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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

How to Choose the Best Pregnancy Probiotics

Written by Michael Ruscio on June 29, 2024

Multi-Strain Probiotics May Give You and Your Baby a Health Edge

Probiotics are one of the most effective tools we have in our gut health arsenal. And a large body of data shows probiotics help with a wide array of conditions. But are they safe or even needed during pregnancy? And if so, what are the best pregnancy probiotics?

In this article, I’ll unpack the research and share some insights from our experience in the clinic when using probiotics during pregnancy. Let’s start with some key background info.

What are the Benefits of Probiotics?

Probiotics are live microorganisms (like healthy bacteria and fungi) that have health benefits for the person taking them. 

I mentioned in the intro that probiotics (good bacteria) are a very effective tool in the gut health arena. But their benefits aren’t just limited to the digestive system. High-quality research trials have found probiotics may: 

This list is pretty fantastic, but I don’t want to leave you with the impression that probiotics are a panacea—they tend to work best in combination with other foundational measures like diet and lifestyle. 

Having great digestive health can translate into great overall health—this may be because your gut microbiota communicates with practically every organ system in your body. Having a healthy gut may also help ensure a healthy pregnancy, so let’s take a look at the particulars.

Gut Health and Pregnancy

Excellent gut health is important for everyone, and pregnant women are no exception.  

A healthy gut during pregnancy may specifically [24]:

  • Reduce the risk of gestational diabetes by moderating the increase in fat mass and insulin resistance.
  • Manage increased inflammation and help to maintain a balanced immune response.
  • Ensure efficient nutrient absorption for baby’s growth and development.
  • Protect against pathogenic bacteria (like Listeria monocytogenes).
  • Reduce the risk of pregnancy complications (like preterm delivery) [25].
  • Protect against excessive weight gain and high blood pressure, and support better metabolic health.
  • Protect the baby against brain health disorders later in life.
  • Improve the gut health of the baby [25].

Part of the equation when it comes to a healthy gut is a balanced gut microbiome. But during pregnancy, the gut microbiome undergoes significant changes.

These alterations may lead to an increased risk of gestational diabetes, high blood pressure, infections, excessive weight gain, metabolic syndrome, and also impact the baby’s future health [24].

So, how do you create a healthy gut during pregnancy (and in general)? In the clinic, we encourage foundational strategies (backed up by science) like following a whole-foods dietary plan, exercising appropriately, spending time in nature, getting restful sleep, and managing stress [24].

In addition to these, research suggests that adding probiotic supplements during pregnancy may take your foundations to the next level [24]. But probiotics are still not widely recommended by many providers during pregnancy. Let me share the research and if there are any risks to consider.

Probiotics During Pregnancy: Research & Risks

Pregnancy outcomes are improved when moms take probiotics during pregnancy. 

For example, their babies tend to have a lower risk of ear and respiratory tract infections [26], eczema (atopic dermatitis) [27], intestinal fungal overgrowth [28], necrotizing enterocolitis (a serious infection mostly in premature infants), and death [27, 29]. They also have a slightly greater gestational age, which may translate into a healthier birth weight and better outcomes overall [27].

These are all excellent advantages for the baby, but mom receives a myriad of benefits from probiotic supplements too. Here are some of the effects of probiotics for pregnant women:

  • Lower risk of vaginal bacterial infections [25]
  • Lower risk of excessive weight gain [25]
  • Lower risk of gestational diabetes  [25]
  • Increased gut microbial diversity [30]
  • Improved immune system response in preparation for labor [31]

Despite research showing probiotics are beneficial during and after pregnancy, controversy still exists. I want to unpack why some providers may be hesitant to recommend probiotics during pregnancy and share a little more about the current perspective.

Probiotics During Pregnancy: Potential Risks

Pregnancy can be a time of unknowns, so it’s important to be cautious about what you’re putting into your body, especially pregnancy supplements like prenatal vitamins and probiotics. Many providers may shy away from the use of probiotics for women who are planning to conceive or those who are pregnant.

This hesitancy may be due to the previous lack of data looking at probiotics during pregnancy, fear about giving live bacteria to women who may have a compromised immune system, or the general lack of regulation in the market since probiotics are regulated like dietary supplements. While these may have been valid concerns previously, more research has been conducted. 

Recent systematic reviews and meta-analyses have deemed probiotics safe during and after pregnancy as well as during lactation (breastfeeding) with no significant adverse effects [32, 33].

Now that we’ve cleared up the confusion about probiotics during pregnancy, let’s get into the best pregnancy probiotics.

The Best Pregnancy Probiotics

In general, probiotics consist of 3 main categories, which are then divided into strain type:

  1. Lactobacillus and Bifidobacterium blends
  2. Saccharomyces boulardii 
  3. Soil-based

The two types most often studied and recommended for pregnant women’s health are Lactobacillus and Bifidobacterium. This doesn’t mean the other two categories shouldn’t be used or aren’t helpful, there just isn’t much in the way of high-quality, pregnancy-specific research (double-blind placebo-controlled trials) at this time. 

There isn’t one specific probiotic (type or strain) that’s best for pregnancy, but there are a few strains that have documented benefits for pregnant women.

One go-to recommendation is a probiotic that contains the strains Lactobacillus rhamnosus Gr-1 and Lactobacillus reuteri RC-14. These strains may be effective at preventing group B streptococcus [34, 35], especially when taken after 30 weeks of pregnancy [36]. 

When a woman is group B positive, antibiotics are the standard treatment. Antibiotics can have a significant impact on gut health, especially on the baby’s developing gut microbiome, so it’s best to avoid their use if possible. Using these probiotic strains may help prevent the use of antibiotics during labor.

In addition to these, here’s a table detailing various probiotics and their potential benefits during pregnancy:

            Probiotic  Potential Benefit
Lactobacillus rhamnosus HN001
  • May reduce depression and anxiety scores during and post-pregnancy [37]
  • May reduce the risk of gestational diabetes mellitus, especially in women at higher risk [38]
LactobacillusBifidobacteriumStreptococcus thermophilus
  • May improve the vaginal microbiome to help prevent bacterial vaginosis [39]
  • May relieve constipation [40]
Bifidobacterium
  • May improve IBS symptoms, reduce anxiety and depression, and enhance sleep quality [41]
Lactobacillus acidophilusLactobacillus caseiBifidobacterium bifidum

In pregnant women with gestational diabetes [42]:

  • May improve fasting glucose levels, serum insulin, and insulin resistance
  • May reduce triglycerides and VLDL cholesterol levels
BifidobacteriumLactobacillus
  • May reduce infant mortality rates [29]

When choosing a probiotic, it’s not necessary to get super specific about which strain you choose [40, 43, 44]. It’s probably best to opt for a high-quality Lacto/Bifido blend that contains multiple strains. 

Here’s a graphic detailing how you go about choosing a quality probiotic supplement:

best pregnancy probiotics

At this point, you may be wondering if you can forgo supplements and instead focus on pre- and probiotic foods. 

Using Pre- and Probiotic Foods During Pregnancy

Using prebiotics and probiotics, boosting dietary fiber, and consuming fermented foods rich in probiotics and enzymes (like yogurt, kefir, and miso) can support healthy gut bacteria balance. But there are some considerations when adding these types of food to your diet when you’re expecting. 

Some fermented foods (cheeses, kimchi, kombucha, sauerkraut, miso, pickles, and apple cider vinegar) can certainly provide a therapeutic dose of probiotics. But fermented foods aren’t automatically a source of proven probiotics—they may contain live bacteria but that bacteria may not have been shown to improve human health. Additionally, many of the microbes in fermented foods may not withstand the acidity of the stomach or small intestine to be able to provide clinical benefit [45]. 

Some fermented foods, especially those that are homemade or unpasteurized, such as certain cheeses and milk, may contain harmful bacteria that can cause infections. Choosing pasteurized or commercially prepared products may reduce this risk [46].

Fermented foods may also cause bloating and gas [47] and they can increase histamine levels—for people sensitive to histamine, this can mean headaches, rashes, and digestive upset [48].

And finally, many fermented foods, like sauerkraut and kimchi, are high in sodium, which can be a concern during pregnancy as it could contribute to increased blood pressure [49, 50].

To sum this up, fermented foods are nutritious options that can provide some probiotics, but they may not always offer the same concentration or strains of beneficial bacteria found in supplements. 

Combining fermented foods with specific prenatal probiotic supplements can be a strategic approach to maximize benefits. But it’s always best for pregnant women to discuss their dietary and supplement choices with a trusted healthcare professional.

Opt for Multi-Strain Probiotics During Pregnancy 

The health of the gut microbiome during pregnancy is essential for the health of mom and baby. Probiotics are a powerful tool for supporting gut microbiome balance (and overall health) but their use in pregnancy is still not widely recommended. 

Research has confirmed the benefits and safety of probiotics during pregnancy. Various strains of Lactobacillus and Bifidobacterium have the most research in pregnant women, but it’s probably not necessary to seek out one specific strain. In the clinic, we tend to recommend a high-quality multi-strain probiotic. 

If you’d like to take a deep dive into all things gut health-related, check out my book Healthy Gut Healthy You. If you’re in need of more personalized support, contact us at the Ruscio Institute for Functional Health

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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