Feasibility of Oral Prenatal Probiotics against Maternal Group B Streptococcus Vaginal and Rectal Colonization



      To examine the effect of an oral prenatal probiotic on group B Streptococcus (GBS) colonization and to demonstrate the feasibility of a larger randomized controlled trial.


      This pilot study was an open‐label, two‐group quasi‐experiment.


      An urban central city nurse‐midwifery and wellness center serving a diverse population.


      Ten pregnant participants received the oral probiotic (Florajen3) taken once daily, and 10 participants served as controls.


      A questionnaire on dietary practices, vaginal cleansing, sexual history, and symptoms and GBS colony count samples were taken at 28‐, 32‐, and 36‐weeks gestation.


      Participants in the probiotic group reported no adverse events or minor side effects; one half reported improved gastrointestinal symptoms. Although two women in each group had positive qualitative prenatal GBS cultures at 36 weeks, the probiotic group participants had lower quantitative GBS colony counts. The eight GBS negative averaged 90% probiotic adherence compared with two GBS positive women who averaged 68%. Yogurt ingestion was inversely related (p= .02) to GBS colonization.


      Prenatal probiotic therapy has the potential to reduce GBS colonization. The potential of the probiotic intervention appears to be linked to daily adherence. A controlled clinical trial with a larger, adequately powered sample is feasible and justified.


      To read this article in full you will need to make a payment
      AWHONN Member Login
      AWHONN Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abad C.L.
        • Safdar N.
        The role of lactobacillus probiotics in the treatment or prevention of urogenital infections: A systematic review.
        Journal of Chemotherapy. 2009; 21: 243-252
        • Antonio M.A.D.
        • Meyn L.
        • Murray P.L.
        • Busse B.
        • Hillier S.L.
        Vaginal colonization by probiotic L. bacillus crispatus CTV‐05 is decreased by sexual activity and endogenous lactobacilli.
        Journal of Infectious Diseases. 2009; 199: 1506-1513
        • Arya A.
        • Cryan B.
        • O'Sullivan K.
        • Greene R.A.
        • Higgins J.R.
        Self‐collected versus health professional‐collected genital swabs to identify the prevalence of group B Streptococcus: a comparison of patient preference and efficacy.
        European Journal of Obstetrics, Gynecology, & Reproductive Biology. 2008; 139: 43-45
        • Association of Ontario Midwives
        Group B Streptococcus: Prevention and management in labour.
        Author, Toronto, Canada2010
        • Balter S.
        • Zell E.R.
        • O'Brien K.L.
        • Roome A.
        • Noga H.
        • Thayu M.
        • Schuchat A.
        Impact of intrapartum antibiotics on the care and evaluation of the neonate.
        Pediatric Infectious Disease Journal. 2003; 22: 853-857
        • Bedford Russell A.R.
        • Murch S.H.
        Could peripartum antibiotics have delayed health consequences for the infant.
        BJOG: An International Journal of Obstetrics and Gynaecology. 2006; 113: 758-765
        • Bizzarro M.J.
        • Dembry L.M.
        • Baltimore R.S.
        • Gallagher P.G.
        Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis.
        Pediatrics. 2008; 121: 689-696
        • Bolton M.
        • Van Der Straten A.
        • Cohen C.R.
        Probiotics: Potential to prevent HIV and sexually transmitted infections in women.
        Sexually Transmitted Infections. 2008; 35: 214-225
        • Brantsaeter A.L.
        • Myhre R.
        • Haugen M.
        • Myjing S.
        • Sengpiel V.
        • Magnus P.
        • Meltzer H.M.
        Intake of probiotic food and risk of preeclampsia in primiparous women: The Norwegian mother and child cohort study.
        American Journal of Epidemiology. 2011; 174: 807-815
        • Buckler B.
        • Bell J.
        • Sams R.
        • Cagle W.
        • Bell S.A.
        • Allen C.
        • Bhatia J.
        Unnecessary workup of asymptomatic neonates in the era of Group B Streptococcus prophylaxis. Infectious Diseases in Obstetrics and Gynecology, Epub 2010 August 22. Article ID 369654.
        2010 (Retrieved from)
        • Centers for Disease Control and Prevention (CDC)
        Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC.
        MMWR Morbidity and Mortality Weekly Report. 2002; 51: 1-22
        • Centers for Disease Control and Prevention (CDC)
        Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC, 2010.
        MMWR Morbidity and Mortality Weekly Report. 2010; 59: 1-32
        • Cottrell B.H.
        An updated review of evidence to discourage douching.
        MCN: American Journal of Maternal/Child Nursing. 2010; 35: 102-107
        • de Vrese M.
        Health benefits of probiotics and prebiotics in women.
        Menopause International. 2009; 15: 35-40
        • Donders G.G.
        Microscopy of the bacterial flora on fresh vaginal smears.
        Infectious Diseases in Obstetrics and Gynecology. 1999; 7: 177-179
        • Elias J.
        • Bozzo P.
        • Einarson A.
        Are probiotics safe for use during pregnancy and lactation.
        Canadian Family Physician. 2011; 57: 299-301
        • Ephraim E.
        • Schultz R.D.
        • Duster M.
        • Warrack S.
        • Spiegel C.A.
        • Safdar N.
        In‐vitro evaluation of the antagonistic effects of the probiotics Lactobacillus Rhamnosus Hn001 and Florajen 3 against Group B Streptococci.
        International Journal of Probiotics and Prebiotics. 2012; 7: 113-120
        • Food and Agriculture Organization of the United Nations & World Health Organization
        Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria: Report of a joint FAO/WHO expert consultation on evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria.
        2001 (Retrieved from)
        • Food and Agriculture Organization of the United Nations & World Health Organization
        Guidelines for the evaluation of probiotics in food: Report of a joint FAO/WHO working group on drafting guidelines for the evaluation of probiotics in food.
        2002 (Retrieved from)
        • Fooks L.J.
        • Gibson G.R.
        Probiotics as modulators of the gut flora.
        British Journal of Nutrition. 2002; 88: S39-S49
        • Glasgow T.S.
        • Speakman M.
        • Firth S.
        • James B.
        • Byington C.L.
        • Young P.C.
        Clinical and economic outcomes for term infants associated with increasing administration of antibiotics to their mothers.
        Paediatric and Perinatal Epidemiology. 2007; 21: 338-346
        • Glasgow T.S.
        • Young P.C.
        • Wallin J.
        • Kwok C.
        • Stoddard G.
        • Firth S.
        • Byington C.L.
        Association of intrapartum antibiotic exposure and late‐onset serious bacterial infections in infants.
        Pediatrics. 2005; 116: 696-702
        • Hanson L.
        • VandeVusse L.
        Group B streptococcus intrapartum prophylaxis guidelines adherence: A perinatal risk management issue.
        Journal of Perinatal and Neonatal Nursing. 2010; 24: 100-103
        • Hickmann M.E.
        • Rench M.A.
        • Ferrieri P.
        • Baker C.J.
        Changing epidemiology of group B streptococcal colonization.
        Pediatrics. 1999; 104: 203-209
        • Kim L.S.
        • Hilli L.
        • Orlowski J.
        • Kupperman J.L.
        • Baral M.
        • Waters R.F.
        Efficacy of probiotics and nutrients in functional gastrointestinal disorders: A preliminary clinical trial.
        Digestive Diseases and Sciences. 2006; 51: 2134-2144
        • Kubota T.
        • Nojima M.
        • Itoh S.
        Vaginal bacterial flora of pregnant women colonized with group B streptococcus.
        Journal of Infection and Chemotherapy. 2002; 8: 326-330
        • McKeever T.M.
        • Lewis S.A.
        • Smith C.
        • Collins J.
        • Heatlie H.
        • Frischer M.
        • Hubbard R.
        Early exposure to infections and antibiotics and the incidence of allergic disease: A birth cohort study with the West Midlands General Practice Research Database.
        Journal of Allergy and Clinical Immunology. 2002; 109: 43-50
        • Mercer B.M.
        • Taylor M.C.
        • Fricke J.L.
        • Baselski V.S.
        • Sibai B.M.
        The accuracy and patient preference for self‐collected group B Streptococcus cultures.
        American Journal of Obstetrics and Gynecology. 1995; 173: 1325-1328
        • Moghaddam M.N.
        Recto‐vaginal colonization of Group B Streptococcus in pregnant women referred to a hospital in Iran and its effect on Lactobacillus normal flora.
        International Journal of Biological Sciences. 2010; 10: 166-169
        • Myhre R.
        • Brantsaeter A.L.
        • Myking S.
        • Gjessing H.K.
        • Sengpiel V.
        • Meltzer H.M.
        • Jacobsson B.
        Intake of probiotic food and risk of spontaneous preterm delivery.
        American Journal of Clinical Nutrition. 2011; 93: 151-157
        • Newton E.R.
        • Butler M.C.
        • Shain R.N.
        Sexual behavior and vaginal colonization by Group B Streptococcus among minority women.
        Obstetrics and Gynecology. 1996; 88: 577-582
        • Ohlsson A.
        • Shah V.S.
        Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007467.
        • Ronnqvist P.D.J.
        • Forsgren‐Brusk U.B.
        • Hakansson E.E.G.
        Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH.
        Acta Obstetricia et Gynecologica Scandinavica. 2006; 85: 726-735
        • Singleton M.L.
        Group B Strep prophylaxis: What are we creating.
        Midwifery Today. 2007; 81: 18-20
        • United Kingdom National Screening Committee (UK NSC)
        Screening for Group B Streptococcal infection in pregnancy: External review against programme appraisal criteria for the UK National Screening Committee.
        Bazian Limited, London, UK2012
        • VandeVusse L.
        • Hanson L.
        • Safdar N.
        Perinatal outcomes of prenatal probiotic and prebiotic administration: An integrative review.
        Journal of Perinatal & Neonatal Nursing. 2013; 27: 288-301
        • West C.
        • Prescott S.
        Prebiotics and probiotics for prevention of allergic disease.
        2013 (Retrieved from)


      Lisa Hanson, PhD, CNM, FACNM, is an associate professor and the Associate Director of the Nurse-Midwifery Program, College of Nursing, Marquette University, and a clinical associate professor, Aurora Sinai Midwifery and Wellness Center, Milwaukee, WI.


      Leona VandeVusse, PhD, RN, CNM, FACNM, is an associate professor and the Director of the Nurse-Midwifery Program, College of Nursing, Marquette University, Milwaukee, WI.


      Megan Duster, MT (ASCP), is a senior research specialist and manager of the Infectious Disease Research Laboratory, University of Wisconsin School of Medicine and Public Health's Division of Infectious Disease, Madison, WI.


      Simone Warrack, BS, is a research specialist at the University of Wisconsin School of Medicine and Public Health Infectious Disease Research Laboratory, Madison, WI.


      Nasia Safdar, MD, PhD, is an associate professor, Department of Medicine and Infectious Disease, University of Wisconsin School of Medicine and Public Health, and associate chief of staff for research, William S. Middleton Memorial Veterans Hospital, Madison, WI.