucial for both clinicians and patients in preparing a birth plan. We sought to perform a systematic review and meta-analysis to assess the pooled influences of disease activity on pregnancy outcomes in women with IBD. Methods We searched MEDLINE, EMBASE, and COCHRANE library to identify articles comparing pregnancy outcomes between active and inactive IBD at the time of conception or during pregnancy. A meta-analysis was performed using a random-effects model to pool estimates and report odds ratios (ORs). Results A total of 28 studies were identified as eligible for the meta-analysis. In women with active IBD, the pooled ORs for low birth weight (LBW), preterm birth, small for gestational age (SGA), spontaneous abortion, and stillbirths were 3.81 (95% confidence interval [CI] 1.81-8.02), 2.42 (95% CI 1.74-3.35), 1.48 (95% CI 1.19-1.85), 1.87 (95% CI 1.17-3.0), and 2.27 (95% CI 1.03-5.04) compared to women with inactive IBD, respectively. In the subgroup analysis based on disease type, women with active ulcerative colitis had an increased risk of LBW, preterm birth, and spontaneous abortion. Women with active Crohn’s disease had a higher risk of preterm birth, SGA, and spontaneous abortion. Conclusions Active IBD during the periconception period and pregnancy is associated with increased risk of adverse pregnancy outcomes. Our data suggest that pregnancy should be planned when the disease is quiescent, and continuous disease control is important even during pregnancy.

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