Buggio Laura, Somigliana Edgardo, Borghi Alessandra, Vercellini Paolo
Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12 - 20122, Milan, Italy.
Deparment of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy.
BMC Womens Health. 2019 Jan 31;19(1):25. doi: 10.1186/s12905-019-0723-4.
Probiotics are live microorganisms that, when administered in adequate amounts, should confer a health benefit to the host. Media sources tend to present probiotics as an appealing health promotion method able to prevent or treat a wide variety of clinical conditions. In obstetrics and gynaecology, Lactobacilli species are mainly used to restore the physiologic vaginal microbiota in order to treat bacterial vaginosis and vulvovaginal candidiasis (VVC) and prevent preterm birth.
Several RCTs investigated the potential benefits of probiotics in gynaecological and obstetrics conditions. For all potential indications, recent specific meta-analyses have been published. Considering vulvovaginal candidiasis in non-pregnant women, probiotics slightly improved the short-term clinical and mycological cure, and reduced the 1-month relapse. However, no important impact of probiotic use was observed on long-term clinical or mycological cure. Similarly, the addition of probiotics to metronidazole for the treatment of bacterial vaginosis was not shown to provide any additional benefit. In obstetrics, using probiotics during pregnancy neither decreased nor increased the risk of preterm birth before 34 weeks or before 37 weeks. Similarly, no benefits emerged for gestational diabetes, preterm premature rupture of membrane, and small and large for gestational age infants.
Despite increasing marketing of probiotics for the treatment of vulvovaginal candidiasis and prevention of preterm birth robust evidence demonstrating a beneficial effect is scarce. Moreover, there was considerable heterogeneity among the different studies in terms of route of administration, strain/s of probiotic adopted, and length of probiotic use. Before recommending the systematic use of probiotics to treat bacterial vaginosis and VVC and prevent preterm birth, high-quality research is needed. Professional medical associations should issue recommendations defining if, when, and how probiotics should be used for gynaecological disorders.
益生菌是一类活的微生物，当给予足够数量时，应该能给宿主带来健康益处。媒体往往将益生菌呈现为一种有吸引力的健康促进方法，能够预防或治疗多种临床病症。在妇产科领域，乳酸杆菌属主要用于恢复生理性阴道微生物群，以治疗细菌性阴道病和外阴阴道念珠菌病（VVC）并预防早产。
多项随机对照试验研究了益生菌在妇产科病症中的潜在益处。针对所有潜在适应症，近期已发表了具体的荟萃分析。对于非孕妇的外阴阴道念珠菌病，益生菌略微改善了短期临床和真菌学治愈情况，并降低了1个月的复发率。然而，未观察到使用益生菌对长期临床或真菌学治愈有重要影响。同样，在治疗细菌性阴道病时，将益生菌添加到甲硝唑中未显示出有任何额外益处。在产科方面，孕期使用益生菌既未降低也未增加34周前或37周前早产的风险。同样，对于妊娠期糖尿病、胎膜早破、小于胎龄儿和大于胎龄儿也未发现有益处。
尽管用于治疗外阴阴道念珠菌病和预防早产的益生菌市场推广不断增加，但有力的证据表明其有益效果却很稀缺。此外，不同研究在给药途径、采用的益生菌菌株以及益生菌使用时长方面存在相当大的异质性。在推荐系统使用益生菌治疗细菌性阴道病和VVC以及预防早产之前，需要高质量的研究。专业医学协会应发布建议，明确益生菌是否、何时以及如何用于妇科疾病。
