Gut Microbiota Influence on Metabolic Health in Pregnancy

A balanced gut microbial community is instrumental in modulating maternal metabolism throughout pregnancy, a period of profound hormonal, immunological and metabolic adaptations. Shifts in the composition and functional capacity of the gut microbiota help to regulate energy harvest, glucose homeostasis, lipid metabolism and immune tolerance. Under healthy conditions, increasing dominance of fibre-fermenting bacteria generates metabolites such as short-chain fatty acids that promote insulin sensitivity and anti-inflammatory pathways. Conversely, dysbiosis—a destabilisation of microbial balance—can lead to impaired bile acid transformation, enhanced intestinal permeability and low-grade inflammation, all of which contribute to pregnancy complications including intrahepatic cholestasis, gestational diabetes mellitus and preterm birth. The gut microbiota thus represents a dynamic interface between diet, host metabolic signalling and obstetric outcomes, with diagnostic and therapeutic potential in maternal–foetal medicine.

Research from Nature Portfolio

Recent studies have elucidated mechanisms by which particular gut bacteria modulate bile acid metabolism to drive pregnancy-specific pathology. One investigation revealed that enrichment of Bacteroides fragilis in affected individuals inhibits the farnesoid X receptor pathway in the liver via its bile salt hydrolase activity, leading to excessive bile acid synthesis and impaired hepatic export, hallmarks of intrahepatic cholestasis of pregnancy. Modulation of this microbiota–bile acid–FXR axis emerges as a promising therapeutic target. In parallel, detailed profiling of women with gestational diabetes has uncovered progressive changes in gut bacterial diversity and phylum ratios, notably an increased Firmicutes : Bacteroidetes index and elevated abundance of species such as Faecalibacterium and Collinsella. These taxa show strong correlations with glycaemic control and inflammatory markers, implicating microbial shifts in the aetiology and persistence of metabolic dysfunction during and after pregnancy.

Gut Microbiota Influence on Metabolic Health in Pregnancy publication trend

The graph below shows the total number of articles in gut microbiota influence on metabolic health in pregnancy across all publications each year (not limited to Nature Index journals).

Technical terms

Gut microbiota: The community of microorganisms residing in the gastrointestinal tract, influencing host metabolism and immunity.

Dysbiosis: An imbalance in the composition or function of the gut microbiota, often associated with disease states.

Gestational diabetes mellitus (GDM): A form of glucose intolerance first recognised during pregnancy that poses risks to maternal and foetal health.

Bile salt hydrolase (BSH): A bacterial enzyme that deconjugates bile acids, altering their signalling and metabolic effects.

Farnesoid X receptor (FXR): A host nuclear receptor that regulates bile acid, lipid and glucose homeostasis, with roles in liver function.

Short-chain fatty acids (SCFAs): Metabolites produced by microbial fermentation of dietary fibres, which modulate insulin sensitivity and inflammatory responses.

References

1. Intestinal flora and pregnancy complications: Current insights and future prospects. iMeta (2024).
2. Gut microbiota alters host bile acid metabolism to contribute to intrahepatic cholestasis of pregnancy. Nature Communications (2023).
3. Spatiotemporal patterns of the pregnancy microbiome and links to reproductive disorders. Science Bulletin (2024).
4. The Gut Microbiome Dynamically Associates with Host Glucose Metabolism throughout Pregnancy: Longitudinal Findings from a Matched Case‐Control Study of Gestational Diabetes Mellitus. Advanced Science (2023).