Henci (and any others they may be able to shed light)-

I am a doula currently working on my bachelor's in nursing to eventually become a CNM and attend homebirths after my indentured servitude is up. I would like to know if there is any valid data (studies or clinical trials) that show that probiotic supplementation through the diet or using probiotic preparations directly on or in the vagina will prevent GBS colonization. I read blogs about stillbirth often because it is what I most fear about becoming a midwife and there seems to be some evidence that 4-10 percent of unexplained stillbirth may actually be caused by intrauterine infections caused by GBS.

In my reading of these blogs I came across a particularly well educated woman with a science background of some kind that was pregnant after stillbirth. An intrauterine GBS infection with an intact bag of waters played a role in the death of her baby and she and her doctor had layed out a plan to do monthly GBS tests throughout the pregnancy, treating with antibiotics anytime GBS was detected. Another person commented that the antibiotics may cause the GBS colonization to worsen and suggested a daily intake of probiotic foods and/or a probiotic supplement to prevent colonization.

To this suggestion the pregnant woman replied that there was no evidence that probiotics could help suppress GBS colonization and that the commenter was mistaken. The commenter posted back with a few different Pubmed abstracts that related to GBS suppression with different applications of probiotics. I will post a link to this whole discussion (I found it interesting). What I'm wondering is if it is yet known scientifically whether or not probiotics will actually prevent or suppress GBS colonization. The pregnant woman with a science background did not seem to think that any of the studies showed probiotics could be beneficial in this application. Here is a link to the site where I read about all of this. I thank anyone who can shed some light on this for me. I will suggest daily probiotic use to all my pregnant clients if this is the case.

http://www.glowinthewoods.com/home/2008/7/8/pubmed-says-gbs-infection-in-pregnancy.html

I have not searched out any research on the effectiveness of probiotics, but my understanding of probiotics is that they can help maintain and restore the normal harmless and beneficial flora and fauna that are indiscriminately killed off by antibiotics, not that they have any antibacterial effect themselves. In women who are given antibiotics, such as GBS + women, they are useful for preventing problems such as thrush, a yeast infection that can, for example, inflame nipples and the baby's mouth, wreaking havoc with breastfeeding.

-- Henci

Henci and others- Here are some abstracts from studies listed in PubMed relating to probiotics and pathogens in the urogenital tract. If anyone has the time to read through the study texts, I would appreciate knowing your different interpretations of them.

Fatih Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Ankara.

Neonatal group B streptococcal (GBS) infections are one of the important health problems because of their high mortality and morbidity rates in certain countries. There are some preventive approaches, including perinatal antibiotic therapy against these infections. Recently, vaccination with conjugated GBS polysaccharides has also been practised. In this study, the in vitro inhibitory effects of 51 lactobacilli (of them 50 were purified from vaginal swabs, 1 from a commercial vaginal tablet) on five GBS (4 clinical isolates and 1 standard strain) were investigated by sandwich plate technique and deferred antagonism well technique. Ten clinical isolates (20%) and the drug-purified Lactobacilli expressed pronounced inhibitory effects on growth of GBS. All of the inhibitory isolates and 10 randomly selected non-inhibitory isolates were identified by API 50CHL kit (BioMeriéx, France). Seven (70%) of the inhibitory clinical isolates were Lactobacillus rhamnosus. The inhibitory isolates had higher acid production than the non-inhibitory ones (p < 0.05), and pH-adjustment destroyed their inhibitory effects entirely. If these results could be applied in vivo, it could be postulated that administration of certain lactobacilli as probiotics via an appropriate regimen may be a safe, physiological and cheaper alternative for prevention of neonatal GBS infections.

PMID: 15900833 [PubMed - indexed for MEDLINE]

Rönnqvist PD, Forsgren-Brusk UB, Grahn-Håkansson EE.

Department of Clinical Bacteriology, Umeå University, Sweden. daniel.ronnqvist@essum.se

BACKGROUND: The relationship between lactobacilli and other microbes and the association with vaginal pH in the female genital tract were examined. The study also included evaluation of the possibility of supplying probiotics to the genital tract by using panty liners impregnated with the probiotic strain Lactobacillus plantarum LB931. METHODS: This was a randomized, placebo-controlled, double-blind, multicenter study involving 191 healthy fertile women. Specified microbes were counted and vaginal pH was measured once a month for five consecutive months. RESULTS: Major individual variations in the genital microflora composition and the vaginal pH were found among the women. The number of lactobacilli was significantly related to vaginal pH (p<0.001) and approximately 70% of the women were permanent carriers of individual lactobacilli strains. Women with high numbers of lactobacilli were less prevalent with Group B streptococci than women with low numbers (p=0.036), and these women had a lower mean vaginal pH. The number of lactobacilli also correlated with the prevalence of yeast. LB931 could be found in 86% of the labial samples and 54% of the vaginal samples. CONCLUSIONS: High numbers of lactobacilli may contribute to a low vaginal pH and seem to have a negative influence on Group B streptococci. LB931 could be transferred from the panty liners to both the vagina and the labial fold.

PMID: 16752267 [PubMed - indexed for MEDLINE]

Reid G, Charbonneau D, Erb J, Kochanowski B, Beuerman D, Poehner R, Bruce AW.

Lawson Health Research Institute, Canadian Research and Development Center for Probiotics, 268 Grosvenor Street, London, ON, Canada N6A 4V2. gregor@uwo.ca

Urogenital infections afflict an estimated one billion people each year. The size of this problem and the increased prevalence of multi-drug resistant pathogens make it imperative that alternative remedies be found. A randomized, placebo-controlled trial of 64 healthy women given daily oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 for 60 days showed no adverse effects. Microscopy analysis showed restoration from asymptomatic bacterial vaginosis microflora to a normal lactobacilli colonized microflora in 37% women during lactobacilli treatment compared to 13% on placebo (P=0.02). Lactobacilli were detected in more women in the lactobacilli-treated group than in the placebo group at 28 day (P=0.08) and 60 day (P=0.05) test points. Culture findings confirmed a significant increase in vaginal lactobacilli at day 28 and 60, a significant depletion in yeast at day 28 and a significant reduction in coliforms at day 28, 60 and 90 for lactobacilli-treated subjects versus controls. The combination of probiotic L. rhamnosus GR-1 and L. fermentum RC-14 is not only safe for daily use in healthy women, but it can reduce colonization of the vagina by potential pathogenic bacteria and yeast.

PMID: 12628548 [PubMed - indexed for MEDLINE]

I realize these studies do not say definitively that probiotics DO help prevent GBS infections, but they do say that they might. Considering that probiotics are not harmful (as far as I know) adding them as a preventitive measure may be of some benefit. What do all of you think?

The abstracts for these studies sound intriguing. I have not heard of any harm of probiotics (anyone who has, please chime in!), so I don't see any reason not to try probiotics as a preventive measure. The best that can happen is that they knock out GBS and a woman who would have been positive for GBS tests negative. At worst, they can help maintain/restore the normal bacterial population if a woman has IV antibiotics in labor for GBS colonization. It's a win both ways.

-- Henci    

Well, GBS comes and goes, so your experience doesn't constitute evidence in the formal sense of the word. Still, the bottom line is that so far as I know, probiotics don't hurt, and you may be an example that they might help.

-- Henci

is there any probiotic in particular that you would recommend taking?  my 3rd daughter died after 22 hours, having contracted group B strep from me during labour and if probiotics might help with the colonisation I would like to try them before getting pregnant again.

I am so sorry that this tragedy has touched your life. I cannot make any specific recommendations, but I am sure that someone in your community can help you choose a brand if you would like to try them. Remember, though, that GBS is a silent infection that comes and goes, so getting rid of it at some point before or during pregnancy will not necessarily solve the problem. That is why giving antibiotics during pregnancy is not protective, although it would seem to be the logical solution. The organism lives in the lower digestive tract and colonizes the lower vagina. Prevention measures would therefore also include good bathroom hygiene: always wipe from front to back, and (pardon my frankness) if a couple engages in anal sex, do not enter the vagina once the penis has been in the rectum.

-- Henci

I'm freaking out! I'm so sorry to hear about your daughter :( my condolensces! I am 39 weeks pregnant and am GBX positive.  My ob mentioned while she was doing an internal, that "she's stripping the membranes" i had no idea what this meant, and did some research this morning. IT seems that its recommended to not strip the membranes in a woman who is gbs+.  Were you put on antibiotics during your labor with your 3rd daughter? I just read that stripping the membranes, and doing internals may cause infection to go into the womb......

You may not hear a response from "Janey." Her post was written in March 2009.

Please do not be anxious! If you have tested positive for Group B strep, you should be receiving antibiotics in labor, a routine precautionary practice that almost completely eliminates the chance of your baby contracting an infection from exposure during labor. That being said, while there is no official policy on labor management, it makes good common sense not to increase the chance of exposure by membrane stripping, breaking the bag of waters, internal exams--especially after membranes have ruptured--or internal monitoring of fetal heart rate or contractions. The organism migrates from the anus and tends to live more toward the vaginal outlet. All of these practices have the potential of moving the bacteria up to the cervix, opening a pathway for it to enter the uterus, or both, and none of them have been shown to offer important benefits such as reducing cesarean rates or improving newborn outcomes. I should add, too, that neither inducing labor nor scheduling a c/sec are recommended for the treatment of women who test positive for Group B strep. Finally, because antibiotics kill off good bacteria as well as bad, you may wish to take probiotics to replace them. This may avoid some of the problems that can arise such as thrush, a yeast infection, that can cause problems with breastfeeding: very sore nipples in the mother, painful mouth in the baby.

~ Henci