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

Authors

Lisa Hanson, Klein Endowed Professor and Associate Director, Marquette University College of Nursing, Midwifery Program, Milwaukee, WI USA. Electronic address: lisa.hanson@mu.edu.
Leona VandeVusse, Associate Professor Emerita, Marquette University College of Nursing Milwaukee, WI USA.
Emily Malloy, Advocate Aurora HealthFollow
Mauricio Garnier-Villarreal, Assistant Professor, Sociology department, Vrije Universiteit Amsterdam.
Lauren Watson, Laboratory Manager, UW Madison School of Medicine and Infectious Disease, Madison, WI, USA.
Alissa Fial, Research & Instruction Services, Associate Librarian, Raynor Memorial Libraries, Marquette University, Milwaukee, WI, USA.
Marie Forgie, Advocate Aurora HealthFollow
Katrina Nardini, Associate Chief, Midwifery Division, University of New Mexico Health Sciences Center, Department of Obstetrics and Gynecology, Albuquerque, New Mexico, USA.
Nasia Safdar, Professor, Infectious Disease, UW Madison School of Medicine. Madison WI, USA.

Recommended Citation

Hanson L, VandeVusse L, Malloy E, et al. Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis. Midwifery. 2022;105:103208. doi:10.1016/j.midw.2021.103208

Affiliations

Advocate Aurora Women's Health Care

Abstract

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 increased the probability of a negative GBS result by 79% (OR = 0.56, 95% CI = 8.7%, 194.1%, p = 0.02) (n = 709). However, only one clinical trial of 6 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.

Type

Article

PubMed ID

34890880