Prevention of Gestational Diabetes Mellitus (GDM) and Probiotics: Mechanism of Action: A Review

Author(s): Aziz Homayouni, Nahal Bagheri, Sakineh Mohammad-Alizadeh-Charandabi, Neda Kashani, Noshin Mobaraki-Asl, Mojgan Mirghafurvand, Hanieh Asgharian, Fereshteh Ansari, Hadi Pourjafar*

Journal Name: Current Diabetes Reviews

Volume 16 , Issue 6 , 2020

Become EABM
Become Reviewer

Abstract:

Background: Gestational Diabetes Mellitus (GDM) is a health problem that is increasing around the world.

Introduction: Prevention of GDM, rather than treatment, could have several benefits in terms of both health and economic cost. Even a slight reduction in maternal glucose in non-diabetic women, particularly in women at high risk for GDM, may have significant benefits for pregnancy results and the future health of off-springs. Probiotics are a relatively new intervention, which are assessed by mothers’ metabolism, and can reduce blood sugar levels, prevent gestational diabetes and reduce the maternal and fetal complications resulting from it. The aim of this study was to review the studies on the prevention of gestational diabetes and assess the potential beneficial effects of probiotics on gestational diabetes and their possible mechanism of action.

Methods: Articles compiled through clinical trials indexed in PubMed, Science Direct, Cochran, and Medlib between 2000 and 2017, with the keywords probiotics, prevention, and gestational diabetes mellitus were selected.

Results: Considering the potential of probiotics in the modulation of gut microbiota, naturalization increases intestinal permeability, regulation of pro-inflammatory mediators’ secretion and thereby controlling local and systemic inflammation results in decreasing intestinal permeability, enhancing the immune system. It likely has the ability to prevent or control diabetes during pregnancy although confirmatory studies are still needed.

Conclusion: Experimental and clinical evidence support the supposition that the modulation of the gut microbiota via probiotic microorganisms could be effective in the prevention of gestational diabetes mellitus.

Keywords: Probiotics, gut microbiota, gestational diabetes mellitus, GDM, pregnancy, hyperglycemia.

[1]
Birkeland KI. Hyperglycaemia in pregnancy: still a lot to learn. Lancet Diabetes Endocrinol 2015; 3(10): 752-3.
[http://dx.doi.org/10.1016/S2213-8587(15)00282-X] [PMID: 26355009]
[2]
Dodd JM, Grivell RM, Crowther CA, Robinson JS. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG 2010; 117(11): 1316-26.
[http://dx.doi.org/10.1111/j.1471-0528.2010.02540.x] [PMID: 20353459]
[3]
Barrett HL, Dekker Nitert M, Conwell LS, Callaway LK. Probiotics for preventing gestational diabetes. Cochrane Database Syst Rev 2014; 2(2)CD009951
[http://dx.doi.org/10.1002/14651858.CD009951.pub2] [PMID: 24574258]
[4]
Camprubi R M, Campoy C, Garcia F L, Lopez-Pedrosa JM, Rueda R, Martin MJ. Maternal diabetes and cognitive performance in the offspring: a systematic review and meta-analysis. PLoS One 2015; 10(11)e0142583
[http://dx.doi.org/10.1371/journal.pone.0142583] [PMID: 26566144]
[5]
Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care 2007; 30(Suppl. 2): S251-60.
[http://dx.doi.org/10.2337/dc07-s225] [PMID: 17596481]
[6]
Schneider S, Bock C, Wetzel M, Maul H, Loerbroks A. The prevalence of gestational diabetes in advanced economies. J Perinat Med 2012; 40(5): 511-20.
[http://dx.doi.org/10.1515/jpm-2012-0015] [PMID: 23120759]
[7]
McIntyre HD, Gibbons KS, Flenady VJ, Callaway LK. Overweight and obesity in Australian mothers: epidemic or endemic? Med J Aust 2012; 196(3): 184-8.https://www.ncbi.nlm.nih.gov/pubmed/22339524
[http://dx.doi.org/10.5694/mja11.11120] [PMID: 22339524]
[8]
Nitert MD, Barrett HL, Foxcroft K, et al. SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women. BMC Pregnancy Childbirth 2013; 13: 50.
[http://dx.doi.org/10.1186/1471-2393-13-50] [PMID: 23442391]
[9]
Langer O, Umans JG, Miodovnik M. The proposed GDM diagnostic criteria: a difference, to be a difference, must make a difference. J Matern Fetal Neonatal Med 2013; 26(2): 111-5.
[http://dx.doi.org/10.3109/14767058.2012.734874] [PMID: 23039192]
[10]
Clarke SF, Murphy EF, Nilaweera K, et al. The gut microbiota and its relationship to diet and obesity: new insights. Gut Microbes 2012; 3(3): 186-202.
[http://dx.doi.org/10.4161/gmic.20168] [PMID: 22572830]
[11]
Vaghef-Mehrabany E, Homayouni-Rad A, Alipour B, Sharif S-K, Vaghef-Mehrabany L, Alipour-Ajiry S. Effects of probiotic supplementation on oxidative stress indices in women with rheumatoid arthritis: a randomized double-blind clinical trial. J Am Coll Nutr 2016; 35(4): 291-9.
[http://dx.doi.org/10.1080/07315724.2014.959208] [PMID: 25856220]
[12]
Sanz Y, Santacruz A, Gauffin P. Gut microbiota in obesity and metabolic disorders. Proc Nutr Soc 2010; 69(3): 434-41.
[http://dx.doi.org/10.1017/S0029665110001813] [PMID: 20540826]
[13]
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352(24): 2477-86.
[http://dx.doi.org/10.1056/NEJMoa042973] [PMID: 15951574]
[14]
Han S, Middleton P, Crowther CA. Exercise for pregnant women for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2012; 7(7)CD009021
[http://dx.doi.org/10.1002/14651858.CD009021.pub2] [PMID: 22786521]
[15]
Sui Z, Turnbull DA, Dodd JM. Overweight and obese women’s perceptions about making healthy change during pregnancy: a mixed method study. Matern Child Health J 2013; 17(10): 1879-87.
[http://dx.doi.org/10.1007/s10995-012-1211-8] [PMID: 23263891]
[16]
Streuling I, Beyerlein A, von Kries R. Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials. Am J Clin Nutr 2010; 92(4): 678-87.
[http://dx.doi.org/10.3945/ajcn.2010.29363] [PMID: 20668049]
[17]
Barrett HL, Callaway LK, Nitert MD. Probiotics: a potential role in the prevention of gestational diabetes? Acta Diabetol 2012; 49(Suppl. 1): S1-S13.
[http://dx.doi.org/10.1007/s00592-012-0444-8] [PMID: 23180045]
[18]
Tarantino G, Finelli C. Systematic review on intervention with prebiotics/probiotics in patients with obesity-related nonalcoholic fatty liver disease. Future Microbiol 2015; 10(5): 889-902.
[http://dx.doi.org/10.2217/fmb.15.13] [PMID: 26000656]
[19]
Campieri M, Gionchetti P. Bacteria as the cause of ulcerative colitis. Gut 2001; 48(1): 132-5.
[http://dx.doi.org/10.1136/gut.48.1.132] [PMID: 11115835]
[20]
Stanton C, Gardiner G, Meehan H, et al. Market potential for probiotics. Am J Clin Nutr 2001; 73(2)(Suppl.): 476S-83S.
[http://dx.doi.org/10.1093/ajcn/73.2.476s] [PMID: 11157361]
[21]
Homayouni A. Letter to the editor. Food Chem 2009; 114(3): 1073.
[http://dx.doi.org/10.1016/j.foodchem.2008.10.012]
[22]
Pourjafar H, Noori N, Gandomi H, Akhondzadeh Basti A, Ansari F. Stability and efficiency of double-coated beads containing Lactobacillus acidophilus obtained from the calcium alginate-chitosan and eudragit S100 nanoparticles microencapsulation. Int J Probiotics Prebiotics 2018; 13(2-3): 77-84.
[23]
Reid JN, Bisanz JE, Monachese M, Burton JP, Reid G. The rationale for probiotics improving reproductive health and pregnancy outcome. Am J Reprod Immunol 2013; 69(6): 558-66.
[http://dx.doi.org/10.1111/aji.12086] [PMID: 23414386]
[24]
Gomes AC, Bueno AA, de Souza RG, Mota JF. Gut microbiota, probiotics and diabetes. Nutr J 2014; 13: 60.
[http://dx.doi.org/10.1186/1475-2891-13-60] [PMID: 24939063]
[25]
Isolauri E, Rautava S, Collado MC, Salminen S. Role of probiotics in reducing the risk of gestational diabetes. Diabetes Obes Metab 2015; 17(8): 713-9.
[http://dx.doi.org/10.1111/dom.12475] [PMID: 25885278]
[26]
Ponzo V, Fedele D, Goitre I, et al. Diet-Gut Microbiota Interactions and Gestational Diabetes Mellitus (GDM). Nutrients 2019; 11(2): 330.
[http://dx.doi.org/10.3390/nu11020330] [PMID: 30717458]
[27]
Babadi M, Khorshidi A, Aghadavood E, et al. The Effects of Probiotic Supplementation on Genetic and Metabolic Profiles in Patients with Gestational Diabetes Mellitus: a Randomized, Double-Blind, Placebo-Controlled Trial. Probiotics Antimicrob Proteins 2019; 11(4): 1227-35.
[http://dx.doi.org/10.1007/s12602-018-9490-z] [PMID: 30535534]
[28]
Callaway LK, McIntyre HD, Barrett HL, et al. Probiotics for the prevention of Gestational Diabetes Mellitus in overweight and obese women: Findings from the SPRING double-blind randomized controlled trial. Diabetes Care 2019; 42(3): 364-71.
[http://dx.doi.org/10.2337/dc18-2248] [PMID: 30659070]
[29]
Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, Asghari-Jafarabadi M, Mofid V. Probiotic yogurt improves antioxidant status in type 2 diabetic patients. Nutrition 2012; 28(5): 539-43.
[http://dx.doi.org/10.1016/j.nut.2011.08.013] [PMID: 22129852]
[30]
Dunn AB, Hanson L, VandeVusse L, Leslie S. Through the microbial looking glass: premature labor, preeclampsia, and gestational diabetes: a scoping review. J Perinat Neonatal Nurs 2019; 33(1): 35-51.
[http://dx.doi.org/10.1097/JPN.0000000000000375] [PMID: 30676461]
[31]
Razmpoosh E, Javadi A, Ejtahed HS, Mirmiran P, Javadi M, Yousefinejad A. The effect of probiotic supplementation on glycemic control and lipid profile in patients with type 2 diabetes: A randomized placebo controlled trial. Diabetes Metab Syndr 2019; 13(1): 175-82.
[http://dx.doi.org/10.1016/j.dsx.2018.08.008] [PMID: 30641692]
[32]
Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature 2006; 444(7122): 1022-3.
[http://dx.doi.org/10.1038/4441022a] [PMID: 17183309]
[33]
Alyce M. Tomas, Yolanda MGutierrez. American Diabetes assosiation guide to gestational diabetes mellitus 2005.
[34]
Kaaja R, Rönnemaa T. Gestational diabetes: pathogenesis and consequences to mother and offspring. Rev Diabet Stud 2008; 5(4): 194-202.
[http://dx.doi.org/10.1900/RDS.2008.5.194] [PMID: 19290380]
[35]
Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss JF III, Petraglia F. Inflammation and pregnancy. Reprod Sci 2009; 16(2): 206-15.
[http://dx.doi.org/10.1177/1933719108329095] [PMID: 19208789]
[36]
Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care 2013; 36(1): 56-62.
[http://dx.doi.org/10.2337/dc12-0741] [PMID: 22891256]
[37]
Briana DD, Malamitsi-Puchner A. Reviews: adipocytokines in normal and complicated pregnancies. Reprod Sci 2009; 16(10): 921-37.
[http://dx.doi.org/10.1177/1933719109336614] [PMID: 19474287]
[38]
Denison FC, Roberts KA, Barr SM, Norman JE. Obesity, pregnancy, inflammation, and vascular function. Reproduction 2010; 140(3): 373-85.
[http://dx.doi.org/10.1530/REP-10-0074] [PMID: 20215337]
[39]
Moazen S, Amani R, Homayouni R A, Shahbazian H, Ahmadi K, Taha J M. Effects of freeze-dried strawberry supplementation on metabolic biomarkers of atherosclerosis in subjects with type 2 diabetes: a randomized double-blind controlled trial. Ann Nutr Metab 2013; 63(3): 256-64.
[http://dx.doi.org/10.1159/000356053] [PMID: 24334868]
[40]
Fasshauer M, Blüher M, Stumvoll M. Adipokines in gestational diabetes. Lancet Diabetes Endocrinol 2014; 2(6): 488-99.
[http://dx.doi.org/10.1016/S2213-8587(13)70176-1] [PMID: 24731659]
[41]
Georgiou HM, Lappas M, Georgiou GM, et al. Screening for biomarkers predictive of gestational diabetes mellitus. Acta Diabetol 2008; 45(3): 157-65.
[http://dx.doi.org/10.1007/s00592-008-0037-8] [PMID: 18496643]
[42]
Lowe LP, Metzger BE, Lowe WL Jr, Dyer AR, McDade TW, McIntyre HD. Inflammatory mediators and glucose in pregnancy: results from a subset of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. J Clin Endocrinol Metab 2010; 95(12): 5427-34.
[http://dx.doi.org/10.1210/jc.2010-1662] [PMID: 20843942]
[43]
Bergmann K, Sypniewska G. Diabetes as a complication of adipose tissue dysfunction. Is there a role for potential new biomarkers? Clin Chem Lab Med 2013; 51(1): 177-85.
[http://dx.doi.org/10.1515/cclm-2012-0490] [PMID: 23241684]
[44]
Koren O, Goodrich JK, Cullender TC, et al. Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell 2012; 150(3): 470-80.
[http://dx.doi.org/10.1016/j.cell.2012.07.008] [PMID: 22863002]
[45]
Okesene‐Gafa KA, McCowan L, Crowther CA, Brown J. Probiotics for treating women with gestational diabetes for improving maternal and fetal health and well‐being. Cochrane Database Syst Rev 2018; 2018(2)
[http://dx.doi.org/10.1002/14651858.CD012970]
[46]
Collado MC, Isolauri E, Laitinen K, Salminen S. Distinct composition of gut microbiota during pregnancy in overweight and normal-weight women. Am J Clin Nutr 2008; 88(4): 894-9.
[http://dx.doi.org/10.1093/ajcn/88.4.894] [PMID: 18842773]
[47]
Collado MC, Isolauri E, Laitinen K, Salminen S. Effect of mother’s weight on infant’s microbiota acquisition, composition, and activity during early infancy: a prospective follow-up study initiated in early pregnancy. Am J Clin Nutr 2010; 92(5): 1023-30.
[48]
Collado MC, Laitinen K, Salminen S, Isolauri E. Maternal weight and excessive weight gain during pregnancy modify the immunomodulatory potential of breast milk. Pediatr Res 2012; 72(1): 77-85.
[http://dx.doi.org/10.1038/pr.2012.42]
[49]
Santacruz A, Collado MC, García-Valdés L, et al. Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women. Br J Nutr 2010; 104(1): 83-92.
[http://dx.doi.org/10.1017/S0007114510000176] [PMID: 20205964]
[50]
Lindsay KL, Brennan L, Kennelly MA, et al. Impact of probiotics in women with gestational diabetes mellitus on metabolic health: a randomized controlled trial. Am J Obstet Gynecol 2015; 212(4): 496.e1-496.e11.
[http://dx.doi.org/10.1016/j.ajog.2015.02.008] [PMID: 25687568]
[51]
Homayoni Rad A, Mehrabany EV, Alipoor B, Mehrabany LV, Javadi M. Do probiotics act more efficiently in foods than in supplements? Nutrition 2012; 28(7-8): 733-6.
[http://dx.doi.org/10.1016/j.nut.2012.01.012] [PMID: 22704699]
[52]
Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr 2010; 103(12): 1792-9.
[http://dx.doi.org/10.1017/S0007114509993898] [PMID: 20128938]
[53]
Laitinen K, Poussa T, Isolauri E. Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Br J Nutr 2009; 101(11): 1679-87.
[http://dx.doi.org/10.1017/S0007114508111461] [PMID: 19017418]
[54]
Lindsay KL, Kennelly M, Culliton M, et al. Probiotics in obese pregnancy do not reduce maternal fasting glucose: a double-blind, placebo-controlled, randomized trial (Probiotics in Pregnancy Study). Am J Clin Nutr 2014; 99(6): 1432-9.
[http://dx.doi.org/10.3945/ajcn.113.079723] [PMID: 24646819]
[55]
Wickens KL, Barthow CA, Murphy R, et al. Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: a randomised controlled trial. Br J Nutr 2017; 117(6): 804-13.
[http://dx.doi.org/10.1017/S0007114517000289] [PMID: 28367765]
[56]
Jafari-Shobeiri M, Ghojazadeh M, Azami-Aghdash S, et al. Prevalence and risk factors of gestational diabetes in iran: a systematic review and meta-analysis. Iran J Public Health 2015; 44(8): 1036-44.https://www.ncbi.nlm.nih.gov/pubmed/26587467
[PMID: 26587467]
[57]
Nitert MD, Barrett HL, Foxcroft K, et al. SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women. BMC Pregnancy Childbirth 2013; 13: 50.
[http://dx.doi.org/10.1186/1471-2393-13-50] [PMID: 23442391]
[58]
Lindsay KL, Brennan L, Kennelly MA, Maguire OC, Smith T, Curran S, et al. Impact of probiotics in women with gestational diabetes mellitus on metabolic health: a randomized controlled trial 2015.
[59]
Dolatkhah N, Hajifaraji M, Abbasalizadeh F, Aghamohammadzadeh N, Mehrabi Y, Abbasi MM. Is there a value for probiotic supplements in gestational diabetes mellitus? A randomized clinical trial. J Health Popul Nutr 2015; 33: 25.
[http://dx.doi.org/10.1186/s41043-015-0034-9] [PMID: 26825666]
[60]
Karamali M, Dadkhah F, Sadrkhanlou M, et al. Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: A randomized, double-blind, placebo-controlled trial. Diabetes Metab 2016; 42(4): 234-41.
[http://dx.doi.org/10.1016/j.diabet.2016.04.009] [PMID: 27209439]
[61]
Jafarnejad S, Saremi S, Jafarnejad F, Arab A. Effects of a multispecies probiotic mixture on glycemic control and inflammatory status in women with gestational diabetes: a randomized controlled clinical trial. J Nutr Metab 2016; 20165190846
[http://dx.doi.org/10.1155/2016/5190846] [PMID: 27429803]
[62]
Badehnoosh B, Karamali M, Zarrati M, et al. The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes. J Matern Fetal Neonatal Med 2018; 31(9): 1128-36.
[http://dx.doi.org/10.1080/14767058.2017.1310193] [PMID: 28326881]
[63]
Ahmadi S, Jamilian M, Tajabadi-Ebrahimi M, Jafari P, Asemi Z. The effects of synbiotic supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes: a randomised, double-blind, placebo-controlled trial. Br J Nutr 2016; 116(8): 1394-401.
[http://dx.doi.org/10.1017/S0007114516003457] [PMID: 27681077]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 6
Year: 2020
Page: [538 - 545]
Pages: 8
DOI: 10.2174/1573399815666190712193828
Price: $65

Article Metrics

PDF: 46