The Effects of Probiotic Supplementation on Genetic and Metabolic Profiles in Patients with Gestational Diabetes Mellitus: a Randomized, Double-Blind, Placebo-Controlled Trial

This study was carried out to evaluate the effects of probiotic supplementation on genetic and metabolic profiles in patients with gestational diabetes mellitus (GDM) who were not on oral hypoglycemic agents. This randomized, double-blind, placebo-controlled clinical trial was conducted in 48 patients with GDM. Participants were randomly divided into two groups to intake either probiotic capsule containing Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum, Lactobacillus fermentum (2x10(9) CFU/g each) (n=24) or placebo (n=24) for 6 weeks. Probiotic intake upregulated peroxisome proliferator-activated receptor gamma (P=0.01), transforming growth factor beta (P=0.002) and vascular endothelial growth factor (P=0.006), and downregulated gene expression of tumor necrosis factor alpha (P=0.03) in peripheral blood mononuclear cells of subjects with GDM. In addition, probiotic supplementation significantly decreased fasting plasma glucose (beta, -3.43 mg/dL; 95% CI, -6.48, -0.38; P=0.02), serum insulin levels (beta, -2.29 mu IU/mL; 95% CI, -3.60, -0.99; P=0.001), and insulin resistance (beta, -0.67; 95% CI, -1.05, -0.29; P=0.001) and significantly increased insulin sensitivity (beta, 0.009; 95% CI, 0.004, 0.01; P=0.001) compared with the placebo. Additionally, consuming probiotic significantly decreased triglycerides (P=0.02), VLDL-cholesterol (P=0.02), and total-/HDL-cholesterol ratio (P=0.006) and significantly increased HDL-cholesterol levels (P=0.03) compared with the placebo. Finally, probiotic administration led to a significant reduction in plasma malondialdehyde (P<0.001), and a significant elevation in plasma nitric oxide (P=0.01) and total antioxidant capacity (P=0.01) was observed compared with the placebo. Overall, probiotic supplementation for 6 weeks to patients with GDM had beneficial effects on gene expression related to insulin and inflammation, glycemic control, few lipid profiles, inflammatory markers, and oxidative stress.