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Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and

Meghan B Azad1, J Gerard Coneys, Anita L Kozyrskyj

  • 1Department of Pediatrics, University of Alberta, Edmonton, AB, Canada T6G 1C9.

BMJ (Clinical Research Ed.)
|December 6, 2013
PubMed

Insights

Perinatal probiotic use showed no evidence of protecting against childhood asthma or wheeze. More research is needed to determine if probiotics can prevent these conditions.

Area of Science:

  • Pediatric Allergy and Immunology
  • Microbiome Research
  • Preventive Medicine

Background:

  • Childhood asthma and wheeze are significant public health concerns.
  • The role of the gut microbiome in immune development is an area of active research.
  • Probiotics are microorganisms purported to confer health benefits, including immune modulation.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) assessing the association between probiotic supplementation during pregnancy or infancy and the development of childhood asthma and wheeze.
  • To evaluate the effect of probiotics on lower respiratory tract infections as a secondary outcome.

Main Methods:

  • A systematic review and meta-analysis of RCTs were conducted.
  • Searches included Medline, Embase, and Central databases up to August 2013, supplemented by clinical trial registries and conference proceedings.
  • Two independent reviewers identified trials where probiotics were administered to mothers during pregnancy or infants in the first year of life, with doctor-diagnosed asthma as the primary outcome.

Main Results:

  • Twenty eligible trials involving 4866 children were included, exhibiting heterogeneity in probiotic type, duration, and follow-up.
  • No significant association was found between probiotic supplementation and the risk of doctor-diagnosed asthma (Risk Ratio: 0.99, 95% CI: 0.81-1.21) or incident wheeze (Risk Ratio: 0.97, 95% CI: 0.87-1.09).
  • A potential increase in lower respiratory tract infections was observed (Risk Ratio: 1.26, 95% CI: 0.99-1.61), though most trials had a high or unclear risk of bias.

Conclusions:

  • Current evidence does not support a protective effect of perinatal probiotic use against childhood asthma or wheeze.
  • Existing RCTs lack sufficient power and long-term follow-up to recommend probiotics for primary prevention of these conditions.
  • Further research, including extended follow-up of existing trials and basic science investigations, is necessary to clarify the role of probiotics.
Abstract

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