Document Type : Review articles


1 College of Medicine/ Department of Obstetrics and Gynecology Mustansiriyah University, Baghdad, Iraq

2 department of pediatrics, college of medicine, Mustansiriyah university Iraq

3 Pathology and Forensic Medicine Department /College of Medicine, Mustansiriyah University, Baghdad, Iraq


Probiotic use to improve health is not new; but recently, it has attracted much attention concerning human health and diseases. The human gut is a delicate ecosystem where bacteria and host cells interact with each other. This is an important part of gut homeostasis and human development.  Disruption of this sensitive ecosystem may have detrimental health repercussions linked to impaired gut microbiota (GM). GM were extensively examined as an underlying mechanism for disease development and progression. Additionally, it was used as a tailored method for preventing and treating disease. Because of the strong association between GM, health, and disease, there has been much interest in employing probiotics or living microorganisms, to regulate GM to prevent or cure specific diseases. Herein, probiotics' role in enhancing women's and pediatric well-being was addressed as a marker of disease and as therapeutic avenues; where we discussed probiotics indications, efficacy, safety profiles, and future prospects in clinical practice.


Main Subjects

[1]      M.-J. Butel, “Probiotics, gut microbiota and health,” Médecine Mal. Infect., vol. 44, no. 1, pp. 1–8, 2014.
[2]      S. Runge and S. P. Rosshart, “The mammalian metaorganism: A holistic view on how microbes of all Kingdoms and niches shape local and systemic immunity,” Front. Immunol., vol. 12, p. 702378, 2021.
[3]      R. W. P. Glowacki, M. J. Engelhart, and P. P. Ahern, “Controlled complexity: optimized systems to study the role of the gut microbiome in host physiology,” Front. Microbiol., vol. 12, p. 735562, 2021.
[4]      Y. Fan and O. Pedersen, “Gut microbiota in human metabolic health and disease,” Nat. Rev. Microbiol., vol. 19, no. 1, pp. 55–71, 2021.
[5]      M. H. Mohajeri et al., “The role of the microbiome for human health: from basic science to clinical applications,” Eur. J. Nutr., vol. 57, pp. 1–14, 2018.
[6]      L. Rizzetto, F. Fava, K. M. Tuohy, and C. Selmi, “Connecting the immune system, systemic chronic inflammation and the gut microbiome: the role of sex,” J. Autoimmun., vol. 92, pp. 12–34, 2018.
[7]      C. B. Marzeta, F. Burgos, M. Del Compare, I. Gerold, O. Tabacco, and G. Vinderola, “Approach to probiotics in pediatrics: the role of Lactobacillus rhamnosus GG,” Acceso abiert, vol. 120, pp. e1–e7, 2022.
[8]      E. B. Hollister et al., “Structure and function of the healthy pre-adolescent pediatric gut microbiome,” Microbiome, vol. 3, no. 1, pp. 1–13, 2015.
[9]      M. E. Sanders and M. L. Marco, “Food formats for effective delivery of probiotics,” Annu. Rev. Food Sci. Technol., vol. 1, pp. 65–85, 2010.
[10]    R. C. Reuben, M. M. M. Y. Elghandour, O. Alqaisi, J. W. Cone, O. Márquez, and A. Z. M. Salem, “Influence of microbial probiotics on ruminant health and nutrition: sources, mode of action and implications,” J. Sci. Food Agric., vol. 102, no. 4, pp. 1319–1340, 2022.
[11]    J. Suez, N. Zmora, E. Segal, and E. Elinav, “The pros, cons, and many unknowns of probiotics,” Nat. Med., vol. 25, no. 5, pp. 716–729, 2019.
[12]    S. Fijan et al., “Health professionals’ knowledge of probiotics: an international survey,” Int. J. Environ. Res. Public Health, vol. 16, no. 17, p. 3128, 2019.
[13]    J. H. H. M. van de Wijgert and M. C. Verwijs, “Lactobacilli‐containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs,” BJOG An Int. J. Obstet. Gynaecol., vol. 127, no. 2, pp. 287–299, 2020.
[14]    T. Teame et al., “Paraprobiotics and postbiotics of probiotic Lactobacilli, their positive effects on the host and action mechanisms: A review,” Front. Nutr., vol. 7, p. 570344, 2020.
[15]    N. Ghaddar, A. El Roz, G. Ghssein, and J.-N. Ibrahim, “Emergence of vulvovaginal candidiasis among Lebanese pregnant women: prevalence, risk factors, and species distribution,” Infect. Dis. Obstet. Gynecol., vol. 2019, 2019.
[16]    W. Nori, F. Shallal, and M. A. G. Zghair, “Aspirin Effect on Mid Luteal Phase Doppler Indices in Patients with Recurrent Pregnancy Loss,” Int. J. Pharm. Res., vol. 12, no. 3, pp. 2929–2934, 2020.
[17]    M. Afrakhteh, “Probiotics and treatment of vulvovaginal candidiasis,” Int J Enteric Pathog, vol. 6, no. 1, pp. 22–26, 2018.
[18]    F. S. Farhan, W. Nori, I. T. A. Al Kadir, and B. H. Hameed, “Can fetal heart lie? Intrapartum CTG changes in COVID-19 mothers,” J. Obstet. Gynecol. India, vol. 72, no. 6, pp. 479–484, 2022.
[19]    M. Fu, X. Zhang, Y. Liang, S. Lin, W. Qian, and S. Fan, “Alterations in vaginal microbiota and associated metabolome in women with recurrent implantation failure,” MBio, vol. 11, no. 3, pp. e03242-19, 2020.
[20]    A. Moreira-Rosário et al., “Gut microbiota diversity and C-reactive protein are predictors of disease severity in COVID-19 patients,” Front. Microbiol., vol. 12, p. 705020, 2021.
[21]    A. I. Ali, W. N. M. Hassan, and S. Alrawi, “A copeptin as a predictor marker for insulin resistance among women with polycystic ovary syndrome,” Curr. Womens. Health Rev., vol. 18, no. 4, pp. 67–72, 2022.
[22]    L. Zhou et al., “Characteristic gut microbiota and predicted metabolic functions in women with PCOS,” Endocr. Connect., vol. 9, no. 1, p. 63, 2020.
[23]    F. He and Y. Li, “Role of gut microbiota in the development of insulin resistance and the mechanism underlying polycystic ovary syndrome: a review,” J. Ovarian Res., vol. 13, no. 1, pp. 1–13, 2020.
[24]    O. Tsonis, F. Gkrozou, and M. Paschopoulos, “Microbiome affecting reproductive outcome in ARTs,” J. Gynecol. Obstet. Hum. Reprod., vol. 50, no. 3, p. 102036, 2021.
[25]    P. Punzón-Jiménez and E. Labarta, “The impact of the female genital tract microbiome in women health and reproduction: A review,” J. Assist. Reprod. Genet., vol. 38, no. 10, pp. 2519–2541, 2021.
[26]    C. Blancafort and J. Llácer, “Can probiotics enhance fertility outcome? Capacity of probiotics as a single intervention to improve the feminine genital tract microbiota in non-symptomatic reproductive-aged women,” Front. Endocrinol. (Lausanne)., vol. 13, 2022.
[27]    N. Zhang, X. Liao, Y. Zhang, M. Li, W. Wang, and S. Zhai, “Probiotic supplements for relieving stress in healthy participants: A protocol for systematic review and meta-analysis of randomized controlled trials,” Medicine (Baltimore)., vol. 98, no. 20, 2019.
[28]    S. Pourmollaei et al., “Anticancer effect of bacteria on cervical cancer: Molecular aspects and therapeutic implications,” Life Sci., vol. 246, p. 117413, 2020.
[29]    Y.-C. Park et al., “A phase 1/2a, dose-escalation, safety and preliminary efficacy study of oral therapeutic vaccine in subjects with cervical intraepithelial neoplasia 3,” J. Gynecol. Oncol., vol. 30, no. 6, 2019.
[30]    G. Qiu, Y. Yu, Y. Wang, and X. Wang, “The significance of probiotics in preventing radiotherapy-induced diarrhea in patients with cervical cancer: A systematic review and meta-analysis,” Int. J. Surg., vol. 65, pp. 61–69, 2019.
[31]    J. J. Goedert et al., “Investigation of the association between the fecal microbiota and breast cancer in postmenopausal women: a population-based case-control pilot study,” JNCI J. Natl. Cancer Inst., vol. 107, no. 8, 2015.
[32]    Q. Chen et al., “Lactic Acid Bacteria: A Promising Tool for Menopausal Health Management in Women,” Nutrients, vol. 14, no. 21, p. 4466, 2022.
[33]    C.-S. Kim et al., “Probiotic supplementation improves cognitive function and mood with changes in gut microbiota in community-dwelling older adults: a randomized, double-blind, placebo-controlled, multicenter trial,” Journals Gerontol. Ser. A, vol. 76, no. 1, pp. 32–40, 2021.
[34]    B. Sánchez, S. Delgado, A. Blanco‐Míguez, A. Lourenço, M. Gueimonde, and A. Margolles, “Probiotics, gut microbiota, and their influence on host health and disease,” Mol. Nutr. Food Res., vol. 61, no. 1, p. 1600240, 2017.
[35]    A. B. Roomi, W. Nori, and S. H. Al-Badry, “The value of serum adiponectin in osteoporotic women: does weight have an effect?,” J. Obes., vol. 2021, 2021.
[36]    S. Maffei, F. Forini, P. Canale, G. Nicolini, and L. Guiducci, “Gut microbiota and sex hormones: crosstalking players in cardiometabolic and cardiovascular disease,” Int. J. Mol. Sci., vol. 23, no. 13, p. 7154, 2022.
[37]    K. Łagowska, A. M. Malinowska, B. Zawieja, and E. Zawieja, “Improvement of glucose metabolism in pregnant women through probiotic supplementation depends on gestational diabetes status: meta-analysis,” Sci. Rep., vol. 10, no. 1, p. 17796, 2020.
[38]    A. Pakmehr, H.-S. Ejtahed, N. Shirzad, M. Hemmatabadi, S. Farhat, and B. Larijani, “Preventive effect of probiotics supplementation on occurrence of gestational diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials,” Front. Med., vol. 9, 2022.
[39]    K. L. Lindsay et al., “Impact of probiotics in women with gestational diabetes mellitus on metabolic health: a randomized controlled trial,” Am. J. Obstet. Gynecol., vol. 212, no. 4, pp. 496-e1, 2015.
[40]    R. Movaghar, A. Farshbaf-Khalili, M. E. MirzaRezaei, and M. Shahnazi, “The Effect of Probiotics or Synbiotics on the Hypertensive Disorders of Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-analysis,” J. Caring Sci., vol. 11, no. 2, p. 94, 2022.
[41]    L. Huang et al., “Gut microbiota changes in preeclampsia, abnormal placental growth and healthy pregnant women,” BMC Microbiol., vol. 21, no. 1, pp. 1–9, 2021.
[42]    K. R. Dhanasekar, B. Shilpa, N. Gomathy, and S. Kundavi, “Prenatal probiotics: The way forward in prevention of preterm birth,” J. Clin. Gynecol. Obstet., vol. 8, no. 3, pp. 63–69, 2019.
[43]    E. Bayar, P. R. Bennett, D. Chan, L. Sykes, and D. A. MacIntyre, “The pregnancy microbiome and preterm birth,” in Seminars in immunopathology, 2020, vol. 42, pp. 487–499.
[44]    W. Nori and H. Ban, “Vaginal microbes confounders and implications on women’s health,” World J. Clin. Cases, vol. 11, no. 9, p. 2119, 2023.
[45]    M. Green, K. Arora, and S. Prakash, “Microbial medicine: prebiotic and probiotic functional foods to target obesity and metabolic syndrome,” Int. J. Mol. Sci., vol. 21, no. 8, p. 2890, 2020.
[46]    G. L. Su et al., “AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders,” Gastroenterology, vol. 159, no. 2, pp. 697–705, 2020.
[47]    H. Szajewska, M. Kołodziej, D. Gieruszczak‐Białek, A. Skorka, M. Ruszczyński, and R. Shamir, “Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children–a 2019 update,” Aliment. Pharmacol. Ther., vol. 49, no. 11, pp. 1376–1384, 2019.
[48]    “Commercial probiotic products: a call for improved quality control. A position paper by the ESPGHAN Working Group for Probiotics and Prebiotics,” J. Pediatr. Sanja Hojsak, Iva Canani, Roberto Berni Guarino, Alfredo Indrio, Flavia Pot, Bruno Shamir, Raanan Szajewska, Hania Vandenplas, Yvan Van Goudoever, Johannes Gastroenterol. Nutr., vol. 65, no. 1, pp. 117–124, 2017.
[49]    A. Fiocchi et al., “World Allergy Organization-McMaster University guidelines for allergic disease prevention (GLAD-P): probiotics,” World Allergy Organ. J., vol. 8, no. 1, pp. 1–13, 2015.
[50]    H. Szajewska et al., “Use of probiotics for the management of acute gastroenteritis in children: an update,” J. Pediatr. Gastroenterol. Nutr., vol. 71, no. 2, pp. 261–269, 2020.
[51]    H. Szajewska et al., “Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics,” J. Pediatr. Gastroenterol. Nutr., vol. 58, no. 4, pp. 531–539, 2014.
[52]    R. M. Stilling, T. G. Dinan, and J. F. Cryan, “Microbial genes, brain & behaviour–epigenetic regulation of the gut–brain axis,” Genes, Brain Behav., vol. 13, no. 1, pp. 69–86, 2014.
[53]    S. Ghaisas, J. Maher, and A. Kanthasamy, “Gut microbiome in health and disease: Linking the microbiome–gut–brain axis and environmental factors in the pathogenesis of systemic and neurodegenerative diseases,” Pharmacol. Ther., vol. 158, pp. 52–62, 2016.
[54]    M. C. Cenit, Y. Sanz, and P. Codoñer-Franch, “Influence of gut microbiota on neuropsychiatric disorders,” World J. Gastroenterol., vol. 23, no. 30, p. 5486, 2017.
[55]    A. Thapar, M. Cooper, O. Eyre, and K. Langley, “Practitioner review: what have we learnt about the causes of ADHD?,” J. Child Psychol. Psychiatry, vol. 54, no. 1, pp. 3–16, 2013.
[56]    A. Tomova et al., “Gastrointestinal microbiota in children with autism in Slovakia,” Physiol. Behav., vol. 138, pp. 179–187, 2015.
[57]    D.-W. Kang et al., “Microbiota transfer therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study,” Microbiome, vol. 5, no. 1, pp. 1–16, 2017.
[58]    M. H. Hsieh and J. Versalovic, “The human microbiome and probiotics: implications for pediatrics,” Curr. Probl. Pediatr. Adolesc. Health Care, vol. 38, no. 10, p. 309, 2008.
[59]    D. Munblit et al., “Human milk and allergic diseases: an unsolved puzzle,” Nutrients, vol. 9, no. 8, p. 894, 2017.
[60]    N. Dhopatkar, J. L. Keeler, H. Mutwalli, K. Whelan, J. Treasure, and H. Himmerich, “Gastrointestinal symptoms, gut microbiome, probiotics and prebiotics in Anorexia Nervosa: a review of mechanistic rationale and clinical evidence,” Psychoneuroendocrinology, p. 105959, 2022.