Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Ethiopia.
J Glob Health. 2024 Sep 13;14:04177. doi: 10.7189/jogh.14.04177.
Microbes in the human body are the determinants of life-long health and disease. Microbiome acquisition starts in utero and matures during early childhood through breastfeeding. However, maternal gut dysbiosis affects the maternal-offspring microbiome interplay. Lines of evidence on dysbiosis-targeted interventions and their effect on maternal-offspring health and gut microbiome are inconsistent and inconclusive. Therefore, this study summarised studies to identify the most common microbiota-targeted intervention during pregnancy and lactation and to comprehensively evaluate its effects on maternal and offspring health.
This umbrella review was conducted by systematically searching databases such as PubMed and the Web of Science from inception to 2 September 2023. The quality was assessed using the Assessment of Multiple Systematic Reviews-2 checklist. The Grading of Recommendations Assessment, Development, and Evaluation was used for grading the strength and certainty of the studies. The overlap of primary studies was quantified by the corrected covered area score.
A total of 17 systematic reviews and meta-analyses with 219 randomised controlled trials, 39 113 mothers, and 20 915 infants were included in this study. About 88% of studies had moderate and above certainty of evidence. Probiotics were the most common and effective interventions at reducing gestational diabetes risk (fasting blood glucose with the mean difference (MD) = -2.92, -0.05; I = 45, 98.97), fasting serum insulin (MD = -2.3, -2.06; I = 45, 77), glycated haemoglobin (Hb A1c) = -0.16; I = 0.00)), Homeostatic Model Assessment of insulin resistance (HOMA-IR) (MD = -20.55, -0.16; I = 0.00, 72.00), and lipid metabolism (MD = -5.47, 0.98; I = 0.00, 90.65). It was also effective in preventing and treating mastitis (risk ratio (RR) = 0.49; I = 2.00), relieving anxiety symptoms (MD = -0.99, 0.01; I = 0.00, 70.00), depression in lactation (MD = -0.46, -0.22; I = 0.00, 74.00) and reducing recto-vaginal bacterial colonisation (odds ratio (OR) = 0.62; I = 4.80), and with no adverse events. It also effectively remodelled the infant gut microbiome (MD = 0.89; I = 95.01) and prevented infant allergies. However, studies on pregnancy outcomes and preeclampsia incidences are limited.
Our findings from high-quality studies identify that probiotics are the most common microbiome interventions during pregnancy and lactation. Probiotics have a strong impact on maternal and offspring health through maintaining gut microbiome homeostasis. However, further studies are needed on the effect of microbiota-targeted interventions on maternal cardiometabolic health, pregnancy, and neonatal outcomes.
This umbrella review was registered with PROSPERO, CRD42023437098.
人体微生物是决定终生健康和疾病的因素。微生物组的获得始于宫内，并通过母乳喂养在幼儿期成熟。然而，母体肠道菌群失调会影响母婴微生物组的相互作用。关于针对菌群失调的干预措施及其对母婴健康和肠道微生物组影响的证据不一致且没有定论。因此，本研究总结了在妊娠和哺乳期最常见的针对微生物组的干预措施，并全面评估了其对母婴健康的影响。
本伞状评价通过系统地从数据库（如 PubMed 和 Web of Science）中搜索从成立到 2023 年 9 月 2 日的文献。使用评估多个系统评价-2 清单评估质量。使用推荐评估、制定和评估分级法来评估研究的强度和确定性。通过校正覆盖面积评分来量化主要研究的重叠。
本研究共纳入了 17 项系统评价和荟萃分析，其中包括 219 项随机对照试验、39113 名母亲和 20915 名婴儿。大约 88%的研究具有中等及以上确定性证据。益生菌是最常见和有效的干预措施，可以降低妊娠期糖尿病的风险（空腹血糖的平均差值（MD）=-2.92，-0.05；I=45，98.97），空腹血清胰岛素（MD=-2.3，-2.06；I=45，77），糖化血红蛋白（Hb A1c）=-0.16；I=0.00），胰岛素抵抗的稳态模型评估（HOMA-IR）（MD=-20.55，-0.16；I=0.00，72.00）和脂质代谢（MD=-5.47，0.98；I=0.00，90.65）。它还在预防和治疗乳腺炎（风险比（RR）=0.49；I=2.00）、缓解焦虑症状（MD=-0.99，0.01；I=0.00，70.00）、缓解哺乳期抑郁（MD=-0.46，-0.22；I=0.00，74.00）和减少直肠阴道细菌定植（比值比（OR）=0.62；I=4.80）方面也很有效，并且没有不良反应。它还能有效重塑婴儿肠道微生物组（MD=0.89；I=95.01），预防婴儿过敏。然而，关于妊娠结局和子痫前期发生率的研究有限。
我们从高质量研究中发现，益生菌是妊娠和哺乳期最常见的微生物组干预措施。益生菌通过维持肠道微生物组的平衡，对母婴健康产生强烈影响。然而，需要进一步研究针对微生物组的干预措施对母婴心血管代谢健康、妊娠和新生儿结局的影响。
本伞状评价在 PROSPERO 上注册，注册号为 CRD42023437098。
