Can a probiotic help with iron deficiency in pregnancy

As a labor and delivery nurse and later as a nurse-midwife, Mary Dawn Koenig frequently saw patients who suffered from iron deficiency. Many of the mothers also complained that the prenatal iron supplements they were prescribed gave them unpleasant side effects, including nausea, vomiting and constipation.

"I started thinking, what can we do differently?" said Koenig, an associate professor in the UIC College of Nursing. "Iron is really important for both mom and baby, but particularly for the baby for neurocognitive development, and it's something you can't recoup later. All that neurocognitive development happens in utero."

With a nearly $3.5 million grant from the National Institutes of Health for a five-year study, Koenig will test whether a probiotic can enhance dietary iron absorption and improve iron status in pregnancy. Probiotics are "live microorganisms which, when administered in adequate amounts, can confer a health benefit on the host," according to Koenig's abstract.

"A lot of times when we think about iron deficiency, we think, 'Let's just encourage the mom to eat an iron-rich diet, and we'll give them a supplement and it'll take care of the problem,'" she said. "But it's much more complex than that."

How will the study work?

Participants in Koenig's study will be given the probiotic Lactiplantibacillus plantarum 299v (LP299V), which has been shown to change the gut microbiome and increase the absorption of iron.

In the study of about 200 people, one group will take the commercially available oral LP299V supplement twice daily with a standard prenatal supplement containing iron, starting from 10 to 16 weeks gestational age, until the time of labor. The other group, the control group, will take the regular prenatal vitamin and a placebo pill in place of the probiotic.

The study will target people who have low levels of hemoglobin, the iron-containing proteins in red blood cells that carry oxygen, but who are not yet anemic. Koenig said this is because it's easy to become anemic once you're "on the border," particularly in the second trimester.

"You see a dip in hemoglobin around that time, so we're hoping this prevents that," she said.

Koenig hypothesizes that those taking the probiotic will have lower rates of maternal iron deficiency anemia than those taking just the prenatal vitamin.

The research team will test the gut microbiome to see if the probiotic produces changes that could help with iron absorption. In addition, Koenig and her team will collect placenta and cord blood at the time of delivery to see if the changes in the mother's iron levels were transferred to the baby. They will also conduct neurocognitive developmental tests on the babies to help determine if there are differences between babies born to moms who took the probiotic versus those who didn't.

An earlier feasibility study found that the probiotic also helped with GI symptoms associated with iron supplements, which is important because those symptoms can cause people to stop taking the prenatal vitamin, Koenig said. This study will explore whether the probiotic is effective in a larger sample than the pilot study.

"This trial has the potential to transform prenatal care and health outcomes for hundreds of thousands of pregnant people and their children in the U.S. and millions worldwide," Koenig said.