Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
J Diabetes Res. 2019 Sep 5;2019:5364730. doi: 10.1155/2019/5364730. eCollection 2019.
Previous studies showed that probiotics could improve glycemic control and attenuate some of the adverse effects of type 2 diabetes. However, whether the effects are generalizable to gestational diabetes mellitus (GDM) remains uncertain.
We conducted a systematic review and meta-analysis to evaluate the effects of probiotic supplement in GDM.
PubMed, EMBASE, the Cochrane Library, and EBSCO were systematically searched for relevant literature published through January 2019. Randomized controlled trials (RCTs) assessing the effects of probiotic supplement on one or more of the following in GDM were included: pregnancy outcome (the primary outcome), glycemic control, blood lipid profile, and inflammation and oxidative stress. Two reviewers independently extracted data and assessed the risk of bias in studies. Meta-analysis was conducted by using the fixed effects model unless substantial heterogeneity was found among studies.
Eleven randomized trials involving 719 participants were included for analysis. Eight of the trials were from Iran. Probiotics were given alone in eight trials and synbiotics in three trials. Though the components of probiotics varied, Lactobacillus was included in all trials and Bifidobacterium in all except one. The duration of intervention ranged from 4 to 8 weeks. Almost all trials (10/11) had a low risk of bias. Probiotic supplementation reduced the risk of a newborn's hyperbilirubinemia by 74% and improved four biomarkers for glycemic control (fasting blood glucose, fasting serum insulin, homeostasis model assessment insulin resistance, and quantitative insulin sensitivity check index), two biomarkers for lipid profile (triglycerides and HDL-cholesterol), and four biomarkers for inflammation and oxidative stress (total glutathione, malondialdehyde, nitric oxide, and total antioxidant capacity). But significant heterogeneity was observed in the meta-analyses on the four biomarkers related to glycemic control and on triglycerides, which could not be explained by prespecified subgroup analyses according to the mean age of participants and intervention type (i.e., probiotics or synbiotics). The effects on the risk of preterm delivery, macrosomia and a newborns' hypoglycemia, gestational age, total cholesterol, and LDL-cholesterol were not statistically significant.
Probiotic supplementation seemed to be able to reduce the risk of a newborn's hyperbilirubinemia and improve glycemic control, blood lipid profiles and inflammation and oxidative stress in pregnant women with GDM. However, due to the heterogeneity among existing studies, the surrogate nature of outcomes, and/or the fact that most studies were from Iran, the clinical significance and generalizability of the above findings remain uncertain. Further studies are warranted to address the limitations of existing evidence and better inform the management of GDM.
先前的研究表明，益生菌可改善 2 型糖尿病患者的血糖控制并减轻一些不良反应。然而，其效果是否适用于妊娠糖尿病（GDM）尚不确定。
我们进行了系统评价和荟萃分析，以评估益生菌补充剂对 GDM 的影响。
通过系统检索 PubMed、EMBASE、Cochrane 图书馆和 EBSCO 数据库，检索截至 2019 年 1 月发表的相关文献。纳入评估益生菌补充剂对 GDM 以下一种或多种结局影响的随机对照试验（RCT）：妊娠结局（主要结局）、血糖控制、血脂谱、炎症和氧化应激。两名评审员独立提取数据并评估研究的偏倚风险。除非研究之间存在实质性异质性，否则使用固定效应模型进行荟萃分析。
纳入 11 项 RCT 共 719 名参与者进行分析。其中 8 项来自伊朗。8 项试验单独使用益生菌，3 项试验使用合生元。尽管益生菌的成分不同，但所有试验均包含乳杆菌，除 1 项外均包含双歧杆菌。干预时间从 4 周到 8 周不等。几乎所有试验（10/11）的偏倚风险较低。益生菌补充剂可使新生儿高胆红素血症的风险降低 74%，并改善 4 项血糖控制的生物标志物（空腹血糖、空腹血清胰岛素、稳态模型评估胰岛素抵抗和定量胰岛素敏感性检查指数）、2 项血脂谱的生物标志物（甘油三酯和高密度脂蛋白胆固醇）和 4 项炎症和氧化应激的生物标志物（总谷胱甘肽、丙二醛、一氧化氮和总抗氧化能力）。但在血糖控制相关的 4 项生物标志物和甘油三酯的荟萃分析中存在显著的异质性，根据参与者的平均年龄和干预类型（即益生菌或合生元）进行的预设亚组分析无法解释这种异质性。益生菌补充剂对早产、巨大儿和新生儿低血糖、孕龄、总胆固醇和 LDL 胆固醇的风险没有统计学意义。
益生菌补充剂似乎能够降低 GDM 孕妇新生儿高胆红素血症的风险，改善血糖控制、血脂谱以及炎症和氧化应激。然而，由于现有研究之间存在异质性、结局的替代性质以及大多数研究来自伊朗，上述发现的临床意义和普遍性仍不确定。需要进一步的研究来解决现有证据的局限性，并为 GDM 的管理提供更好的信息。
