The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review

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TL;DR

This narrative review examines the role of prebiotic supplementation during pregnancy and lactation as a safe, cost-effective strategy to modulate maternal and infant gut microbiota. The evidence suggests prebiotics may help prevent or manage pregnancy complications such as gestational diabetes, obesity, and preeclampsia, while also potentially reducing the risk of pediatric disorders including asthma, allergies, and atopic dermatitis. However, the authors conclude that current evidence is limited and heterogeneous, and more robust long-term clinical trials are needed before clear clinical recommendations can be made.

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**Background:** Pregnancy involves significant metabolic, endocrine, and gut microbiota changes. The gut microbiota shifts between the first and third trimesters, with increased Proteobacteria and Actinobacteria and decreased bacterial diversity. Nutritional interventions, particularly prebiotics, represent a feasible and cost-effective adjuvant strategy to address these changes and improve outcomes for both mother and offspring. Prebiotics are defined by ISAPP as dietary components with complex carbohydrates that are selectively utilized by host microorganisms, conferring health benefits. They include fructans (FOS, inulin), galactooligosaccharides (GOS), resistant starch, pectin-derived oligosaccharides, and non-carbohydrate oligosaccharides such as polyphenols. This narrative review aims to describe available evidence from the last 10 years on prebiotic use in pregnancy and develop useful clinical guidelines.

**Methods:** This was a narrative review using the PubMed database exclusively. The search criteria were "prebiotics" [AND] "pregnancy", yielding 265 publications. Filters applied included full text availability and article types: books and documents, meta-analyses, reviews, systematic reviews, clinical trials, and randomized controlled trials. After screening, 72 articles were assessed, with 5 excluded for not relating to pregnancy, 1 for being animal production research, 1 for not mentioning prebiotics in the text, and 1 systematic review from 2012 discarded for containing older empirical articles. The final integrative count was 64 articles, with the oldest from 2013. An additional 9 articles were added for conceptualization in the Introduction and other sections, bringing the final total to 73 articles.

**Key Results:** For healthy pregnancy, a randomized double-blind placebo-controlled trial with maternal FOS intake during the third trimester showed a significant increase in fecal Bifidobacterium spp. and Bifidobacterium longum in the intervention group. Another RCT found that synbiotics containing Lactobacillus sporogenes and inulin significantly lowered serum insulin levels compared to controls over 9 weeks. A meta-analysis confirmed that adverse effects from pro- and prebiotic use during pregnancy and lactation were rare and typically limited to changes in stool consistency, with no serious risks to mother or child. For gestational diabetes, a meta-analysis by Zhou et al. demonstrated that synbiotic intervention significantly improved glucose and lipid metabolism, had anti-inflammatory and antioxidant effects, and reduced risks of fetal hyperbilirubinemia, fetal macrosomia, and newborn weight. However, Łagowska et al. found similar benefits from probiotics alone, suggesting not all Lactobacillus and Bifidobacterium strains can ferment certain prebiotics. For hypertension and preeclampsia, Movaghar et al. found no notable benefits from probiotics or synbiotics in women with hypertensive disorders, though limited studies were available. For bacterial vaginosis, systematic reviews found pre/probiotic regimens had even higher cure rates than antibiotics. For perinatal mental health, systematic reviews reported limited evidence of lower incidence of anxiety and depressive symptoms with pro-, pre-, and synbiotic supplementation during pregnancy. For pediatric outcomes, a randomized controlled trial administering a specific prebiotic mixture from birth found supplemented groups had more fecal bifidobacteria and lactobacilli at 3, 6, and 12 months, with differences maintained six months after supplementation stopped. For asthma and allergy prevention, a meta-analysis of two studies with 249 infants reported reduced infant asthma or recurrent wheeze in prebiotic-treated infants, and one study reported significantly reduced food allergy risk. However, the World Allergy Organization review found insufficient evidence to support prebiotic use during pregnancy for allergy prevention. For skin maladies, a systematic review and meta-analysis of 10 intervention trials with 4242 participants showed no clear evidence that prebiotic supplementation reduces eczema at age ≤4 years, though maternal supplementation may be more appropriate than infant supplementation.

**Clinical Implications:** The review concludes that maternal nutritional status is critical for early microbial colonization in newborns, and prebiotics are feasible, cost-effective elements that can be added to infant diets through supplemented milk or breast milk from supplemented mothers. The combination of prebiotics and probiotics is necessary for proper infant gut microbiota colonization. However, the authors emphasize that in healthy women, preference should be given to healthy dietary patterns (e.g., Mediterranean diet) rich in natural prebiotics, with supplementation reserved for when dietary requirements cannot be met. Major limitations include the paucity of data, heterogeneity in study designs, and the need for long-term studies from newborn through adolescence. The authors advocate for integrative therapies including nutritionists in pregnancy management and note that future research should focus on optimizing synbiotic combinations and identifying which patient groups benefit most.