Probiotics during pregnancy – are they really worth the hype?

Registered dietician Ashleigh Caradas looks at the possible benefits of using probiotics during pregnancy.


While we know probiotics play a role in gastro-intestinal health, their use in pregnancy is a novel area of research. Since they are safe, doctors, gynaecologists, homeopaths and nutritionists are now prescribing them more often during pregnancy. But is their use based on real research, or are we going with our “gut feel” when it comes to adding probiotics to a pregnancy supplement regime?

ALSO SEE: Do’s and don’ts of supplementing during pregnancy

What are probiotics?

Our bowels contain trillions of bacteria from more than 500 different species, which means there are more bacteria in each of our guts than there are people in the world. Probiotics are the good bacteria that inhabit our gut alongside the bad guys, or the bacteria and fungi that threaten our digestive health. When the bad guys outweigh the good, our digestion and immunity can become compromised.

When a mother’s diet is high in processed foods, low in fruit and vegetables, and high in caffeine or carbonated beverages, gut health can suffer. Stress, antibiotics and other medications can cause what is known as poor gut flora, or a situation where the bad bacteria overtakes the good. Probiotics are found naturally in yoghurt, kefir and other fermented foods. Certain fibres in wholegrains, fruits and vegetables can help naturally boost probiotic production in the gut, and supplements contain strains known to be beneficial to human health.

ALSO SEE: First trimester pregnancy diet plan

Pregnancy and gut health

Given that pregnancy is a time when bowel habits generally change, probiotic supplements can help keep you regular and boost your immunity. Yeast infections, like candida, are also more common during pregnancy and a balanced gut flora helps to prevent infections like thrush.

Your baby will also inherit your bacterial flora during the first two years of his life, so your gut health will reflect in the gut health of your baby. There is some evidence that taking probiotics during pregnancy can reduce the chance of your child developing allergies, but one of the most interesting applications is the gut-brain connection and the role certain probiotics play in preventing autism. Although still a grey area, the theory was initially investigated when researchers found that rats that were fed a certain strain of probiotics exhibited a reduction in autism-like behaviours.

Probiotics unravelled

While we may understand that probiotics could have benefits for our health, their application is wide and certain strains help with particular issues, so simply buying one at the pharmacy and taking it may not help. This means it’s essential to consult your healthcare provider before embarking on a probiotic regime.

Probiotics are generally divided into two types, Lactobacillus bacteria and Bifidobacterium, with the strains being abbreviated with a B. or an L. before the name.

These common probiotic strains have applications during pregnancy:

  • L. acidophilus is the most commonly prescribed probiotic due to its ability to readily colonise the walls of the small intestine. It supports nutrient absorption and helps with the digestion of dairy products. It also has applications in candida and constipation prevention.
  • B. bifidum is often found together with L. acidophilus in supplemental form. It helps with digestion, particularly of dairy products, and helps break down carbohydrates, fats and proteins.
  • B. longum is particularly active as a toxin scavenger in the digestive system.
  • L. reuteri is commonly used to treat diarrhoea, but can also help improve vitamin B12 levels and treat yeast infections. It could also play a role in preventing autism spectrum disorders.
  • L. rhamnosus is often known as the “travel probiotic”, and can help prevent diarrhoea brought on by unsanitary preparation of food. It also has applications in the prevention and treatment of urinary-tract infections.
  • L. plantarum is sometimes referred to as Lp299v and is used in the treatment of irritable bowel syndrome.

ALSO SEE: 25 foods you should include in pregnancy diet

Probiotic Science

According to a data analysis by the National Institute of Health (NIH) in the US, there is preliminary evidence that some probiotics are helpful in preventing diarrhoea caused by infections and antibiotics, while others can improve irritable bowel syndrome symptoms. However, we still don’t know which probiotics are helpful and which are not.

Safety studies on probiotics indicate that they are safe for use during pregnancy and that side effects are uncommon. The US Food and Drug Administration (FDA) has not approved probiotics for preventing or treating any health problem at this stage. However, studies are demonstrating possible applications beyond gut health.

A 2017 study published in the Italian journal Acta BioMedica looked at the role of a multi-strain probiotic in over 1 000 women enrolled in an antenatal clinic and found that, in addition to probiotics significantly reducing gut disorders, they also resulted in a decreased incidence of bacterial infections, a 30% decrease in premature rupture of membranes and fewer emergency C-sections during labour.

Dr Kerri Sacks, a Johannesburg-based homeopath who routinely prescribes probiotics says that she usually advises her patients to take a daily probiotic containing two Lactobacillus and two Bifidobacterium strains. She adds that there are other strains that could be beneficial during pregnancy, but she doesn’t routinely use them. “I find the use of probiotics helps the moms’ immune system, constipation and morning sickness,” she says. For urinary-tract infections in pregnancy, Dr Sacks recommends a combination of the Reuteri and Rhamnosus strains.

Dr Deshni Naidoo, a gynaecologist in Johannesburg, doesn’t routinely prescribe probiotics, unless the patient is experiencing a urinary-tract infection, or recurrent diarrhoea or candida. According to Dr Naidoo, “There is no research to prove the decrease of allergies in children born to mothers on probiotics. There is also no validity to the autism-probiotic link.” However, she does agree that probiotics are safe to use during pregnancy.

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