TY - JOUR
T1 - Probiotic interventions to reduce antepartum Group B streptococcus colonization
T2 - A systematic review and meta-analysis
AU - Hanson, Lisa
AU - VandeVusse, Leona
AU - Malloy, Emily
AU - Garnier-Villarreal, Mauricio
AU - Watson, Lauren
AU - Fial, Alissa
AU - Forgie, Marie
AU - Nardini, Katrina
AU - Safdar, Nasia
N1 - Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
KW - Antenatal
KW - GBS
KW - in vitro, Systematic Review, Meta-analysis
KW - Probiotics
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U2 - 10.1016/j.midw.2021.103208
DO - 10.1016/j.midw.2021.103208
M3 - Article
AN - SCOPUS:85120689046
SN - 0266-6138
VL - 105
SP - 1
EP - 13
JO - Midwifery
JF - Midwifery
M1 - 103208
ER -