Original Articles: Brief Communication
Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant,☆☆

https://doi.org/10.1067/mai.2002.120273Get rights and content

Abstract

The prevalence of atopic diseases is increasing throughout the Western world, and means of primary prevention are needed to reverse this trend. The role of breast-feeding, the best source of infant nutrition, in protection against atopic disease remains elusive. In this double-blinded, placebo-controlled study of 62 mother-infant pairs, it is shown that administering probiotics to the pregnant and lactating mother increased the immunoprotective potential of breast milk, as assessed by the amount of anti-inflammatory transforming growth factor β2 (TGF-β2) in the milk (2885 pg/mL [95% CI, 1624-4146] in mothers receiving probiotics vs 1340 pg/mL [95% CI, 978-1702] in mothers receiving placebo; P = .018). The risk of developing atopic eczema during the first 2 years of life in infants whose mothers received probiotics was significantly reduced in comparison with that in infants whose mothers received placebo (15% and 47%, respectively; relative risk, 0.32 [95% CI, 0.12-0.85]; P = .0098). Maternal atopy was a clear risk factor for atopic eczema in the infant. The infants most likely to benefit from maternal probiotic supplementation were those with an elevated cord blood IgE concentration. Administering probiotics during pregnancy and breast-feeding thus offers a safe and effective mode of promoting the immunoprotective potential of breast-feeding and provides protection against atopic eczema during the first 2 years of life. (J Allergy Clin Immunol 2002;109:119-21.)

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Subjects and methods

This study was conducted as a part of a double-blinded, placebo-controlled trial evaluating the preventive potential of probiotics in allergy, as described in detail elsewhere.6 In all, 159 pregnant women from atopic families were randomized to receive either Lactobacillus rhamnosus strain GG (ATCC 53103; daily dose, 2 × 1010 colony forming units; Valio Ltd, Helsinki, Finland), or placebo (microcrystalline cellulose; Valio Ltd) during the 4 weeks before giving birth (mean, 28 days; 95% CI,

Results

The infants born to mothers receiving probiotics and those born to mothers receiving placebo were comparable with respect to mode of delivery, maternal atopic disease, and whether there were older siblings in the family, as well as mean duration of exclusive and total breast-feeding (Table I).

The concentration of TGF-β2 in the breast milk of mothers receiving probiotics was higher (2885 pg/mL [95% CI, 1624-4146]) than that in the breast milk of mothers receiving placebo (1340 pg/mL [95% CI,

Discussion

Probiotics were shown here to confer protection from atopic eczema for the infant when administered to the mother before delivery and during breast-feeding. Infants with an elevated cord blood IgE concentration, considered to reflect atopic sensitization in utero, were most likely to benefit from these agents, inasmuch as probiotics increased the amount of TGF-β2 in breast milk. This suggests that probiotics exert their effect on the early immunologic mechanisms involved in the development of

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Supported by the Academy of Finland.

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Reprint requests: Samuli Rautava, MD, Department of Paediatrics, University of Turku, PO Box 52, FIN-20521, Turku, Finland.

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