Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis.
Lisa Hanson, Leona VandeVusse, Emily Malloy and 6 others
PMID 34890880WHAT IT FOUND
Pooled trials found oral probiotics lowered the chance of testing positive for Group B strep at 36 weeks, but only one trial was significant and most were small.
Do not replace screening or antibiotics.
Key findings
01The pooled analysis of six clinical trials found probiotics significantly decreased the likelihood of a positive GBS test.
02The evidence was limited because only one included clinical trial had low risk of bias and only one had a statistically significant GBS outcome.
03In the double-blind randomized trial, 36-week GBS positivity was 9 of 57 in the probiotic group and 12 of 56 in the placebo group, with no significant difference.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 10 articles were chosen and 6 clinical trials were meta-analysed, with 709 participants total. Only one clinical trial had low risk of bias, and several studies were small, unblinded, or used different probiotic strains and doses. Adherence was not reported in several trials, and some trials did not collect baseline GBS status. Race, ethnicity, diet, infection, and antibiotic use were inconsistently reported, and some control groups were confounded. One trial used vaginal-only swabs rather than vaginal-rectal swabs, which may miss the rectal GBS reservoir. One study reported reduced GBS without a p value or statistical analysis.
Declared interests
Review authors Lisa Hanson, Leona VandeVusse and Nasia Safdar conducted the 2014 open-label quasi experiment with pilot funding and probiotic product provided by American Lifelines, the maker of Florajen3. American Lifelines also supplied Florajen3 and placebo capsules for Hanson's NIH funded RCT and Florajen Digestion for the open-label quasi experiment. The company reported that it had no input into design, conduct, analysis or dissemination.
The easy way to misread this
Do not conclude probiotics are proven to reduce GBS colonization or can replace standard screening and intrapartum antibiotics. The pooled positive result came from six small mixed-quality trials, only one had low risk of bias, and the double-blind randomized trial did not show a significant difference in 36-week GBS positivity.