Can I Take Probiotics While Pregnant?: Benefits & Safety
Congratulations on your pregnancy! If you're experiencing digestive discomfort and are considering taking probiotics, you might be wondering, "Can I take probiotics while pregnant?" In this article, we will discuss the safety and benefits of taking probiotics during pregnancy (way beyond just digestive help), recommend some of the best options, provide tips on choosing a quality probiotic, and highlight who should avoid taking probiotics while pregnant.
photo credit: Alicia Petresc
Is it safe to take probiotics while pregnant?
Not only is it safe to take probiotics in pregnancy, it can be extremely beneficial for both you and your developing baby. Taking a probiotic even in early pregnancy can come with myriad health benefits with very little risk associated (Keep reading to the bottom to see who may not want to take probiotics). We will go over all the ways that probiotics can help during pregnancy in this article.
But don't just take my word for it— a meta-analysis concluded that probiotics don’t pose a risk during pregnancy and lactation.
But just because probiotics are safe doesn't mean you should take just any probiotic.
All probiotics are not created equal
Probiotics are my bread and butter. I spent 6 years of my career as a microbiologist and then developer, ensuring quality probiotic formulations. I have LOTS of opinions on what constitutes a good probiotic, and I recommend them to most all of my friends and clients when pregnant. The truth is, though, there is a lot of crap out there.
If you are going to spend your money on a supplement, I want to make sure it's working for you! It's one of my biggest pet peeves when marketing has totally taken over and things are touted as a "Women's" or "Vaginal" probiotic just because it's in a pink package. There is a lot of evidence that probiotics can be so helpful, especially during pregnancy, but you need to make sure you are getting one with A) strains that are actually making an impact on the issue you want to address and B) are actually ALIVE.
In my previous role, I have literally tested the viability of products off the shelf, and you would be shocked by the lack of quality out there. Some actually had ZERO cells that were alive. So I shout the probiotic quality gospel whenever I can and thought it the perfect opportunity to create this guide to allow more people in on the secret.
Since some of you may not be up to speed on probiotics, let's start with the basics. But first, a disclaimer:
Probiotics have been studied and shown to be safe and effective in pregnant women and even extremely preterm infants, but it is always recommended to check with your healthcare provider when starting a new supplement—especially in pregnancy. While I am very familiar with the literature and landscape of probiotics, the recommendations and advice outlined here are solely considered nutrition support and education and not intended for the purpose of providing medical nutrition therapy, nor intended to diagnose, prescribe, treat, prevent, cure, or heal any condition or disease.
OK, let's jump in.
What even is a probiotic?
I'll bet most of you have heard the word probiotic and liken it to "good bacteria." But that isn't really the whole picture. A probiotic is defined as live microorganisms that, when consumed in adequate amounts, confer a health benefit on the host. Let's unpack that a bit.
"Live microorganisms…": means any microbe—namely bacteria and yeast—that is actually living. Meaning the cells can't be dead, even if the dead cells have a beneficial effect (postbiotics are a thing and have science to back them up; they just aren't probiotics).
"…when consumed in adequate amounts…": means the product has to have the amount of live cells that have been clinically shown to help with X, Y, Z symptom. Basically, the amount of cells listed on the package should be the level (e.g., 2 Billion CFU or 10 Billion CFU) that has been clinically shown to help with the marketed benefit of the product AND be guaranteed alive through the expiration of that product.
"…confer a health benefit…": the microbes, be they bacterial strains or yeast, need to actually be shown to do what they say they are going to do. For example, if you are selling a women's probiotic for vaginal balance, it needs to include strains in the right amount that have been shown to have a benefit on vaginal balance. Take Lactobacillus rhamnosus GG. That is a great probiotic strain, but mainly for digestive and immune health. There aren't clinical studies showing it to balance the vaginal tract. In fact, a study showed that it did not colonize or alter the vaginal tract like another strain of Lactobacillus rhamnosus (GR-1) could. Strains MATTER.
"…on the host.": it should be studied in the target consumer. So if the probiotic is basing all of its evidence of benefit on an animal study, or only tested in men (did you know women weren't even allowed in clinical studies until the mid 80s?!) when it is intended for women, it has not met the bar of a true probiotic.
Meeting all of these criteria is a high bar, as it should be! Especially if the product is intended for pregnant women and infants. And the truth is that probably 50% or more of the probiotics out there just don't meet these standards.
This is also the reason why yogurt, kimchi, and other fermented foods—while totally beneficial for most people—aren't technically probiotics. They aren't necessarily standardized and guaranteed potent, and the strains may not be clinically studied to provide a specific benefit. There are some fermented foods that would be considered a probiotic because it has actually been clinically studied to show the benefit as it—Activia yogurt, for example.
So know that while probiotic is a buzzword these days, it shouldn't be thrown around to just any product with "good bacteria."
photo credit: Volodymyr Hryshchenko
Benefit of Taking Probiotics in Pregnancy
Did you know:
Up to a third of pregnant women struggle with constipation and other digestive discomforts
Bacterial vaginosis (BV) is caused by an out-of-balance vaginal microbiome and can increase your risk of preterm labor
Being diagnosed with Group B strep can, although rarely, cause neonatal GBS infection and usually means antibiotics prior to labor
Critical bacterial species are going extinct in the US infant microbiome, which impacts colic, immune function, and lifelong well-being
But can I take probiotics while pregnant to benefit these situations? Short answer—yes, probiotics have been shown to benefit all of these situations to some extent.
Here are a few common issues that can benefit from the use of probiotics in pregnancy.
Constipation
There are specific probiotic strains that are particularly helpful in alleviating constipation. Bifidobacterium lactis BB-12 and Bifidobacterium lactis HN019 have been clinically shown to help increase the frequency of bowel movements and decrease abdominal discomfort. Typically, 1-2 B CFU/capsule of either of these strains confers a benefit.
Vaginal Imbalances and Infections (Bacterial Vaginosis, Yeast infections, Group B Strep)
Due to changes in hormones during pregnancy, bacterial vaginosis (BV) can become more prevalent, and it is estimated that up to 32% of pregnant women will develop BV during the course of their pregnancy.
Women without abnormalities of the vaginal flora in the first trimester had a 75% lower risk of delivery before 35 weeks compared with women with abnormal vaginal flora.
You should be especially cognizant of managing vaginal flora imbalances when there are other risk factors for preterm labor present, like smoking, multiple pregnancies (twins or more), or a history of preterm birth.
Various probiotic strains have been clinically shown to reduce the risk of recurrence of BV after treatment, and some have even been shown to reverse BV without antibiotic treatment. You'd want to looks for a product containing strains that have been shown to help support the return of vaginal flora to a normal state dominated by lactobacilli and a pH <4.5. These include the combination of Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1, the combination of Lactobacillus gasseri LBV150, Lactobacillus rhamnosus LBV96, Lactobacillus jensenii LVB116, Lactobacillus crispatus LVB88 , and the combination of Lactobacillus acidophilus LA-14 and Lactobacillus rhamnosus HN001 at doses of 2-5B CFU/day.
Group B strep colonization is estimated to occur in about 20% of pregnant women, and while it usually does not lead to harm in the baby, most healthcare providers administer preventative antibiotics during labor, which can lead to dysbiosis in the mother and baby. Studies have found that proper adherence to specialized probiotic intake in the third trimester can help decrease your risk of colonization. Look for doses of 2B each of Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1.
Impacting your mood Postpartum
The gut and the mind are incredibly linked by something called the gut-brain axis, and gut dysbiosis has been implicated in depression, including postpartum depression (PPD). Those with PPD have been shown to have significantly different microbial populations compared to healthy controls. The probiotic strain Lactobacillus rhamnosus HN001 has been clinically shown to reduce the risk of postpartum anxiety and depressive scores when taken during pregnancy and up to 6 months postpartum.
Benefiting your future baby's gut microbiome
It has been shown that babies born in today’s age have lower levels of the crucial infant gut symbiont, Bifidobacteria—specifically Bifidobacterium longum subsp. infantis (B. infantis)—and increasing levels of potentially inflammatory bacteria, suggesting potentially widespread dysbiosis. This can lead to changes in the gut and fecal pH, contributing to increased allergies, diaper rash, and digestive issues. Supplementation with a high-quality probiotic is a great way to introduce human bifidobacteria species to the gut and can help to support the correct development of the microbiome.
Some good options include the Jarro-Dophilus® Infant Probiotic drops and the Evivo® Infant Probiotic Powder.
It also appears that babies acquire B. infantis after birth, so you can consider including a probiotic with this organism if breastfeeding or supplying your baby with a probiotic containing it after they are born.
Related: Your microbiome and gut health during pregnancy and why it matters
photo credit: Wren Meinberg
When to start probiotics in pregnancy
Probiotics can start to provide a benefit as early on in your pregnancy as you start them—ideally at conception or even before trying to conceive! They are safe in the delicate first trimester, so you can rest easy there. Remember that vaginal infections in the first trimester can inform preterm labor risk, so starting earlier is better. For Group B strep risk, it can be helpful to start in the third trimester.
OK, you've convinced me, but how do I find one that actually works?
Here are some FAQs and tips for finding a high-quality probiotic you can trust.
Do I need to buy a probiotic in the refrigerated section?
You may have heard that only the probiotics you find in the refrigerated section at the store are high-quality. That may have been true in the past, but packaging technology has improved dramatically, and you can find high-quality probiotics in both the refrigerated or shelf-stable section of the grocery store. If you prefer the convenience of a shelf-stable probiotic, look for one that has a stated guarantee of potency through the expiration date of the product, not just at the time of manufacture. This should be listed below the supplement facts. Aluminum blister packs and desiccant-lined bottles are optimal for ensuring the quality of shelf-stable probiotics.
I heard probiotics are pointless and are just killed by stomach acid anyway. Is that true?
Probiotics that mention delayed-release capsules are preferable because, while many probiotic strains are naturally acid-resistant to survive passage through the stomach, some are not, and delayed-release capsules do help ensure optimal delivery to the gut.
What about strains?
Please, please, please only take a probiotic with the strain names listed on the package, as opposed to just general species information (e.g., Lactobacillus rhamnosus GG vs. just Lactobacillus rhamnosus). Different probiotic strains of the same species can have very different effects in the body. To understand species vs. strain differentiation in probiotics, consider this: all dogs are under the species Canis familiaris; however, within that species, you have a vast variety such as German Shepherds, Bulldogs, and Chihuahuas. Probiotic strains can be thought of as different breeds.
What’s a CFU?
If you've ever shopped for a probiotic, you may have seen the letters CFU on the package. That stands for Colony Forming Units and is a way to measure the amount of live cells in a product (remember—we want to make sure they are actually alive). It works by diluting the product and growing it up on culture media and counting the number of cells that grow. Some of the new darlings of the probiotic world measure their product's viability in AFUs or Active Fluorescent Units. It’s a newer method used to measure viability; however, it has the ability to give higher numbers than CFU because it can capture cells that may be viable but not necessarily able to grow in the culture media of the CFU methods. Also, most of the clinical studies done are measured in CFUs, so it can be hard to know whether you are truly getting the amount that conferred the health benefit if it's only measured in AFU.
Can I take probiotics with prenatal vitamins?
Absolutely. Some prenatals claim to have probiotics, but usually the format is not optimized for survival of the probiotics, so it’s best to take one specially formulated alongside your probiotic. But you can definitely take them at the same time to help you remember. In fact, some probiotics actually help nutrient absorption so they can help you get the most out of your prenatal.
Related: why you should keep taking your prenatal after giving birth
Best probiotics while pregnant
Its important to know which probiotics are safe during pregnancy. Ones that include the strains mentioned above are great places to start, and avoid any combined with herbs. Some good options out there are this Jarrow FemDophilus probiotic or RepHresh ProB are great options for pregnancy. I also LOVE the probiotic for the brand I used to work for—Renew Life—and actually think it is hands-down the best probiotic for the value as it contains the beneficial B. infantis for baby and vaginal health strains RC-14 and GR-1. Unfortunately, the brand was just sold to another company, so I can no longer vouch for the quality—truly *heartbreaking* for me.
photo credit: Unsplash
When you should exercise caution before taking probiotics
Again, I want to be clear it is always recommended to check with your healthcare provider when starting a new supplement—especially in pregnancy. While I am very familiar with the literature and landscape of probiotics, I am not a licensed healthcare provider and therefore any recommendations here should be discussed with your primary healthcare provider. But I also wanted to call out a few instances of who should not take probiotics while pregnant potentially:
If you or your baby are immunocompromised
If you are overweight or obese. This is currently being investigated because there is conflicting research showing a potential increase in preeclampsia risk with probiotics specifically in overweight and obese individuals. The evidence is conflicting, with some meta-analyses showing increased risk and others showing low certainty of evidence. This discrepancy likely comes from the studies not being designed or statistically powered to study this outcome (it was more of a discovery after the fact, which can skew results). But out of an abundance of caution, I recommend avoiding the use of probiotics in overweight and obese pregnant women until the pros and cons have been discussed with their healthcare providers.
Final Thoughts
Navigating the world of probiotics, especially during pregnancy, can be overwhelming given the sheer number of products out there. Understanding what constitutes a high-quality probiotic is crucial to ensuring you get the most benefit from your supplement.
For pregnant women, probiotics offer potential benefits such as help alleviating constipation, managing vaginal imbalances, and positively influencing your baby's gut microbiome. With the right strains and doses and attention to quality, probiotics can support both maternal and infant health.
It’s essential to choose products from reputable brands, verify strain-specific benefits, and confirm the viability of the microorganisms through the product's expiration date.
And as always—consult with your healthcare provider before starting any new supplement, particularly during pregnancy, to ensure it aligns with your specific health needs and conditions.
By making informed choices and using high-quality probiotics, you can maximize the potential benefits for both you and your baby.
Now instead of asking yourself “Can I take probiotics while pregnant?” you’ll be asking yourself what other ways you can support your growing belly!
Probiotics can be so helpful but they are just one piece of the puzzle. Book your 15 minute complimentary consult to see how I can support your and your growing baby's microbiomes today!
