Healthy Gut Microbiota in Pregnancy

Do you know that gut microbiome status during pregnancy can affect mother’s and baby’s health? Alteration of gut microbiota in early pregnancy can increase the risk for later development of gestational diabetes mellitus (GDM), which is a great threat to maternal and neonatal health1. Pregnant woman with GDM has higher chance of developing gestational hypertension2, cardiovascular disease and type 2 diabetes (T2DM)3. GDM also places the offspring at risk of preterm birth, macrosomia, neonatal respiratory distress, hypoglycemia, polycythemia, type 2 diabetes mellitus, obesity and cardiovascular disease4.

Many of the mothers encounter post-partum “baby blue” after giving birth. In fact, numerous studies have shown that gut microbiota dysbiosis contributes to psychological condition such as depression and anxiety and the mechanism involves interactions between gut and brain (microbiota-gut-brain axis)5. According to a preprint research paper, reduction in diversity of gut microbiota and anti-inflammatory bacteria, and an increase in opportunistic pathogenic bacteria in 32-39 weeks of gestation are more likely to cause post-partum depression6. According to a study that involves 57 women, the composition of the gut microbiota in mothers with postpartum depression was different from healthy women7. Phascolarctobacterium, Lachnospiraceae, Faecalibacterium, and Tyzzerella.3 were also found to be correlated with severity of depressive symptoms7. Therefore, it is believed that composition and balance of gut microbiota during pregnancy play important role in the development of post-partum depression and anxiety. Persistence of severe post-partum depression was also found to impose negative impacts on child development that includes behavioral problems, mathematics grades and prevalence of depression in later life.

Composition and abundancy of the maternal microbiome are also suggested to influence susceptibility of dermatitis in the offspring. It was shown that mothers with reduced diversity of Proteobacteria and relative abundance of Actinobacteria in their feces during pregnancy has higher chance to deliver offspring with dermatitis8.

During pregnancy, gut microbiomes from the mother can be transferred to the fetus via placenta, cord blood and amniotic fluid9. This close interaction between the mother and infant can also be one mechanism to link the maternal microbiome to the immune development and risk of allergic diseases in offspring. Therefore, taking care of your gut health during pregnancy is the best thing a mother can do for the baby.

Tips to maintain healthy gut microbiota in pregnancy:

• Include plenty of prebiotic foods such as vegetables, fruits, legumes and wholegrains which are rich in dietary fiber as they serve as energy source for beneficial gut bacteria and bioactive metabolites such as short-chain fatty acid (SCFA) produced by gut microbiota through the anaerobic fermentation of dietary fiber can improve gut and mental health10. Fiber rich prebiotic food can also help to reduce constipation issue which is commonly seen in pregnancy.
• Substitute processed or sugar-filled junk food with healthier snacks when you have strong cravings for sugars during pregnancy due to hormonal change. Processed or sugar-filled junk food like cakes, biscuits, milk chocolates, candies, potato chips and etc. can lead to unhealthy gut microbiome and increase the risk of gestational diabetes mellitus in the mother. Healthier snacks like fresh fruits, dried fruits, nuts, and wholegrains are better alternatives for the mother.
• Include omega-3 polyunsaturated fatty acids (PUFAs) rich foods into your diet such as fish (such as salmon and sardine), plant oils (such as flaxseed and canola oil), nuts (especially walnuts), seeds (such as flaxseed and chia seed), and leafy vegetables. Fish oil supplements can also be considered if you can’t get PUFAs from daily diet. Omega-3 fatty acids are not only critical for fetal brain and retina development but also suggested to restore one’s gut microbiota balance and exert anti-inflammatory effect by increasing SCFA production11.
• Stay active as exercise can enhance the number of beneficial microbial species, enrich the microflora diversity, improve the development of commensal bacteria and improve health status to the mother12. Exercise during pregnancy can also ostensibly decrease the occurrence of GDM13. In order to stay healthy, pregnant mother can do moderate exercise such as brisk walking for at least 150 minutes (for example, 30 minutes a day, five days a week)14.
• Manage stress level as long-term stress can disrupt gut microbial community of the mother and pose negative impacts to mother’s and offspring’s health. A study showed that mothers with high stress level during pregnancy had significantly higher relative abundances of Proteobacteria genera that contains pathogens (related to Escherichia, Serratia, and Enterobacter) and lower relative abundances of lactic acid bacteria (i.e., Lactobacillus, Lactoccus, Aerococcus) and Bifidobacteria , in which the changes imply potentially increased level of inflammation14. These mothers also showed higher incidence of having babies with intestinal problems and allergic reactions15. Diaphragmatic breathing exercises or yoga appears to provide positive effects on psychological state of pregnant women16-17. However, it is important to consult your doctor before starting the exercises.
• Add probiotics into your diet to promote gut health. It was demonstrated that probiotics supplementation with Lactobacillus and Bifidobacterium during pregnancy has beneficial effects on glucose metabolic health among pregnant women, including women with GDM, and even healthy pregnant women18. Prenatal supplementation of Bifidobacteria is also effective in preventing allergic diseases (eczema) in the infants19. Probiotic supplementation with Lactobacillus and Bifidobacterium were also reported to lower depression and anxiety scores in pregnant women20.

Reference
[1] Ma, S., You, Y., Huang, L., Long, S., Zhang, J., Guo, C., ... & Tan, H. (2020). Alterations in gut microbiota of gestational diabetes patients during the first trimester of pregnancy. Frontiers in Cellular and Infection Microbiology, 10, 58.
[2] Tobias, D. K., Hu, F. B., Forman, J. P., Chavarro, J., & Zhang, C. (2011). Increased risk of hypertension after gestational diabetes mellitus: findings from a large prospective cohort study. Diabetes Care, 34(7), 1582-1584.
[3] Kramer, C. K., Campbell, S., & Retnakaran, R. (2019). Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia, 62(6), 905-914.
[4] Stewart, A., & Malhotra, A. (2015). Gestational diabetes and the neonate: challenges and solutions. Research and Reports in Neonatology, 5, 31-39.
[5] Halverson, T., & Alagiakrishnan, K. (2020). Gut microbes in neurocognitive and mental health disorders. Annals of Medicine, 52(8), 423-443.
[6] Zhang, X., Gan, Q., Yang, H., Ye, W., Zhao, X., Long, Y., ... & Zhu, C. (2020). Effect of gut microbiotas diversity during 32-39 weeks of gestation on postpartum depression. Preprint. doi: https://doi.org/10.21203/rs.3.rs-91665/v1
[7] Zhou, Y., Chen, C., Yu, H., & Yang, Z. (2020). Fecal Microbiota Changes in Patients With Postpartum Depressive Disorder. Frontiers in Cellular and Infection Microbiology, 10, 511.
[8] Tanabe, H., Sakurai, K., Kato, T., Kawasaki, Y., Nakano, T., Yamaide, F., ... & Mori, C. (2019). Association of the maternal microbiome in Japanese pregnant women with the cumulative prevalence of dermatitis in early infancy: A pilot study from the Chiba study of Mother and Child Health birth cohort. World Allergy Organization Journal, 12(10), 100065.
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[13] Ming, W. K., Ding, W., Zhang, C. J., Zhong, L., Long, Y., Li, Z., ... & Wang, Z. (2018). The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC Pregnancy and Childbirth, 18(1), 1-9.
[14] Centers for Disease Control and Prevention (CDC) (2020). Healthy pregnant or postpartum women. Retrieved from https://www.cdc.gov/physicalactivity/basics/pregnancy/index.htm
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[16] Fiskin, G., & Sahin, N. H. (2018). Effect of diaphragmatic breathing exercise on psychological parameters in gestational diabetes: A randomised controlled trial. European Journal of Integrative Medicine, 23, 50-56.
[17] Kusaka, M., Matsuzaki, M., Shiraishi, M., & Haruna, M. (2016). Immediate stress reduction effects of yoga during pregnancy: One group pre-post test. Women and Birth, 29(5), e82-e88.
[18] Zheng, J., Feng, Q., Zheng, S., & Xiao, X. (2018). The effects of probiotics supplementation on metabolic health in pregnant women: An evidence based meta-analysis. PLoS One, 13(5), e0197771.
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[20] Desai, V., Kozyrskyj, A. L., Lau, S., Sanni, O., Dennett, L., Walter, J., & Ospina, M. B. (2021). Effectiveness of probiotic, prebiotic and synbiotic supplementation to improve perinatal mental health in mothers: a systematic review and meta-analysis. Frontiers in Psychiatry, 12, 508.