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Gestational diabetes mellitus (GDM) is the most common pregnancy complication.
Due to obesity and the increase in the average age of pregnant women, its prevalence continues to rise globally, reaching as high as14.
8%
.
Women with GDM are more likely to develop diabetes within five to ten years after pregnancy, up to 20%-60%, and the incidence of metabolic diseases in their offspring also increases significantly
diabetes
Probiotics play an important role in improving the intestinal microenvironment, regulating the immune system, and preventing systemic diseases and inflammation.
In many studies, they are regarded as a potential, economical and practical method to improve pregnant women's blood sugar and insulin resistance/sensitivity.
, But there are still some conflicting conclusions in some studies
.
This study aims to synthesize more high-quality randomized controlled trials (RCTs) to provide evidence of the effects of probiotic supplements on blood sugar control, insulin resistance/sensitivity and GDM prevention in pregnant women
.
.
A total of 4,644 articles were found through searching 11 electronic databases, which were finally carefully reviewed according to the selection criteria, and 20 RCTs were included (Figure 1):
20 studies covered 2972 participants
.
Participants were divided into three groups: pregnant women who were overweight or obese, women with GDM, and healthy pregnant women
Figure 2 shows the literature quality assessment of all included studies:
1.
The effect of probiotic supplements on blood sugar
The effect of probiotic supplements on blood sugar
In 20 studies with 2555 participants, compared with the control group, the intervention group had lower FPG levels (MD = −0.
11; 95% CI = −0.
15 to −0.
04;
P = 0.
0007) (Table 2)
2.
1 hour and 2 hour OGTT and HbA1C evaluation2.
P P P P P A total of 389 pregnant women reported HbA1c in the three studies, and the results showed no significant difference
3.
The effect of probiotics on insulin
The effect of probiotics on insulin
16 studies covered a total of 1446 participants and measured information about FPI levels (Table 2)
.
Compared with the intervention group and the control group, a significant reduction was observed (MD = 1.
P Compared with overweight/obese pregnant women, FPI levels in GDM pregnant women (MD-2.
For different types of probiotic interventions, short-term intervention can promote insulin control ( MD=−1.
The HOMA-IR results measured by 1383 participants in 16 studies showed a significant improvement compared to the control group (MD = +0.
36; 95% CI = +0.
53 to +0.
20; P <0.
00001) (Table 2)
.
For different pregnancy status, the results showed that probiotic supplements for women with GDM (MD = 0.
P P P P P P
In addition, 242 participants conducted 4 studies and measured HOMA-B (Table 2)
.
The same analysis results show that probiotics have a positive effect on reducing HOMA-B (MD = 21.
80; 95% CI = 31.
92 to +11.
67; P <0.
00001)
.
When it comes to different pregnancy states, the meta results show that probiotics are also beneficial to GDM (MD = +25.
25; 95% CI = +39.
04 to +11.
47; P = 0.
0003) and healthy women (MD = +17.
74; 95% CI = +32.
66 to +2.
82; P =0.
02)
.
The dosage of probiotics has no effect on HOMA-IR and HOMA-B
.
Nine studies enrolled 582 participants and measured QUICKI (Table 2)
.
Compared with the control group, the QUICKI of the probiotic group improved (MD = 0.
01; 95% CI = 0.
00 to 0.
01; P = 0.
001)
.
The analysis results for different pregnancy conditions showed that GDM (MD = 0.
00; 95% CI = 0.
00 to 0.
01; P = 0.
03) and healthy women (MD = 0.
02; 95% CI = 0.
01 to 0.
03; P = 0.
001) compared with the control group Compared to women are slightly different
.
Considering the number of studies, only the high-dose group was meta-analyzed, and there were statistical differences between the intervention group and the placebo group
.
.
The incidence of GDM was measured in 7 studies, covering a total of 1645 participants
.
There was no statistical difference between the intervention group and the control group (RR = 1.
03; 95% CI = 0.
94 to 1.
18; P = 0.
67)
.
For different pregnant women, the same results were obtained (RR = 1.
09; 95% CI = 0.
95 to 1.
25; P = 0.
24)
.
Regarding the different durations and intervention types of probiotics, long-term interventions (RR = 1.
03; 95% CI = 0.
90 to 1.
18; P = 0.
69) and probiotic capsules (RR = 1.
05; 95% CI = 0.
92 to 1.
21; P = 0.
44 ) Did not reduce the incidence of GDM
.
.
There was no statistical difference between the intervention group and the control group (RR = 1.
03; 95% CI = 0.
94 to 1.
18; P = 0.
67)
.
For different pregnant women, the same results were obtained (RR = 1.
09; 95% CI = 0.
95 to 1.
25; P = 0.
24)
.
Regarding the different durations and intervention types of probiotics, long-term interventions (RR = 1.
03; 95% CI = 0.
90 to 1.
18; P = 0.
69) and probiotic capsules (RR = 1.
05; 95% CI = 0.
92 to 1.
21; P = 0.
44 ) Did not reduce the incidence of GDM
.
The incidence of GDM was measured in 7 studies, covering a total of 1645 participants
.
There was no statistical difference between the intervention group and the control group (RR = 1.
03; 95% CI = 0.
94 to 1.
18; P = 0.
67)
.
For different pregnant women, the same results were obtained (RR = 1.
09; 95% CI = 0.
95 to 1.
25; P = 0.
24)
.
Regarding the different durations and intervention types of probiotics, long-term interventions (RR = 1.
03; 95% CI = 0.
90 to 1.
18; P = 0.
69) and probiotic capsules (RR = 1.
05; 95% CI = 0.
92 to 1.
21; P = 0.
44 ) Did not reduce the incidence of GDM
.
After the subgroup analysis, a sensitivity analysis was performed, which produced similar results, but with higher accuracy and less heterogeneity, and most of the pooled results showed relatively stable (Table 3)
.
Most of the included studies are concentrated at the top of the funnel, which further proves that the sample size is large and this review is credible (Figure 3)
.
.
Most of the included studies are concentrated at the top of the funnel, which further proves that the sample size is large and this review is credible (Figure 3)
.
After the subgroup analysis, a sensitivity analysis was performed, which produced similar results, but with higher accuracy and less heterogeneity, and most of the pooled results showed relatively stable (Table 3)
.
Most of the included studies are concentrated at the top of the funnel, which further proves that the sample size is large and this review is credible (Figure 3)
.
Meta-analysis shows that probiotic supplements have a positive effect on increasing FPG levels, insulin levels, insulin resistance and insulin sensitivity, especially in GDM and healthy pregnant women
.
After subgroup analysis, the effect of probiotic capsules is better than probiotic yogurt, short-term intervention (≤12 weeks) seems to be more effective, and high-dose probiotics (≥10) 9 CFU) played a role in reducing FPG
.
However, probiotic supplements neither improve the levels of HbA1c and 1h and 2hOGTT, nor reduce the incidence of GDM, so probiotics may not be an ideal prevention strategy
.
.
After subgroup analysis, the effect of probiotic capsules is better than probiotic yogurt, short-term intervention (≤12 weeks) seems to be more effective, and high-dose probiotics (≥10) 9 CFU) played a role in reducing FPG
.
However, probiotic supplements neither improve the levels of HbA1c and 1h and 2hOGTT, nor reduce the incidence of GDM, so probiotics may not be an ideal prevention strategy
.
Meta-analysis shows that probiotic supplements have a positive effect on increasing FPG levels, insulin levels, insulin resistance and insulin sensitivity, especially in GDM and healthy pregnant women
.
After subgroup analysis, the effect of probiotic capsules is better than probiotic yogurt, short-term intervention (≤12 weeks) seems to be more effective, and high-dose probiotics (≥10) 9 CFU) played a role in reducing FPG
.
However, probiotic supplements neither improve the levels of HbA1c and 1h and 2hOGTT, nor reduce the incidence of GDM, so probiotics may not be an ideal prevention strategy
.
9
Although the results of this study did not show a significant effect on blood sugar control, the positive effects of probiotics are still undeniable
.
Probiotics are expected to become an adjuvant treatment strategy for diabetes
.
.
Original source:
Yu-Qing Pan, et al,Probiotic Supplements Improve Blood Glucose and Insulin Resistance/Sensitivity among Healthy and GDM Pregnant Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Evidence-Based Complementary and Alternative Medicine Volume 2021, Article ID 9830200, 17 pages
https://doi.
org/10.
1155/2021/9830200