I was messaged by someone expecting a baby who complained about this constant barrage of advertisements on Facebook and in Email for post natal supplements, etc. She wanted to know what actually have science behind it. I approach this in two ways:
- Documented supplements with studies on Pub Med (BEST) focus on human clinical studies (lots of vet studies)
- Microbiome shifts seen from delivery and suggestions to mitigate them
Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts.
Drugs and Lactation Database (LactMed®) – [2023]
There are a number of prenatal studies of interest, i.e. Prenatal Gut Microbiota Predicts Temperament in Offspring at 1-2 Years [2024] but that is out of scope. “Our findings support the maternal-fetal GM axis in the setting of fetal-placental development with subsequent postnatal neurocognitive developmental outcomes, and suggest that early childhood temperament is in part associated with specific GM in the prenatal setting.”
Documented Supplements
- From Nutritional Gaps and Supplementation in the First 1000 Days – [2019] we have the following table (I deleted no change rows)
| Nutrient | DRI (Pregnancy) DRI (Lactation) | DRI (Non-Pregnancy) | Examples of Common Dietary Sources (Listed Alphabetically) |
|---|---|---|---|
| Carbohydrate | 175 g/day 210 g/day | 130 g/day | Fruits, legumes, low-fat dairy products, vegetables (starch and non-starchy), whole grains |
| Total Fiber | 28 g/day * 29 g/day * | 25 g/day * | Fruits, legumes, vegetables, whole grains |
| Protein | 71 g/day 71 g/day | 46 g/day | Animal sources: Beef, chicken, dairy products, eggs, pork, seafood, turkey Plant sources: Legumes, nuts, quinoa, seeds, soy |
| Linoleic Acid (Omega-6) | 13 g/day * 13 g/day * | 12 g/day * | Nuts, seeds, vegetable oils (including soybean, safflower and corn oil) |
| alpha-Linolenic Acid (Omega-3) | 1.4 g/day * 1.3 g/day * | 1.1 g/day * | Fatty fish, oils (including flax seed). Smaller amounts found in poultry, meats and eggs |
| Vitamin A | 770 μg RAE/day 1300 μg RAE/day | 700 μg RAE/day | Apricots, broccoli, carrots, fortified milk and eggs, kale, mangoes, margarine, sweet potatoes |
| Vitamin C | 85 mg/day 120 mg/day | 75 mg/day | Citrus fruits, kiwifruit, strawberries, vegetables (red pepper, green pepper, broccoli, Brussels sprouts, cabbage) |
| Vitamin E | 15 mg/day 19 mg/day | 15 mg/day | Nuts, plant-based oils, seeds |
| Vitamin B6 | 1.9 mg/day 2.0 mg/day | 1.3 mg/day | Fish, meat, poultry and whole grains including oats |
| Vitamin B12 | 2.6 μg/day 2.8 μg/day | 2.4 μg/day | Dairy products, eggs, meat, poultry, seafood |
| Choline | 450 mg/day * 550 mg/day * | 425 mg/day * | Beef and chicken, eggs (with yolk), mushrooms, salmon, wheat germ |
| Folate | 600 μg/day 500 μg/day | 400 μg/day | Beans, dark green vegetables (including spinach and asparagus), fortified cereals, fortified juices (including orange juice), nuts |
| Iodine | 220 μg/day 290 μg/day | 150 μg/day | Dairy products, fish, iodized salt, seaweed |
- Selenium – 100 microgram (µg) selenium yeast tablets
- Selenium Intake and Postnatal Depression—A Short Review – [2024]
- a significant inverse association between selenium intake and the risk of postpartum depression [2022]
- Selenium Intake and Postnatal Depression—A Short Review – [2024]
- Beneficial Effects of Limosilactobacillus reuteri PBS072 and Bifidobacterium breve BB077 on Mood Imbalance, Self-Confidence, and Breastfeeding in Women during the First Trimester Postpartum – PMC (nih.gov) [2023]
- The Relationship between the Infant Gut Microbiota and Allergy. The Role of Bifidobacterium breve and Prebiotic Oligosaccharides in the Activation of Anti-Allergic Mechanisms in Early Life – [2020]
- Ability of Bifidobacterium breve 702258 to transfer from mother to infant: the MicrobeMom randomized controlled trial [2023] “The presence of the supplemented strain was detected through at least 2 methods (polymerase chain reaction and culture) in 2 infants in the intervention group (n=2/65; 3.1%) and none in the control group (n=0; 0%; P=.230).”
- Effects of Varied Omega-3 Fatty Acid Supplementation on Postpartum Mental Health and the Association between Prenatal Erythrocyte Omega-3 Fatty Acid Levels and Postpartum Mental Health – [2023] “consumption of α-linolenic acid during pregnancy may stabilize postpartum mental health.”
- Nutritional experiences of postpartum mothers – A qualitative study – [2024] “Most of the practices were beneficial to the mother and a few of them were harmful like avoiding protein-rich foods, few vegetables, most fruits, and night meals. “
- Maternal Diet during Pregnancy and Lactation and Risk of Child Food Allergies and Atopic Allergic Diseases: A Systematic Review [Internet] – [2020] found no significant evidence post natal
Microbiome Changes
- The Postpartum Maternal and Newborn Microbiomes – 2017
- “the vaginal microbiome dramatically changes composition with an increase in alpha diversity characterized by a decrease in Lactobacillus species.” This hints at these probiotics:
- “Human studies have found individuals with major depressive disorder had significantly lower counts of Bifidobacterium and Lactobacillus and variations in bacterial diversity (Aizawa et al., 2016; Jiang et al., 2015).” Hints at the above 3 probiotics being beneficial: L. Crispatus, L.Jensenii and Bifidobacterium breve
- “When used as a preventative measure, probiotics can help prevent overgrowth of virulent microbial species that contribute to mastitis” [2012]
- The preventive and therapeutic effects of probiotics on mastitis: A systematic review and meta-analysis – PMC (nih.gov) “The incidence of mastitis in women taking probiotics was significantly lower (49%) than that in women taking the placebo ” lists: Lactobacillus salivarius and Lactobacillus fermentum
- Ligilactobacillus salivarius PS2 Supplementation during Pregnancy and Lactation Prevents Mastitis: A Randomised Controlled Trial – PMC (nih.gov) “supplementation of L. salivarius PS2 during late pregnancy and early lactation was safe and effective in preventing mastitis, which is one of the main barriers for continuing breastfeeding.”
- Ligilactobacillus salivarius PS2 Supplementation during Pregnancy and Lactation Prevents Mastitis: A Randomised Controlled Trial – PMC (nih.gov) “supplementation of L. salivarius PS2 during late pregnancy and early lactation was safe and effective in preventing mastitis, which is one of the main barriers for continuing breastfeeding.”
Asthma Risks
One RCT showed that early Lactobacillus rhamnosus GG (LGG) led to a reduction in the cumulative incidence rate of asthma. Another study demonstrated that mixed strains of Lactobacillus paracasei and Lactobacillus fermentum could support clinical improvement in children with asthma while one trial reported a significant reduction in the frequency of asthma exacerbations using a mixture of Ligilactobacillus salivarius and Bifidobacterium breve.
Postnatal probiotic supplementation can prevent and optimize treatment of childhood asthma and atopic disorders: A systematic review of randomized controlled trials [2022]
- Allergic Patients with Long-Term Asthma Display Low Levels of Bifidobacterium adolescentis [2016]
- “breastfeeding is associated with lower incidence of allergic and autoimmune diseases”[2020]…The microbiome of breastfed infants is dominated by species of Bifidobacterium and Lactobacillus which are known to have immunomodulatory properties and protect against allergies. In contrast, the microbiome of formula-fed infants contains a lower abundance of these beneficial bacteria and is dominated by the Clostridium, Granulicatella, Citrobacter, Enterobacter, and Bilophila species
- My take is that if the mother is supplementing with Bifidobacterium and Lactobacillus (especially if using powder dissolved in water), then there will be transference to the infant through typical actions (kissing, infant putting fingers in mother’s mouth, etc) see below (UBC study!)
- Breastmilk Feeding Practices Are Associated with the Co-Occurrence of Bacteria in Mothers’ Milk and the Infant Gut: the CHILD Cohort Study [2020] note:
- This co-occurrence is reduced when breastmilk is pumped and fed from a bottle
- This co-occurrence is reduced when breastmilk is pumped and fed from a bottle
Bottom Line
The following probiotics would appear to have benefit post partum
- Lactobacillus Salivarius
- Lactobacillus Fermentum
- Lactobacillus Crispatus
- Lactobacillus Jensenii
- Bifidobacterium Breve
Additionally: Bifidobacterium species associated with breastfeeding produce aromatic lactic acids in the infant gut [2021] identifies Bifidobacterium longum, Bifidobacterium breve and Bifidobacterium bifidum and cites “important for controlling intestinal homoeostasis and immune responses.” in the infant
- Role of Bifidobacteria on Infant Health – [2021] given some reports of adverse reaction from directly giving probiotics to infants and the study cited above finding that the mother taking them can transfer them to the infant, I favor the maternal route.