Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis.

2022-02
Midwifery 105

PubMed: 34890880
DOI: 10.1016/j.midw.2021.103208

Study Design

Type: Meta-Analysis
Sample size: n = 709
Population: Antenatal participants with known positive GBS colonisation or unknown GBS status.
Methods: Systematic review and meta-analysis of studies of probiotic interventions containing species of Lactobacillus or Streptococcus; six clinical trials were systematically reviewed and meta-analysed (n = 709).

Objective

To systematically review and meta-analyse studies of the efficacy of probiotics to reduce antenatal Group B Streptococcus (GBS) colonisation.

Participants

Antenatal participants with known positive GBS colonisation or unknown GBS status.

Intervention

Probiotic interventions containing species of Lactobacillus or Streptococcus.

Design

Systematic review and meta-analysis.

Measurements and findings

The systematic review included 10 studies. Five articles contained in vitro studies of probiotic interventions to determine antagonistic activity against GBS. Six clinical trials of probiotics to reduce antenatal GBS were systematically reviewed and meta-analysed. The meta-analysis revealed that the use of an antenatal probiotic decreased the probability of a positive GBS result by 44% (OR = 0.56, 95% CI = 8.7%, 194.1%, p = 0.02) (n = 709). However, only one clinical trial of 10 had a low risk of bias.

Key conclusions

The probiotic interventions subjected to in vitro testing showed antagonistic activity against GBS through the mechanisms of acidification, immune modulation, and adhesion. The findings of the meta-analysis of the clinical trials revealed that probiotics are a moderately effective intervention to reduce antenatal GBS colonisation. More well-controlled trials with diverse participants and with better elucidation of variables influencing GBS colonisation rates are needed.

Implications for practice

Probiotic interventions appear to be a safe and effective primary prevention strategy for antenatal GBS colonisation. Application of this low-risk intervention needs more study but may reduce the need for intrapartum antibiotic prophylaxis in countries or regions where antenatal GBS screening is used. Midwives can be instrumental in conducting and supporting larger well-controlled clinical trials.

Research Insights

Supplement	Dose	Health Outcome	Effect Type	Effect Size	Source
Lactobacillus salivarius CRL 1328	—	Reduced Group B Streptococcus Activity	Beneficial	Small	View source The probiotic interventions subjected to in vitro testing showed antagonistic activity against GBS through the mechanisms of acidification, immune modulation, and adhesion.
Lactobacillus salivarius CRL 1328	—	Reduced Group B Streptococcus Colonization	Beneficial	Moderate	View source The meta-analysis revealed that the use of an antenatal probiotic decreased the probability of a positive GBS result by 44% (OR = 0.56... p = 0.02) (n = 709).