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Pregnancy outcome of women exposed to  Lactobacillus during early pregnancy  Cheil General Hospital & Women’s Healthcare C...
<ul><li>Definition of Probiotics </li></ul><ul><li>Current Use of Probiotics </li></ul><ul><li>Purpose of this study </li>...
<ul><li>Live microorganisms that, when administered in adequate amounts,  </li></ul><ul><li>confer a health benefit on  th...
 
Current use of Probiotics :Taking probiotics as dietary supplement without prescription…. :But the safety of probiotics fo...
<ul><li>To clarify the risks ass. with exposure to probiotics in early pregnancy  </li></ul><ul><li>and provide a more sol...
<ul><li>Subject: </li></ul><ul><li>from March 2000 to Sep. 2010  </li></ul><ul><li>104 pregnancy women who were taking pro...
<ul><li>No meaningful correlation between exposure to probiotics during pregnancy and adverse outcomes in infants </li></u...
Table 1.Characteristics of the participants 0.87 98 (49) 48 (48) Alcohol 0.20 31 (15.5) 9 (9) Cigarette smoking 0.57 52 (2...
Table 2. Pregnancy outcomes of women inadvertently exposed to lactobacillus in the first trimester of pregnancy 0.48 1 0 C...
<ul><li>Probiotics have traditionally been used to treat disease related to the gastrointestinal tract.  </li></ul><ul><li...
<ul><li>Observations supporting a role for probiotics in inhibiting allergic responses in early life </li></ul><ul><li>1. ...
<ul><li>Allergen exposure </li></ul><ul><li>Early sensitization </li></ul><ul><li>Development of clinical allergy </li></u...
Allergy. 2000 Jan;55(1):2-10 Holloway JA  Dose atopic disease start in fetal life?
<ul><li>Probiotics and allergic disease </li></ul>Use of Probiotics 1996. suppressive effect on lymphocyte proliferation a...
Probiotics Safety in Pregnancy: A Systematic Review and Meta-analysis of Randomized Controlled Trial of Lactobacillus, Bif...
A Cochrane systemic review concluded that,  when the results for the different probiotics strains used in clinical trials ...
<ul><li>Probiotics and prebiotics </li></ul><ul><li>:clinical effects in allergic  disease </li></ul><ul><li>Current opini...
Probiotics for the prevention or treatment of allergic disease J Allergy clin immunol 2007
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&lt;마더세이프라운드> Pregnancy outcome of women exposed to lactobacillus during pregnancy(이지은)

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  • Pre-biotic
  • Immune modulation: colonisation has been associated with the maturation of humoral immune mechanisms, particularly of circulating IgA and IgM secreting cells reflecting the dependency of the regulation of the mucosal immune response on the normal gut microflora. Early childhood 시기에 microbial exposure 감소가 -&gt; allergic disease 증가의 원인이다 . 라는 가설은 . Epidemiologic support + microbial factor 들의 immune devolpment 에 대한 영향력이 더 이해되기시작하면서 , 이 가설은 더욱 consolation. -&gt;experimental use 하게됨 . for preventing or inhibiting allergic immune response 하는데 .
  • 아토피 피부염의 발현 - 유전인자 관여 . 그러나 최근 몇십년간의 유병율의 증가는 이 유전적 요소로 설명되지 않는다 . 이것은 알레르기 질환의 발생과 감작에 환경적인 요인이 결정적인 역할을 했을것이라는 반증 . 음식요인으로 모유수유에 관한 연구 많음 . 흡인 알레르겐으로 담배연기 노출 , 공기 질에 관한 연구들도 많고 여기에 ++++ 장내세균이 감작의 생성에 영향을 준다는 가설 . ( 장내 세균이 또하나의 영향을 끼칠 수 있는 요인으로 설명하고있는 가설이 )
  • 그림설명 – 출생 전 , 후 Th2 type reactivity 변화 . Th2 반응이 출생시 우세하지만 점차로 약하되어 꺽인다 . 아토피질환이 발생한 환아에서는 출산 후 Th2 반응이 강한 상태로 유지되지만 아토피질환이 유지되지않은 아이들에서는 약화된다 . Holloway JA. et.at.2000 알레르기 질환 자체의 메커니즘 간단히 . 1993. 임신기간동안 태내에서는 주요 면역계가 Th1 에서 Th2 로 전환되어있어 , 이는 엄마의 면역체계가 fetal allograft 에 대해 반응하는게 낮아지도록 유도하여 성공적인 임신이 되도록 한다 . ( 이는 여러연구들이 뒷받침함 : 원인을 알 수 없는 반복되는 유산을 경험하는 산모의 Tcell clone 에서 Th2 type 사이토카인인 IL-4, IL-10 의 생성이 낮다 . 일정농도의 프로게스테론은 T 세포가 Th2 type 의 사이토카인 IL-4 을 생성하도록 도와 임신유지를 돕는다 ) 따라서 , 임신과 관련된 면역환경은 태반을 통해 노출된 항원에 대해 Th2 반응으로 이어질 가능성이 높다 . 는 것을 의미한다 . 게다가 , 모두 이런 상황일 경우 왜 모든사람이 알레르기 질환을 경험하는 것은 아닌가 - 하는 의문에 대한 답변은 그림과 같다 . 즉 , Th1 type 반응성이 얼마나 차이있느냐 . 원래 성인에 비해 신생아는 Th1 type 사이토카인인 IFN-r 생성이 낮지만 , 알레르기 위험이 있는 영아의 경우 더욱 낮다 . 출생시 Th1 type 사이토카인이 downregulation 되어있거나 성숙이 지연되어있으면 Th2 매개 질환의 발달과 지속에 관여하는것으로 보인다 .
  • 이러한 prevention study 들은 대게 산모에게 임신 마지막 몇주간 probiotics 를 먹이는 식으로 진행 . Studies investigating the impact of maternal supplementation with probiotics on immune parameters and gastrointestinal microbiota at birth and in early infancy. 엄마가 lactobacillus rhamnosus strain GG 를 먹는다고해서 infant 에게도 이 strain 이 colonization 되는 것이 아니다 . Affect 영향을 미치는 것이다 . 즉 L.rhamnosus 를 엄마가 복용하면 그 infant 에게서는 bifidobacterium 이 더 colonization. 이는 즉 이로운 효과를 보인다는 것 . 엄마가 복용함으로써 changes in some immunological mediators in umbilical cord plasma and breast milk.
  • 8 가지 연구를 metaanalysis
  • Transcript of "&lt;마더세이프라운드> Pregnancy outcome of women exposed to lactobacillus during pregnancy(이지은)"

    1. 1. Pregnancy outcome of women exposed to Lactobacillus during early pregnancy Cheil General Hospital & Women’s Healthcare Center Resident. Lee Ji Eun
    2. 2. <ul><li>Definition of Probiotics </li></ul><ul><li>Current Use of Probiotics </li></ul><ul><li>Purpose of this study </li></ul><ul><li>Methods of this study </li></ul><ul><li>Results of this study </li></ul><ul><li>Discussion </li></ul>Contents
    3. 3. <ul><li>Live microorganisms that, when administered in adequate amounts, </li></ul><ul><li>confer a health benefit on the host </li></ul>Definition of Probiotics
    4. 5. Current use of Probiotics :Taking probiotics as dietary supplement without prescription…. :But the safety of probiotics for pregnancy has not been established. Herbal medicins in pregnancy and lactation – an evidence based approach . 2006 Mills EJ, Koren G.
    5. 6. <ul><li>To clarify the risks ass. with exposure to probiotics in early pregnancy </li></ul><ul><li>and provide a more solid basis for the future research efforts on probiotics. </li></ul>Purpose of this study
    6. 7. <ul><li>Subject: </li></ul><ul><li>from March 2000 to Sep. 2010 </li></ul><ul><li>104 pregnancy women who were taking probiotics in early pregnancy </li></ul><ul><li>Study outcome: </li></ul><ul><li>1. number of life births and spontaneous abortion, gestational age at birth, birth weight, number of babies born with major birth defect </li></ul><ul><li>2. number of babies born with a low birth weight, and chromosomal abnormalities, number of preterm birth. </li></ul>Methods of this study
    7. 8. <ul><li>No meaningful correlation between exposure to probiotics during pregnancy and adverse outcomes in infants </li></ul>Results of this study
    8. 9. Table 1.Characteristics of the participants 0.87 98 (49) 48 (48) Alcohol 0.20 31 (15.5) 9 (9) Cigarette smoking 0.57 52 (26) 27 (27) X-ray Other relevant coexpo. 0.0 5.5 ± 4.6 12.4 ± 7.5 Coexpo. to other med.(n) - - 4 (1-90) Duration of expo.(days) - - 510 (170~1392) Dose (mg/day) - - 4.2 (-1.2~17.2) G.A. at expo.(weeks) Exposure to lacto. 0.25 2.2 ± 1.23 2.0 ±1.37 Gravity (n) 0.09 31.5 ± 3.7 30.7±4.1 Age (years) P-value Control (n=200) Exposed (n=100)
    9. 10. Table 2. Pregnancy outcomes of women inadvertently exposed to lactobacillus in the first trimester of pregnancy 0.48 1 0 Chromosomal abnormalities 0.59 6 (3.2%) 2 (2.0%) Minor malformations 0.76 5 (2.7%) 2 (2.0%) Major malformations 0.32 18 (9.6%) 13 (13.5%) Preterm birth 0.34 18 (9.6%) 6 (6.3%) Low birth weight ( 0.73 3191 ± 574 3200 ± 609 Birth weight (g) 0.84 38.8 ± 2.9 38.9 ± 2.6 G.A. at birth (weeks) 187 96 Life births 0.50 21 (10.5%) 8 (8%) Spontaneous Abortion P-value Control (n=200) Exposed (n=100)
    10. 11. <ul><li>Probiotics have traditionally been used to treat disease related to the gastrointestinal tract. </li></ul><ul><li>By Avoiding colonization by pathogens and reducing the risk for over growth of potential pathogenic bacteria. </li></ul>Use of Probiotics + Understanding of the effect of the microbial Immune modulation
    11. 12. <ul><li>Observations supporting a role for probiotics in inhibiting allergic responses in early life </li></ul><ul><li>1. Epidemiologic links between less exposure to microbe and allergic disease, and protective effects of higher microbial burden </li></ul><ul><li>2. Intestinal microbiotica are the largest source of microbial exposure </li></ul><ul><li>through early immune development </li></ul><ul><li>3. Intestianl microbiotica appear to bee essential for development of oral tolerance. </li></ul><ul><li>4. Changing pattern of microbiotica with progressive Westernization and links with allergic disease </li></ul><ul><li>5. Difference in perinatal colonization in children who go on to deveolp allergic disease….. </li></ul><ul><li>American Academy of Allergy,Asthma & Immunology 2007;120:255 </li></ul>probiotics & allergic disease + Epidemiologic support
    12. 13. <ul><li>Allergen exposure </li></ul><ul><li>Early sensitization </li></ul><ul><li>Development of clinical allergy </li></ul>Atopic eczema Genetic predisposition Allergen exposure. Immune modulation
    13. 14. Allergy. 2000 Jan;55(1):2-10 Holloway JA Dose atopic disease start in fetal life?
    14. 15. <ul><li>Probiotics and allergic disease </li></ul>Use of Probiotics 1996. suppressive effect on lymphocyte proliferation and IL-4 generation in vitro 2000. Immunoinflammatory responses to dietary antigens in allergic individuals were shown to be alleviated by probiotics 2000.Significant improvement in the course of atopic eczema in infants given probiotics supplemented elimination diets 2001. Kalliomaki M. Probiotics in primary prevention of atopic disease ……… ..
    15. 16. Probiotics Safety in Pregnancy: A Systematic Review and Meta-analysis of Randomized Controlled Trial of Lactobacillus, Bifidobacterium and Saccharomyces spp. J Obstet Gynaecol Can 2009;31(6):542-552 : The meta-analysis did not indicate that administering certain strains of Lactobacillus spp. and Bifidobacterium spp. had any effect on Cesarean section rate, birth weight, or gestational age. : Certain strains of Lactobaciilus sp. And Bifidobacterium sp. may prevent atopic disease in infants when administered to their mothers in pregnancy.
    16. 17. A Cochrane systemic review concluded that, when the results for the different probiotics strains used in clinical trials are pooled, probiotics are not effective for the treatment of eczema.
    17. 18. <ul><li>Probiotics and prebiotics </li></ul><ul><li>:clinical effects in allergic disease </li></ul><ul><li>Current opinion in pediatrics 2010 </li></ul>There are fewer studies of prebiotics for the treatment or prevention of allergic disease. But data suggest that prebiotic-supplemented formulas may be effective for preventing eczema in infants at high risk of developing allergic disease
    18. 19. Probiotics for the prevention or treatment of allergic disease J Allergy clin immunol 2007
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