by Anne Eglash MD, IBCLC, FABM
Does maternal probiotic intake alter her breastmilk? We know that breastmilk creates a healthier bacterial balance in the infant gut, and this healthier gut bacterium plays an important role in the improved health outcomes that exist in breastfeeding infants. Probiotics in breastmilk as well as the breastmilk bioactive factors help create the optimal bacterial balance in the breastfeeding infant’s gut.
Where does the healthy bacteria in breastmilk come from? It has been theorized that it comes from the mother’s skin bacteria, the infant’s mouth bacteria, and some evidence indicates that it could be coming from the maternal gut. The question is whether maternal ingestion of probiotics will alter or increase the probiotic bacteria in her breastmilk.
The Probiotics in the Prevention of Allergy among Children in Trondheim (ProPACT) study published in 2010 found that giving mothers Lactobacillus rhamnosus GG (along with a few other probiotics) during their pregnancy and postpartum was associated with increased Lactobacillus rhamnosus GG in the infant stool, and a 40% decreased risk of atopic dermatitis at age 2. The question is whether the maternal ingestion of the probiotic was most effective during pregnancy, postpartum or both.
The researchers of the study for today’s Clinical Question of the Week analyzed the milk samples from the PRoPACT study, to measure the amount of lactobacillus rhamnosus GG. This was a randomized controlled trial of 415 mothers, with ½ of the mothers receiving a probiotic beverage with lactobacillus rhamnosus GG in combination with probiotics, and the other ½ as the control group receiving a pasteurized version of the probiotic beverage, with no active probiotics.
What do you think the researchers found, regarding transmission of lactobacillus rhamnosus GG into the breastmilk after maternal ingestion? Choose just 1 answer:
- The mothers with the active probiotic drink had more lactobacillus rhamnosus GG in their breastmilk, and these mothers had a lower risk of having an infant with atopic dermatitis.
- The placebo mothers had a high amount of lactobacillus rhamnosus GG in their breastmilk, similar to the mothers with the active probiotic drink.
- Nearly none of the mothers, no matter if given active probiotic drink or not, had lactobacillus rhamnosus GG in their breastmilk.
See the Answer
Answer: C
Breastfeeding-associated microbiota in human milk following supplementation with Lactobacillus rhamnosus GG, Lactobacillus acidophilus La-5, and Bifidobacterium animalis ssp. lactis Bb-12.
Simpson MR, Avershina E, Storrø O, Johnsen R, Rudi K, Øien T
Breastfeeding is one of the major factors affecting the early development of the infant gut microbiota, and weaning is associated with a shift in the gut microbiota toward a more adult composition. Through breastfeeding, infants receive bioactive components that shape their microbiota while also being exposed to the breast milk and breast surface microbial communities. Recent studies have suggested the possibility of an entero-mammary route of microbial transfer, opening the possibility of infant gut microbiota modulation through maternal probiotic supplementation. In this study, we have analyzed breast milk samples collected at 10 d and 3 mo postpartum from women participating in the Probiotics in the Prevention of Allergy among Children in Trondheim placebo controlled trial. Women who were randomized to the probiotic arm of the Probiotics in the Prevention of Allergy among Children in Trondheim trial received a fermented milk supplemented with Lactobacillus rhamnosus GG, Lactobacillus acidophilus La-5, and Bifidobacterium animalis ssp. lactis Bb-12, consuming this daily from 4 wk before their expected due date until 3 mo after birth. In total, 472 breast milk samples were assessed for the administered bacteria using quantitative real-time PCR and the microbiota transferred during breastfeeding was analyzed using 16S ribosomal RNA gene sequencing of 142 samples. We found that breastfeeding is unlikely to be a significant source of L. rhamnosus GG, L. acidophilus La-5, and B. animalis ssp. lactis Bb-12 for infants in the probiotic arm of the trial. Furthermore, maternal supplementation did not significantly affect the overall composition of the breast milk microbiota transferred during breastfeeding. We also present a descriptive analysis of this microbiota, which was largely dominated by Streptococcus and Staphylococcus genera at both 10 d and 3 mo postpartum. Samples collected at 3 mo postpartum had a statistically significant lower presence and relative abundance of the Staphylococcus genus. These samples also had a greater number of observed species and diversity, including more operational taxonomic units from the Rothia, Veillonella, Granulicatella, and Methylbacterium genera.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Probiotics are certainly a big business, and products for the breastfeeding mama abound, claiming evidence that the magic pills will supercharge breastmilk in its quest to establish the optimal infant gut microbiota. The question is whether probiotics taken during pregnancy have a greater effect on infant health as compared to probiotics taken during lactation. This study showed that infants had a markedly decreased risk of atopic dermatitis by age 2 if their mothers consumed probiotics during pregnancy and postpartum, but in reality, very little of this probiotic was found in the breastmilk. The infants with the presence of the probiotics in their stool had less atopic dermatitis, so it may have been the fetal exposure to the probiotics, and contact with maternal gut bacteria during birth that may have colonized the infant gut with the probiotics.
For now there is not convincing evidence that maternal ingestion of probiotics solely during breastfeeding will benefit or alter her infant’s health.
Lynn Apple
Interesting to read. What seems important and not defined is percentage of children age 2 have contact dermatitis and of those children with dermatitis what percentage received artificial milk before 6 months and before 12 months. I suspect the percentage of exclusively breast fed children have a very low percentage of drmatitis irregardless of probitics.