Clinical trials of this probiotic as an accompanying treatment for pre-term premature rupture of membranes (PPROM) alongside antibiotics resulted in an extended period of time between exposure to the pathogen and when symptoms first appear.
As a result the baby’s gestational age was prolonged by three weeks, contributing to the increased birth weight when compared to the control group.
PPROM is considered the cause for almost one third of pre-term deliveries and the risk of complications such as cord compression, respiratory distress syndrome and even neonatal death increases following PPROM. Textbook treatment involves the administration of glucocorticoids and antibiotics to PPROM cases before 34 weeks.
In this study a blend of Lactobacillus rhamnosus and L. gasseri at 1x108 Colony Forming Units (CFU) contained within the 'Ecovag'-branded capsule, showed a significant reduction in antibiotic side-effects.
Antibiotic use has been linked to the perturbation of normal vaginal microbiota and the possible overgrowth of virulent microorganisms, which increases the risk of infection.
The research team, based at the National and Kapodistrian University of Athens in Greece conducted a randomised trial of cases with PPROM (24–34 weeks) that were admitted to the hospital’s department between 2011 and 2015.
49 cases received vaginal probiotics for 10 days in combination with antibiotic prophylaxis and were compared to 57 others that received only antibiotics for the same time period.
Results showed that the mean gestational age at birth (35.49 vs. 32.53 weeks), the mean duration of the latency period (5.60 vs. 2.48 weeks), and the mean birth weight (2,439.08 vs. 2,004.81 g) were significantly higher in the study group in comparison to the controls.
The association between the presence of lactobacilli and the protection from infections is not completely understood, according to Dr George Daskalakis of the Alexandra Maternity Hospital at the National and Kapodistrian University of Athens in Greece.
Lactobacilli and gut protection
One explanation has pointed to lactobacilli as responsible for creating a hostile environment that prevents genital tract infections to thrive. It does this by reducing the vaginal pH from the metabolism of the mucosal glycogen and the production of lactic acid.
In addition, the lactobacilli may compete for nutrients with other potentially harmful microorganisms, which are also eliminated by the secretion of antibacterial substances.
“PPROM is responsible for one third of all preterm deliveries worldwide,” said Daskalakis. “Based on the clinical data, we believe that probiotics can be used as an adjunct to antibiotics or following antibiotics in PPROM cases, as they may restore the vaginal microbiota and thus prolong pregnancy."
"What seems to be promising is that this specific Lactobacilli strains given trans-vaginally can prolong the latency period after PPROM.”
There are a number of studies that show that probiotics may have beneficial effects on pregnancy outcome by reducing the risk of gestational diabetes and preeclampsia and by improving infant immunity.
A recent Cochrane review concluded that while the effectiveness of probiotics for the prevention of prematurity was not conclusive, the transvaginal use of probiotics reduced the risk of genital infections by 81%.
“Evidence is increasing that a healthy vaginal microbiota contributes positively to conception and to overall pregnancy health,” said Erik Brandsborg, chief scientific officer at Ecovag manufacturer, Bifodan.
Source: Fetal Diagnosis and Therapy
Published online ahead of print, DOI: 10.1159/000450995
'Vaginal Probiotic Administration in the Management of Preterm Premature Rupture of Membranes.'
Authors: George Daskalakis, Alexis Karambelas