120 Med J Indones, Vol. 24, No. 2 June 2015 Review Article The status of probiotics supplementation during pregnancy Noroyono Wibowo,1 Johanes C. Mose,2 Made K. Karkata,3 Bangun T. Purwaka,4 Herman Kristanto,5 Maisuri T. Chalid,6 Yusrawati,7 Makmur Sitepu,8 Juneke J. Kaeng,9 Nuswil Bernolian,10 Damar Pramusinto,1 Rima Irwinda1 1 Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia 2 Department of Obstetric and Gynecology, Faculty of Medicine, Padjajaran University, Bandung, Indonesia 3 Department of Obstetric and Gynecology, Faculty of Medicine, Udayana University, Bali, Indonesia 4 Department of Obstetric and Gynecology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia 5 Department of Obstetric and Gynecology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia 6 Department of Obstetric and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia 7 Department of Obstetric and Gynecology, Faculty of Medicine, Andalas University, Padang, Indonesia 8 Department of Obstetric and Gynecology, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia 9 Department of Obstetric and Gynecology, Faculty of Medicine, Sam Ratulangi University, Medan, Indonesia 10 Department of Obstetric and Gynecology, Faculty of Medicine, Sriwijaya University, Palembang, Indonesia ABSTRAK ABSTRACT Probiotik telah sejak lama diketahui fungsinya dalam dunia Probiotics have been known for their use in medical field for medis. Salah satu aplikasinya adalah penggunaan probiotik quite a long time. Strong evidences are now available for the selama kehamilan. Studi terbaru menunjukkan bahwa use of probiotics in clinical setting. One of the current issues suplementasi probiotik prenatal dinilai aman dan berguna. on this topic is the use of probiotics in pregnancy. Recent Pada review ini, kami menyorot fungsi probiotik pada ibu hamil. studies showed that probiotics may be safe and beneficial Beberapa strain probiotik terbukti mampu mencegah kelahiran for prenatal supplementation. In this review, we highlighted prematur dan preeklampsia pada ibu yang mendapatkan several proven use of probiotics supplementation in suplementasi prenatal, mengurangi kemungkinan dermatitis pregnant women. A few selected strains of probiotics atopi meski tidak mampu mencegah kejadian asma dan showed promising outcome to prevent preterm labor and sesak. Mekanisme yang terkait dengan fungsi ini masih belum preeclampsia, and to reduce atopic eczema but not asthma diketahui secara pasti, namun diperkirakan sangat berkaitan and wheezing, in offspring of women who had prenatal dengan regulasi sel T. probiotics supplementation. The mechanism of action responsible for this effect is closely related to the regulation of T cells, although the exact pathways are not defined yet. Keywords: preeclampsia, pregnancy, probiotics, prenatal supplementation, preterm labor pISSN: 0853-1773 • eISSN: 2252-8083 • http://dx.doi.org/10.13181/mji.v24i2.1223 • Med J Indones. 2015;24:120-30 • Received 21 Mar 2015 • Accepted 18 Jun 2015 Correspondence author: Noroyono Wibowo, [email protected] Copyright @ 2015 Authors. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 International License (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are properly cited. Medical Journal of Indonesia Wibowo, et al. 121 Probiotics supplementations in pregnancy The role of microorganisms in food has been useful metabolites or enzymes, enhancement of mucosal function, and modulation of host the role of microorganism in food spoiling was immune responses.8,9 A.known Kircher, for a longin 1658, time. Thewho first examined person todecaying suggest bodies, meat, milk, and other substances and said the process was caused by “worms” invisible to include a preventive or therapeutic action of the naked eye.1 But it was not until 1837 that L. probiotics.Some modern Charteris, definitions et al10 on probiotics Pasteur showed that microorganisms caused the ‘microorganisms, which, when ingested, may have a positive effect in the prevention defined and probiotics treatment as prevent food from spoiling.1 souring of milk and used heat for the first time to have also been found to be effective in treatment Today, the established roles of microorganisms of a severalspecific pathologicgastrointestinal condition’. disorder Since probioticssuch as in food can be divided into three groups2,3 (1) acute infectious diarrhea,11 antibiotic-associated pathogenic microorganisms that cause infection or diarrhea,12 and irritable bowel syndrome,13 they food poisoning, (2) saprophytic microorganisms are also considered as therapeutic agents.14 that play role in biodegradation and food spoiling, Probiotics are also associated with risk reduction in developing atopic sensitization in children,15 fermentation process and to maintain healthy lower incidence of gestational diabetes mellitus16 digestiveand (3) tract.beneficial4 microorganisms used in and preeclampsia,17 and fewer case of necrotizing enterocolitis in preterm infants18, if given during prenatal period. named probiotic. The original observation of the roleAmong of probioticsthe beneficial to promote microorganisms human health is a group was Despite the common mechanism of actions underwent by a Russian scientist Eli Metchnikoff, who suggested that “The dependence of the 19 One strain of intestinal microbes on the food makes it possible probioticproposed, canthe havebeneficial different effects clinical of probioticseffect to avary certain and candisease, be strain-specific. compared to other strain of bodies and to replace the harmful microbes by probiotics. For example, a study by Wagner, et usefulto adopt microbes” measures in 1907. to modify5 the flora in our al20 found that four different strains of probiotics The number of microbes along human digestive immune effect in preventing colonization and tract is tremendous, sizing up to 100 trillion sepsisshowed with different Candida efficacy albicans and in great mice. diversity Therefore, of microorganisms.6 These microbes are of distinct generalization of probiotics effects without solid evidence should be avoided. different type, from 56 phenotypes in mouth tophenotypes 195 in colon. and Theyeach arespecific responsible site can to breakcarry This literature review is aimed to address the down ingested polysaccharides, including the indigestible plant-derived pectin.7 possible benefits of probiotics and to recommend In 2001, World Health Organization/Food and Definitiontheir usage in the field of obstetric. Agriculture Organization of the United Nations and Stillwell21 in 1965 to describe ‘substances microorganisms which when administered in secretedThe term by probiotic one microorganism was first introduced which stimulates by Lilly (WHO/FAO) defined probiotics as “living 22 the host”.8 Probiotics consist of yeast or bacteria, highlighted that probiotics were living matter especiallyadequate amountslactic acid confer bacteria. a health4,9 The mostbenefit well- on bythe describinggrowth ofthem another’. as ‘a living In 1989,microbial Fuller food known members of this group are Lactobacillus, Bifidobacterium and Streptococcus. They supplement which beneficially affects the host against acid and bile, ability to colonize the possibleanimal bypreventive improving or therapeuticits microbial effect balance’. for the exhibit strain-specific differences on resistance9 hostNewer because definitions recent of publicationsprobiotics includestated thatthe The possible mechanism of actions includes probiotics are proven to be effective in treating inhibitiongastrointestinal of pathogenic tract andbacteria, clinical production efficacy. of gastrointestinal disorders.10 Medical Journal of Indonesia 122 Med J Indones, Vol. 24, No. 2 June 2015 Other terms that are closely related to probiotics strengthening the gut epithelial barrier, and are prebiotics and synbiotics. Prebiotics are modulation of the immune system.28 indigestible food ingredient that are advantageous to the host by selectively promote the growth or Lactobacillus can modulate the regulation of genes 23 Meanwhile, encoding adherence junction protein, such as: synbiotic is the combination of prebiotics and probioticsactivity of beneficialdesigned entericto improve bacteria. the survival of phosphorylation of adherence junction proteins.28 ingested microorganisms and the colonization of LactobacillusE-cadherin and casei β-catenin, exhibited while an alsoability influence to restore the the intestinal tract.24 mucosal integrity by enhancing expression and redistributing tight junction proteins of To be considered as probiotics, microorganisms the zonula occludens and protein kinase C. have to own several characteristics. They must be resistant to gastric acid and bile, safe and by Lactobacillus rhamnosus GG demonstrated 5, and have the anti-apoptoticTwo isolated activityand purified and therefore peptide limitsecreted the ability to colonize the intestinal tract and ward epithelial damage.28 Another mechanism is the offconfer the health pathogenic benefit forbacteria. the host25 Furthermore, ability to promote mucous secretion to improve any probiotics must be able to endure the barrier by increasing mucin production mediated manufacturing process