Hypothesized mechanisms include the increase of anti-inflammatory cytokines and the reduction of vaginal pH, creating a favorable environment for the growth of healthy bacteria [2,5]. Moreover, using probiotics for pregnancy may improve maternal carbohydrate metabolism by modulating the composition and function of gut bacteria, aiding in constipation relief (Figure 1), and improving insulin sensitivity .
Insights from recent research
Jarde et al.  conducted a systematic review and meta-analysis on the risk of preterm birth and other adverse pregnancy outcomes in pregnant women using probiotics to verify these hypotheses. In this analysis, the trials also included prebiotics, which are indirect food components that stimulate the growth or activity of beneficial microorganisms.
A total of 21 studies (4,098 women) were included in the final analysis; among them, 5 studies (1,017 women) assessed the risk of preterm birth <34 weeks, while the risk <37 weeks was evaluated in 11 studies (2,484 women).
The use of probiotics for pregnancy did not reduce or increase the risk of preterm birth before 34 weeks (RR (risk ratio) 1.03; 95% CI (confidence interval): 0.29-3.64) or before 37 weeks (RR 1.08; 95% CI: 0.71-1.63). Furthermore, the authors did not observe a protective effect of probiotic supplementation for most secondary outcomes, including gestational diabetes, preterm premature rupture of membranes (PPROM), and small or large for gestational-age infants.
The only statistically significant difference regarding probiotic supplementation was related to glucose metabolism (Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). However, the synthesized estimate for gestational diabetes did not show any benefit from probiotic supplementation (RR 1.25; 95% CI 0.61-2.56).
Contrary to these results, a recent randomized controlled trial (RCT) from Greece  demonstrated the benefits of probiotic use in women with PPROM. Patients were assigned to either the vaginal administration of probiotics for 10 days combined with prophylactic antibiotic treatment (n = 59) or conventional antibiotic treatment alone (n = 57).
In women treated with the combined protocol, the average gestational age at delivery (35.49 vs. 32.53 weeks) and latency period (5.60 vs. 2.48 weeks) were significantly higher than the control group. Therefore, probiotics for pregnancy supplementation may result in a lower preterm birth rate than standard care.
A recent population-based prospective cohort study in Norway  investigated the potential association between the use of probiotic-containing milk and the rates of preterm birth and preeclampsia. The maternal inflammatory response related to preterm birth, preeclampsia, and the anti-inflammatory effects of probiotics were also criteria for evaluating their role in using probiotics for pregnancy [9, 10].
The authors found that using probiotic-containing milk in late pregnancy, but not in early or throughout pregnancy, was associated with a reduced risk of preeclampsia (OR (adjusted odds ratio): 0.80; 95% CI, 0.64-0.94). Regarding preterm birth, consuming probiotic-containing milk in early pregnancy, but not in late pregnancy or throughout pregnancy, was associated with a reduced risk of preterm birth (OR: 0.79; 95% CI, 0.64-0.97). In both cases, no dose-response relationship was found.
The hypothetical role of oral probiotics on the vaginal microenvironment during pregnancy was assessed by Gille et al.  in a randomized, triple-blind, placebo-controlled trial (RCT) conducted on 320 women. Participants received either oral probiotics or a placebo. The study’s primary outcome was the proportion of vaginal smears with a normal Nugent score (<4) after eight weeks of treatment.
Oral probiotics did not increase the rate of normal vaginal microflora compared to placebo. After intervention analysis, the rate of normal vaginal microflora decreased from 82.6 to 77.8% in the probiotic group and from 79.1 to 74.3% in the placebo group, with no significant difference between the groups (P = 0.29).
Currently, various specialized probiotics are available on the market for pregnant women. From the above research results, we can understand the important roles of probiotics for pregnancy. It addresses not only digestive issues and constipation and reduces the risk of preterm birth and preeclampsia but also has anti-inflammatory effects and supports the treatment of gynecological infections.
What LiveSpo offers?
During pregnancy, constipation can frequently occur for almost all expectant mothers. In addition to supplementing foods such as yogurt, fruits, and vegetables, pregnant women can use LiveSpo PREG-MOM probiotics (Figure 2) to improve their digestive issues. This product is safe for pregnant women and effectively treats constipation and improves appetite during pregnancy.
Benefits of LiveSpo PregMom probiotics for pregnancy
- Provides a supplement of beneficial gut bacteria for a healthy digestive system.
- It supports reducing constipation, bloating, and flatulence.
- It stimulates digestion improves appetite, and strengthens the immune system.
The clinical trial for LiveSpo PregMom has indicated its effectiveness and safety for both expectant mothers and infants. It contains 3 billion probiotic organisms in 5ml, including Bacillus Clausii, Bacillus subtilis, and Bacillus coagulans. These Bacillus probiotic strains are heat-resistant up to 80°C. Mothers can add this liquid probiotic to milk or herbal tea without compromising their effectiveness. Additionally, they are resistant to gastric acid, making it easier for them and reach the intestines.
⦁ Jarde A, Lewis-Mikhael AM, Moayyedi P, Stearns JC, Collins SM, Beyene J, et al. Pregnancy outcomes in women taking probiotics or prebiotics: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018;18:14.
⦁ Reid G, Bocking A. The potential for probiotics to prevent bacterial vaginosis and preterm labor. Am J Obstet Gynecol. 2003;189:1202–8.
⦁ Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371:75–84.
⦁ Kirihara N, Kamitomo M, Tabira T, Hashimoto T, Taniguchi H, Maeda T. Effect of probiotics on perinatal outcome in patients at high risk of preterm birth. J Obstet Gynaecol Res. 2018;44:241–7.
⦁ Reid G, Younes JA, Van der Mei HC, Gloor GB, Knight R, Busscher HJ. Microbiota restoration: natural and supplemented recovery of human microbial communities. Nat Rev Microbiol. 2011;9:27–38.
⦁ Lindsay KL, Brennan L, Kennelly MA, Maguire OC, Smith T, Curran S, et al. Impact of probiotics in women with gestational diabetes mellitus on metabolic health: a randomized controlled trial. Am J Obstet Gyneco 2015;212:496.e1
⦁ Daskalakis GJ, Karambelas AK. Vaginal probiotic Administration in the Management of preterm premature rupture of membranes. Fetal Diagn Ther. 2017;42:92–8.
⦁ Nordqvist M, Jacobsson B, Brantsæter AL, Myhre R, Nilsson S, Sengpiel V. Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway. BMJ Open. 2018;8:e018021. https://doi.org/10.1136/bmjopen-2017-018021.
⦁ Yeganegi M, Watson CS, Martins A, Kim SO, Reid G, Challis JR, et al. Effect of lactobacillus rhamnosus GR-1 supernatant and fetal sex on lipopolysaccharideinduced cytokine and prostaglandin-regulating enzymes in human placental trophoblast cells: implications for treatment of bacterial vaginosis and prevention of preterm labor. Am J Obstet Gynecol. 2009;200:532.e1–8.
⦁ Bloise E, Torricelli M, Novembri R, Borges LE, Carrarrelli P, Reis FM, et al. Heat-killed lactobacillus rhamnosus GG modulates urocortin and cytokine release in primary trophoblast cells. Placenta. 2010;31:867–72.
⦁ Gille C, Böer B, Marschal M, Urschitz MS, Heinecke V, Hund V, et al. Effect of probiotics on vaginal health in pregnancy. EFFPRO, a randomized controlled trial. Am J Obstet Gynecol. 2016;215:608.e1–7.