ascorbic-acid and Pre-Eclampsia

Vitamin C has been suggested as beneficial in preventing and curing the common cold, decreasing the incidence of preterm delivery and preeclampsia, decreasing risk of cancer and cardiovascular disease, and improving the quality of life by inhibiting blindness and dementia. In this article, we review the hypothesized mechanisms of these purported health benefits and the evidence behind such claims.

Topics: Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Common Cold; Dementia; Female; Humans; Neoplasms; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Vision Disorders; Vitamins

Miscarriage is a common complication of pregnancy that can be caused by a wide range of factors. Poor dietary intake of vitamins has been associated with an increased risk of miscarriage, therefore supplementing women with vitamins either prior to or in early pregnancy may help prevent miscarriage.. The objectives of this review were to determine the effectiveness and safety of any vitamin supplementation, on the risk of spontaneous miscarriage.. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (6 November 2015) and reference lists of retrieved studies.. All randomised and quasi-randomised trials comparing supplementation during pregnancy with one or more vitamins with either placebo, other vitamins, no vitamins or other interventions. We have included supplementation that started prior to conception, periconceptionally or in early pregnancy (less than 20 weeks' gestation).. Three review authors independently assessed trials for inclusion, extracted data and assessed trial quality. We assessed the quality of the evidence using the GRADE approach. The quality of evidence is included for numerical results of outcomes included in the 'Summary of findings' tables.. We included a total of 40 trials (involving 276,820 women and 278,413 pregnancies) assessing supplementation with any vitamin(s) starting prior to 20 weeks' gestation and reporting at least one primary outcome that was eligible for the review. Eight trials were cluster-randomised and contributed data for 217,726 women and 219,267 pregnancies in total.Approximately half of the included trials were assessed to have a low risk of bias for both random sequence generation and adequate concealment of participants to treatment and control groups. Vitamin C supplementation There was no difference in the risk of total fetal loss (risk ratio (RR) 1.14, 95% confidence interval (CI) 0.92 to 1.40, seven trials, 18,949 women; high-quality evidence); early or late miscarriage (RR 0.90, 95% CI 0.65 to 1.26, four trials, 13,346 women; moderate-quality evidence); stillbirth (RR 1.31, 95% CI 0.97 to 1.76, seven trials, 21,442 women; moderate-quality evidence) or adverse effects of vitamin supplementation (RR 1.16, 95% CI 0.39 to 3.41, one trial, 739 women; moderate-quality evidence) between women receiving vitamin C with vitamin E compared with placebo or no vitamin C groups. No clear differences were seen in the risk of total fetal loss or miscarriage between women receiving any other combination of vitamin C compared with placebo or no vitamin C groups. Vitamin A supplementation No difference was found in the risk of total fetal loss (RR 1.01, 95% CI 0.61 to 1.66, three trials, 1640 women; low-quality evidence); early or late miscarriage (RR 0.86, 95% CI 0.46 to 1.62, two trials, 1397 women; low-quality evidence) or stillbirth (RR 1.29, 95% CI 0.57 to 2.91, three trials, 1640 women; low-quality evidence) between women receiving vitamin A plus iron and folate compared with placebo or no vitamin A groups. There was no evidence of differences in the risk of total fetal loss or miscarriage between women receiving any other combination of vitamin A compared with placebo or no vitamin A groups. Multivitamin supplementation There was evidence of a decrease in the risk for stillbirth among women receiving multivitamins plus iron and folic acid compared iron and folate only groups (RR 0.92, 95% CI 0.85 to 0.99, 10 trials, 79,851 women; high-quality evidence). Although total fetal loss was lower in women who were given multivitamins without folic acid (RR 0.49, 95% CI 0.34 to 0.70, one trial, 907 women); and multivitamins with or without vitamin A (RR 0.60, 95% CI 0.39 to 0.92, one. Taking any vitamin supplements prior to pregnancy or in early pregnancy does not prevent women experiencing miscarriage. However, evidence showed that women receiving multivitamins plus iron and folic acid had reduced risk for stillbirth. There is insufficient evidence to examine the effects of different combinations of vitamins on miscarriage and miscarriage-related outcomes.

Topics: Abortion, Habitual; Abortion, Spontaneous; Antioxidants; Ascorbic Acid; Dietary Supplements; Female; Folic Acid; Humans; Iron; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Prenatal Care; Randomized Controlled Trials as Topic; Stillbirth; Vitamin A; Vitamins

Vitamin C supplementation may help reduce the risk of pregnancy complications such as pre-eclampsia, intrauterine growth restriction and maternal anaemia. There is a need to evaluate the efficacy and safety of vitamin C supplementation in pregnancy.. To evaluate the effects of vitamin C supplementation, alone or in combination with other separate supplements on pregnancy outcomes, adverse events, side effects and use of health resources.. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies.. All randomised or quasi-randomised controlled trials evaluating vitamin C supplementation in pregnant women. Interventions using a multivitamin supplement containing vitamin C or where the primary supplement was iron were excluded.. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.. Twenty-nine trials involving 24,300 women are included in this review. Overall, 11 trials were judged to be of low risk of bias, eight were high risk of bias and for 10 trials it was unclear. No clear differences were seen between women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control for the risk of stillbirth (risk ratio (RR) 1.15, 95% confidence intervals (CI) 0.89 to 1.49; 20,038 participants; 11 studies; I² = 0%; moderate quality evidence), neonatal death (RR 0.79, 95% CI 0.58 to 1.08; 19,575 participants; 11 studies; I² = 0%), perinatal death (average RR 1.07, 95% CI 0.77 to 1.49; 17,105 participants; seven studies; I² = 35%), birthweight (mean difference (MD) 26.88 g, 95% CI -18.81 to 72.58; 17,326 participants; 13 studies; I² = 69%), intrauterine growth restriction (RR 0.98, 95% CI 0.91 to 1.06; 20,361 participants; 12 studies; I² = 15%; high quality evidence), preterm birth (average RR 0.99, 95% CI 0.90 to 1.10; 22,250 participants; 16 studies; I² = 49%; high quality evidence), preterm PROM (prelabour rupture of membranes) (average RR 0.98, 95% CI 0.70 to 1.36; 16,825 participants; 10 studies; I² = 70%; low quality evidence), term PROM (average RR 1.26, 95% CI 0.62 to 2.56; 2674 participants; three studies; I² = 87%), and clinical pre-eclampsia (average RR 0.92, 95% CI 0.80 to 1.05; 21,956 participants; 16 studies; I² = 41%; high quality evidence).Women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control were at decreased risk of having a placental abruption (RR 0.64, 95% CI 0.44 to 0.92; 15,755 participants; eight studies; I² = 0%; high quality evidence) and had a small increase in gestational age at birth (MD 0.31, 95% CI 0.01 to 0.61; 14,062 participants; nine studies; I² = 65%), however they were also more likely to self-report abdominal pain (RR 1.66, 95% CI 1.16 to 2.37; 1877 participants; one study). In the subgroup analyses based on the type of supplement, vitamin C supplementation alone was associated with a reduced risk of preterm PROM (average RR 0.66, 95% CI 0.48 to 0.91; 1282 participants; five studies; I² = 0%) and term PROM (average RR 0.55, 95% CI 0.32 to 0.94; 170 participants; one study). Conversely, the risk of term PROM was increased when supplementation included vitamin C and vitamin E (average RR 1.73, 95% CI 1.34 to 2.23; 3060 participants; two studies; I² = 0%). There were no differences in the effects o. The data do not support routine vitamin C supplementation alone or in combination with other supplements for the prevention of fetal or neonatal death, poor fetal growth, preterm birth or pre-eclampsia. Further research is required to elucidate the possible role of vitamin C in the prevention of placental abruption and prelabour rupture of membranes. There was no convincing evidence that vitamin C supplementation alone or in combination with other supplements results in other important benefits or harms.

Topics: Anemia; Ascorbic Acid; Dietary Supplements; Female; Fetal Growth Retardation; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Randomized Controlled Trials as Topic; Vitamins

Preeclampsia, intrauterine growth restriction (IUGR), and placental abruption are obstetrical conditions that constitute the syndrome of ischemic placental disease or IPD, the leading cause of indicated preterm birth and an important cause of neonatal morbidity and mortality. While the phenotypic manifestations vary significantly for preeclampsia, IUGR, and abruption, these conditions may share a common underlying etiology as evidenced by: (1) shared clinical risk factors, (2) increased recurrence risk across pregnancies as well as increased co-occurrence of IPD conditions within a pregnancy, and (3) findings that suggest the underlying pathophysiologic processes may be similar. IPD is of major clinical importance and accounts for a large proportion of indicated preterm delivery ranging from the periviable to late preterm period. Successful prevention of IPD and resultant preterm delivery could substantially improve neonatal and maternal outcomes. This article will review the following topics: (1) The complicated research literature on aspirin and the prevention of preeclampsia and IUGR. (2) Research evidence on other medical interventions to prevent IPD. (3) New clinical interventions currently under investigations, including statins. (4) Current clinical recommendations for prevention of ischemic placental disease.

Topics: Abruptio Placentae; Anticoagulants; Ascorbic Acid; Aspirin; Calcium, Dietary; Dietary Supplements; Fatty Acids, Omega-3; Female; Fetal Growth Retardation; Fibrinolytic Agents; Humans; Ischemia; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Premature Birth; Risk Factors; Vitamin E

The water-soluble vitamins B6, B12 and C play important roles in maternal health as well as fetal development and physiology during gestation. This systematic review evaluates the risks and benefits of interventions with vitamins B6, B12 and C during pregnancy on maternal, neonatal and child health and nutrition outcomes. Relevant publications were identified by searching PubMed, Popline and Web of Science databases. Meta-analyses were conducted for outcomes where results from at least three controlled trials were available. Potential benefits of vitamin B6 supplementation were reduction in nausea and vomiting, improvement in dental health, and treatment of some cases of anaemia. In meta-analysis based on three small studies, vitamin B6 supplementation had a significant positive effect on birthweight (d = 217 g [95% confidence interval (CI) 130, 304]). Interventions with vitamin C alone or combined with vitamin E did not systematically reduce the incidence of pre-eclampsia, premature rupture of membranes, or other adverse pregnancy outcomes. In meta-analyses, vitamins C and E increased the risk of pregnancy-related hypertension (relative risk 1.10 [95% CI 1.02, 1.19]). Effects of vitamin B6 or C intervention on other neonatal outcomes, including preterm birth, low birthweight, and perinatal morbidity and mortality, were not significant. Data on child health outcomes were lacking. Despite the prevalence of vitamin B12 deficiency amongst populations with limited intake of animal source foods, no intervention trials have evaluated vitamin B12 supplementation before or during pregnancy. In conclusion, existing evidence does not justify vitamin C supplementation during pregnancy. Additional studies are needed to confirm positive effects of vitamin B6 supplementation on infant birthweight and other outcomes. While vitamin B12 supplementation may reduce the incidence of neural tube defects in the offspring based on theoretical considerations, research is needed to support this hypothesis.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Birth Weight; Child Welfare; Child, Preschool; Dietary Supplements; Female; Humans; Infant; Infant Nutritional Physiological Phenomena; Maternal Nutritional Physiological Phenomena; Maternal Welfare; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Randomized Controlled Trials as Topic; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency

Miscarriage is a common complication of pregnancy that can be caused by a wide range of factors. Poor dietary intake of vitamins has been associated with an increased risk of miscarriage, therefore supplementing women with vitamins either prior to or in early pregnancy may help prevent miscarriage.. The objectives of this review are to determine the effectiveness and safety of any vitamin supplementation, on the risk of spontaneous miscarriage, maternal adverse outcomes and fetal and infant adverse outcomes.. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (21 June 2010).. All randomised and quasi-randomised trials comparing one or more vitamins with either placebo, other vitamins, no vitamins or other interventions, prior to conception, periconceptionally or in early pregnancy (less than 20 weeks' gestation).. At least two review authors independently assessed trials for inclusion, extracted data and assessed trial quality.. We identified 28 trials assessing supplementation with any vitamin(s) starting prior to 20 weeks' gestation and reporting at least one primary outcome that was eligible for the review. Overall, the included trials involved 96,674 women and 98,267 pregnancies. Three trials were cluster randomised and combined contributed data for 62,669 women and 64,210 pregnancies in total. No significant differences were seen between women taking any vitamins compared with controls for total fetal loss (relative risk (RR) 1.04, 95% confidence interval (CI) 0.95 to 1.14), early or late miscarriage (RR 1.09, 95% CI 0.95 to 1.25) or stillbirth (RR 0.86, 95% CI 0.65 to 1.13) and most of the other primary outcomes, using fixed-effect models. Compared with controls, women given any type of vitamin(s) pre or peri-conception were more likely to have a multiple pregnancy (RR 1.38, 95% CI 1.12 to 1.70, three trials, 20,986 women).. Taking any vitamin supplements prior to pregnancy or in early pregnancy does not prevent women experiencing miscarriage or stillbirth. However, women taking vitamin supplements may be more likely to have a multiple pregnancy. There is insufficient evidence to examine the effects of different combinations of vitamins on miscarriage, stillbirth or other maternal and infant outcomes.

Topics: Abortion, Habitual; Abortion, Spontaneous; Ascorbic Acid; Dietary Supplements; Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Randomized Controlled Trials as Topic; Vitamin A; Vitamins

To determine whether supplementation with vitamins C and E during pregnancy reduces the risk of preeclampsia and other adverse maternal and perinatal outcomes.. Systematic review and metaanalysis of randomized controlled trials.. Nine trials involving a total of 19,810 women were included. Overall, there were no significant differences between the vitamin and placebo groups in the risk of preeclampsia (9.6% vs 9.6%; relative risk, 1.00, 95% confidence interval, 0.92-1.09). Similar results were obtained when subgroup analyses were restricted to women at high risk or low/moderate risk for preeclampsia. Women supplemented with vitamins C and E were at increased risk of developing gestational hypertension and premature rupture of membranes, and decreased risk of abruptio placentae. There were no significant differences between the vitamin and placebo groups in the risk of other adverse maternal or fetal/perinatal outcomes.. Supplementation with vitamins C and E during pregnancy does not prevent preeclampsia.

Topics: Ascorbic Acid; Dietary Supplements; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Vitamin E; Vitamins

The aim of this study is to review literature about the efficacy of low dose aspirin (LDA) and vitamins C/E (VCE) to prevent pre-eclampsia in women at high and low risk. Randomized clinical trials were included and stratified for high and low risk women. Inclusion criteria were: assignment of patients in treated or placebo groups, definition of pre-eclampsia according to the guidelines of the International Society for the Study of Hypertension in Pregnancy. Exclusion criteria were: omitting at least one of the inclusion criteria, trials involving women with pre-eclampsia at trial entry, studies investigating hypertensive disorders other than pre-eclampsia, prophylaxis of intrauterine growth restriction with low-dose aspirin or vitamins C/E, non-randomized studies and data reported in graphs or percentages. The incidence of pre-eclampsia, perinatal outcomes and adverse effects attributable to LDA and VCE were compared between treated women and placebo. Inter-studies heterogeneity was tested. P<0.05 was considered significant. pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. PRISMA guidelines were followed. Fifteen studies were pooled. LDA did not decrease the incidence of pre-eclampsia in high-risk (396/5025 - 8% vs placebo: 464/5027 - 9%; P=0.05; OR: 0.72; 95% CI: 0.51-1.00) and low-risk (137/4939 - 3% vs placebo: 166/4962 - 3%; P=0.10; OR: 0.82; 95% CI: 0.65-1.04) women. Similarly, VCE did not reduce the incidence of pre-eclampsia in high-risk (VCE: 250/1744 - 14% vs placebo: 275/1741 - 16%; P=0.24; OR: 0.84; 95% CI: 0.63-1.12) and low-risk (VCE: 56/935 - 6% vs placebo 47/942 - 5%; P=0.57; OR: 1.20; 95% CI: 0.82-1.75) women. In high-risk women, other hypertensive disorders were more frequent in VCE (121/1692 - 7%) than placebo (79/1693 - 5%; P=0.002). Perinatal outcomes were not improved by LDA or VCE.. there is no evidence to support the administration of LDA or VCE to prevent pre-eclampsia.

Topics: Antioxidants; Ascorbic Acid; Aspirin; Female; Humans; Platelet Aggregation Inhibitors; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Vitamin E

To perform a systematic review and meta-analysis of the effectiveness of combined vitamin C and E (vitCE) supplementation for the prevention of preeclampsia.. PubMED, Web of Science, and Cochrane Central Register of Controlled Trials from inception through June 2010, and bibliographies of review articles and eligible studies.. Fifteen eligible studies that evaluated vitCE supplementation for the prevention of preeclampsia were identified. On the basis of prespecified inclusion and exclusion criteria, 9 were included in the meta-analysis. All were randomized controlled trials. The reporting and methodologic quality of the included studies was assessed with the CONSORT checklist and the Jadad scale.. The 9 included studies had moderate-to-high CONSORT and Jadad scores. The incidence of preeclampsia was 9.7% (949 of 9833) in the vitCE group and 9.5% (946 of 9842) in the placebo group. A random effects model was used for pooling and no difference was found in the relative risk (RR) of preeclampsia between the vitCE and placebo groups (RR: 0.98; 95% confidence interval [CI]: 0.87-1.10). The incidence of gestational hypertension was 22.6% (1915 of 8491) in the vitCE group and 20.3% (1728 of 8500) in the placebo group (RR: 1.11, 95% CI: 1.05-1.17). The incidence of placental abruption was 0.58% (43 of 7379) in the vitCE group and 0.87% (64 of 7361) in the placebo group (RR: 0.67, 95% CI: 0.46-0.98). No significant differences were observed for other maternal and neonatal outcomes.. Combined VitCE supplementation does not decrease the risk of preeclampsia and should not be offered to gravidas for the prevention of preeclampsia or other pregnancy induced hypertensive disorders. Furthermore, combined supplementation with vitCE increased the risk of GH but decreased the risk of placental abruption. However, these latter associations may not be causal, especially since they were the product of multiple statistical comparisons, and the 95% CI around the point estimates almost included one.. After completion of this educational activity, the obstetrician/gynecologist should be better able to assess the causes of preeclampsia and related conditions; evaluate and interpret the evidence regarding the use of combined vitamins C and E in prevention of preeclampsia and related conditions; and interpret and understand the effects of the supplementation of vitamins C and E for the prevention of preeclampsia or other pregnancy induced hypertensive disorders.. Obstetricians & Gynecologists, Family Physicians.

Topics: Ascorbic Acid; Dietary Supplements; Drug Therapy, Combination; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Pregnancy; Vitamin E

To evaluate whether vitamin C and E co-supplementation of women at risk of preeclampsia can reduce maternal and neonatal disorders.. Electronic databases were searched up to May 2008 to find studies investigating pregnancy outcomes in women at risk of preeclampsia following exposure to combined vitamin C and E supplementation. The outcomes of interest were gestational hypertension, preeclampsia, preterm delivery, small for gestational age, and low birth weight. The relative risk (RR) and confidence interval (CI) for the individual studies were pooled and heterogeneity analysis was performed.. Seven studies involving 5969 pregnant women at risk of preeclampsia were included: 2982 received vitamin C and E and 2987 received placebo. The RRs are 1.3 (95% CI of 1.08-1.57, p = 0.0066) for gestational hypertension, 0.7 (95% CI of 0.58-1.08, P = 0.1653) for preeclampsia, 1.12 (95% CI of 0.96-1.32, p = 0.141) for preterm delivery, 1.04 (95% CI of 0.94-1.15, p = 0.4789) for small for gestational age, and 1.13 (95% CI of 1.004-1.27, p = 0.0429) for low birth weight. CONCLUSION. Combined vitamin C and E supplementation not only have no potential benefit in improvement of maternal and neonatal outcome but increase the risk of gestational hypertension in women at risk of preeclampsia and low birth weight in neonates.

Topics: Ascorbic Acid; Dietary Supplements; Drug Therapy, Combination; Female; Humans; Pre-Eclampsia; Pregnancy; Treatment Outcome; Vitamin E; Vitamins

Preeclampsia is characterized by increased lipid peroxidation and diminished antioxidant capacity; however, there is no consensus as to the extent of these conditions.. To assess the association of lipid peroxidation and antioxidant status with preeclampsia quantitatively using meta-analysis.. Systematic review and meta-analysis.. Studies were identified by performing an extensive search using BIOSIS (1986-2007), EMBASE (1986-2007), Medline (1986-2007), and the Cochrane database.. Standardized mean differences (SMD) with 95% confidence intervals (CI) were used in the meta-analysis and sources of heterogeneity were examined.. In the included studies, the overall SMD was a 1.21 nmol/mL increase in serum malondialdehyde in preeclampsia cases compared to controls (95% CI: 0.76, 1.66). Overall, total serum thiobarbituric acid-reactive substances SMD were 1.62 nmol/mL greater in cases than in controls (95% CI: 0.27, 2.96). The overall estimate SMD for serum vitamin E was 1.12 nmol/mL less in cases than controls (95% CI: -1.77, -0.48) and vitamin C SMD overall estimate was -0.53 (95%CI: -1.03, -0.02), significantly lower in cases compared with controls. The overall SMD for erythrocyte superoxide dismutase was -2.37 (95% CI: -4.76, 0.03), a marginally significant decrease in cases versus controls.. Established preeclampsia is associated with increased concentrations of oxidative stress markers including lipid peroxidation products, and a reduction in antioxidant concentrations.. Obstetricians & Gynecologists, Family Physicians.. After completion of this educational activity, the participant should be better able to describe the pattern of oxidative stress markers associated with preeclampsia, and interpret the available literature as it relates to oxidative stress and preeclampsia.

Topics: Antioxidants; Ascorbic Acid; Biomarkers; Female; Free Radical Scavengers; Humans; Lipid Peroxidation; Oxidative Stress; Pre-Eclampsia; Pregnancy; Superoxide Dismutase; Thiobarbituric Acid Reactive Substances; Vitamin E

Preeclampsia (PE) is an important and a leading cause of both maternal morbidity and adverse perinatal outcomes. Despite progress in perinatal medicine for patients with an established diagnosis of PE, a therapeutic approach other than termination of pregnancy was unsuccessful. Women predisposed to PE begin pregnancy with a certain degree of endothelial dysfunction, a lesion that precedes shallow placentation. The proposed sequence of events comprises endothelial dysfunction, defective trophoblast invasion, and consequential impaired placental perfusion, immune maladaptation and inflammation. The possible link between these could be oxidative stress by excessive production of reactive oxygen species coupled with inadequate or overwhelmed antioxidant defense mechanisms. These defense mechanisms, involving antioxidant vitamins and enzyme systems, may restrain the extent of damage caused by oxidative stress. Markers of oxidative stress in women with established PE were confirmed. Accordingly, these findings support an expected beneficial effect of antioxidant therapy in the prevention of PE and other pregnancy-related disorders. Numerous studies have been carried out in order to investigate this possible and simple prophylactic and/or therapeutic approach in prevention of oxidative stress and eventual reduction of PE and its perinatal complications. In this review the role of vitamin antioxidants in prevention and treatment of PE is discussed. Despite the logic behind using antioxidant vitamins, the data, thus far, are at best conflicting.

Topics: Antioxidants; Ascorbic Acid; Dietary Supplements; Female; Humans; Infant, Newborn; Oxidative Stress; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Reactive Oxygen Species; Vitamin E

The effect of combined vitamin C and E supplementation during pregnancy on the prevention of preeclampsia and major adverse infant outcomes has been reviewed. We searched MEDLINE and the Central Library of Controlled Trials of the Cochrane Library through August 2006 for relevant clinical trials. Interstudy heterogeneity was evaluated using the chi(2) statistic (Q statistic) test. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with a fixed or random-effects model as appropriate. Four trials that collectively randomized 4680 pregnant women to either the combination of vitamin C and vitamin E or placebo were included in the analysis. There were no significant differences between the vitamin and placebo groups in the risk of preeclampsia, 11% versus 11.4%, RR 0.97 (95% CI 0.82-1.13), fetal or neonatal loss, 2.6% versus 2.3%, RR 1.10 (95% CI 0.78-1.57), or small for gestational age (SGA) infant, 20.6% versus 20%, RR 0.94 (95% CI 0.74-1.19). Although there was a higher risk for preterm birth in the vitamin group, 19.5% versus 18%, RR 1.07 (95% CI 0.96-1.20), this finding was not significant. Combined vitamin C and E supplementation during pregnancy does not reduce the risk of preeclampsia, fetal or neonatal loss, small for gestational age infant, or preterm birth. Such supplementation should be discouraged unless solid supporting data from randomized trials become available.. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to recall that many methods have been used to prevent preeclampsia, state that increased oxidative stress has been postulated and many trials have used antioxidants to prevent the disease, and explain that MEDLINE analysis of the literature questions the use of vitamin C and E supplements.

Topics: Antioxidants; Ascorbic Acid; Dietary Supplements; Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Randomized Controlled Trials as Topic; Risk Assessment; United States; Vitamin E

The clinical use of antioxidants has gained considerable interest during the last decade. It was suggested from epidemiological studies that diets high in fruits and vegetables might help decrease the risk of cardiovascular disease. Therefore, supplements of vitamins C and E were applied through protocols aimed to prevent diseases such as atherosclerosis, preeclampsia or hypertension, thought to be mediated by oxidative stress. Despite the biological properties of these vitamins could account for an effective protection, as shown by several clinical and experimental studies, their efficacy remains controversial in the light of some recent clinical trials and meta-analyses. However, the methodology of these studies, criteria for selection of patients, the uncertain extent of progression of the disease when initiating supplementation, the lack of mechanistic studies containing basic scientific aspects, such as the bioavailability, pharmacokinetic properties, and the nature of the antioxidant sources of vitamins, could account for the inconsistency of the various clinical trials and meta-analyses assessing the efficacy of these vitamins to prevent human diseases. This review presents a survey of the clinical use of antioxidant vitamins E and C, proposing study models based on the biological effects of these compounds likely to counteract the pathophysiological mechanisms able to explain the structural and functional organ damage.

Topics: Antioxidants; Ascorbic Acid; Atherosclerosis; Female; Humans; Hypertension; Models, Biological; Oxidative Stress; Pre-Eclampsia; Pregnancy; Vitamin E; Vitamins

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Vitamin E

The review summarizes the results of recent randomized clinical trials whose primary purpose was to prevent preeclampsia and explores safety concerns that have been raised by these trials. Preeclampsia remains one the most common causes of perinatal and maternal mortality, particularly in resource-poor developing countries where its impact on morbidity and mortality is 20 to 100-fold greater than that in developed countries. The potential benefit of antioxidant vitamins and calcium continue to be explored, and are the subject of this review.. Two large, prospective, randomized trials involving more than 4000 low and high-risk subjects, respectively, compared vitamin C/E to placebo. There were no differences noted in the frequency of preeclampsia between groups. Additionally, potential adverse influences of supplementation on low birthweight, late stillbirth, and severity and timing of preeclampsia and neonatal acidosis were noted. A large, multicenter calcium vs. placebo trial sponsored by the World Health Organization in locations known to have dietary calcium deficiency failed to reduce preeclampsia or low birthweight rates.. These negative trials have reduced the likelihood that antioxidant or calcium supplementation will significantly impact the incidence of this disease. The safety concerns regarding antioxidants must be carefully explored.

Topics: Antioxidants; Ascorbic Acid; Calcium; Female; Humans; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Vitamin E

Vitamin C supplementation may help reduce the risk of pregnancy complications like pre-eclampsia, intrauterine growth restriction and maternal anaemia. There is a need to evaluate the efficacy and safety of vitamin C supplementation in pregnancy.. To evaluate the effects of vitamin C supplementation, alone or in combination with other separate supplements, on pregnancy outcomes, adverse events, side-effects and use of health resources.. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (23 June 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2004), MEDLINE, Current Contents and EMBASE.. All randomised or quasi-randomised controlled trials evaluating vitamin C supplementation in pregnant women. Interventions using a multivitamin supplement containing vitamin C or where the primary supplement was iron were excluded.. Two authors independently assessed trials for inclusion, extracted data and assessed trial quality.. Five trials, involving 766 women, are included in this review. No difference was seen between women supplemented with vitamin C alone or combined with other supplements compared with placebo for the risk of stillbirth (relative risk (RR) 0.87, 95% confidence intervals (CI) 0.41 to 1.87, three trials, 539 women), perinatal death (RR 1.16, 95% CI 0.61 to 2.18, two trials, 238 women), birthweight (weighted mean difference (WMD) -139.00 g, 95% CI -517.68 to 239.68, one trial, 100 women) or intrauterine growth restriction (RR 0.72, 95% CI 0.49 to 1.04, two trials, 383 women). Women supplemented with vitamin C alone or combined with other supplements were at increased risk of giving birth preterm (RR 1.38, 95% CI 1.04 to 1.82, three trials, 583 women). Significant heterogeneity was found for neonatal death and pre-eclampsia. No difference was seen between women supplemented with vitamin C combined with other supplements for the risk of neonatal death (RR 1.73, 95% CI 0.25 to 12.12, two trials, 221 women), using a random-effects model. For pre-eclampsia, women supplemented with vitamin C combined with other supplements were at decreased risk when using a fixed-effect model (RR 0.47, 95% CI 0.30 to 0.75, four trials, 710 women); however, this difference could not be demonstrated when using a random-effects model (RR 0.52, 95% CI 0.23 to 1.20, four trials, 710 women).. The data are too few to say if vitamin C supplementation, alone or combined with other supplements, is beneficial during pregnancy. Preterm birth may have been increased with vitamin C supplementation.

Topics: Ascorbic Acid; Dietary Supplements; Female; Fetal Death; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Randomized Controlled Trials as Topic

Miscarriage is a common complication of pregnancy that can be caused by a wide range of factors. Poor dietary intake of vitamins has been associated with an increased risk of miscarriage, therefore supplementing women with vitamins either prior to or in early pregnancy may help prevent miscarriage.. The objectives of this review are to determine the effectiveness and safety of any vitamin supplementation, on the risk of spontaneous miscarriage, maternal adverse outcomes and fetal and infant adverse outcomes.. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (8 September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003) and MEDLINE (1966 to May 2003), Current Contents (1998 to May 2003) and EMBASE (1980 to May 2003).. All randomised and quasi-randomised trials comparing one or more vitamins with either placebo, other vitamins, no vitamins or other interventions, prior to conception, periconceptionally or in early pregnancy (less than 20 weeks' gestation).. Two review authors independently assessed trials for inclusion, extracted data and assessed trial quality.. We identified seventeen trials assessing supplementation with any vitamin(s) starting prior to 20 weeks' gestation and reporting at least one primary outcome that were eligible for the review. Overall, the included trials involved 35,812 women and 37,353 pregnancies. Two trials were cluster randomised and contributed data for 20,758 women and 22,299 pregnancies in total. No difference was seen between women taking any vitamins compared with controls for total fetal loss (relative risk (RR) 1.05, 95% confidence interval (CI) 0.95 to 1.15), early or late miscarriage (RR 1.08, 95% CI 0.95 to 1.24) or stillbirth (RR 0.85, 95% CI 0.63 to 1.14) and most of the other primary outcomes, using fixed-effect models. For the other primary outcomes, women given any type of vitamin(s) compared with controls were less likely to develop pre-eclampsia (RR 0.68, 95% CI 0.54 to 0.85, four trials, 5580 women) and more likely to have a multiple pregnancy (RR 1.38, 95% CI 1.12 to 1.70, three trials, 20,986 women).. Taking vitamin supplements, alone or in combination with other vitamins, prior to pregnancy or in early pregnancy, does not prevent women experiencing miscarriage or stillbirth. However, women taking vitamin supplements may be less likely to develop pre-eclampsia and more likely to have a multiple pregnancy.

Topics: Abortion, Habitual; Abortion, Spontaneous; Ascorbic Acid; Dietary Supplements; Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic; Vitamin A; Vitamins

Pre-eclampsia is a disorder characterised by pregnancy-induced hypertension and new-onset proteinuria occurring in the second half of pregnancy. Worldwide, approximately 2-3% of all pregnant women develop pre-eclampsia. The condition is a major cause of maternal and fetal morbidity and mortality. Abnormal placentation is an important predisposing factor for pre-eclampsia, while endothelial activation appears to be central to the pathophysiological changes, possibly indicative of a two-stage disorder characterised by reduced placental perfusion and a maternal syndrome. There is increasing evidence that pre-eclampsia is associated with both increased oxidative stress and reduced antioxidant defences, which has led to the hypothesis that oxidative stress may play an important role in the pathogenesis of pre-eclampsia, perhaps acting as the link in a two-stage model of pre-eclampsia. In support of this hypothesis a small, but important, preliminary study has shown a highly significant (P=0.02) reduction in the incidence of pre-eclampsia in women at risk who were taking a supplement of vitamins C and E from mid-pregnancy. Furthermore, these findings support the hypothesis that oxidative stress is at least partly responsible for the endothelial dysfunction of pre-eclampsia. Several larger multicentre trials are currently underway to evaluate the efficacy, safety and cost benefits of antioxidant supplementation during pregnancy for the prevention of pre-eclampsia in both low- and high-risk women, including women with diabetes. The results of these trials are awaited with interest.

Topics: Antioxidants; Ascorbic Acid; Clinical Trials as Topic; Dietary Supplements; Female; Humans; Oxidation-Reduction; Oxidative Stress; Pre-Eclampsia; Pregnancy; Safety; Treatment Outcome; Vitamin E

New frontiers have been opened lately in the understanding of the patho-phisiology of preeclampsia thus giving new directions in the process of therapy of this condition. Oxidative stress is a condition characterized by peroxidants predominating over antioxidants. Numerous intensive studies are carried out to reveal the role of oxidative stress in the pathogenesis of preeclampsia.

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Oxidative Stress; Pre-Eclampsia; Pregnancy; Risk; Vitamin E

Preeclampsia is the disorder of pregnancy with the highest rate of both maternal and neonatal morbidity and mortality. The maternal syndrome is characterized by oxidative stress and activation of the vascular endothelium that may originate from placental release of lipid peroxidation products, cytokines, and microparticles leading to an acute inflammatory response. The current understanding of the etiology has allowed the improvement of predictive tests, tests that could make intervention possible from early pregnancy onwards. Although the large secondary intervention antioxidant trials in cardiovascular diseases did not show any beneficial effect of vitamin E and vitamin C, either alone or in combination, knowledge of the nature of the pathogenesis of preeclampsia offers hope for the beneficial use of antioxidants in the prevention of the disorder. Not only has our previous small trial shown that antioxidant prophylactics in high-risk women lowered the prevalence of preeclampsia, but also new evidence has demonstrated multiple other actions of alpha-tocopherol (such as anti-inflammation and inhibition of NAD(P)H oxidase activation) besides its antioxidant properties that could be advantageous in the prevention of the disorder. Several larger trials are under way to investigate the precise role that vitamins C and E can play in the prevention of preeclampsia.

Topics: alpha-Tocopherol; Antioxidants; Ascorbic Acid; Female; Humans; Oxidative Stress; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Vitamin E

Preeclampsia is a leading cause of maternal and neonatal mortality and morbidity. It is a complex syndrome of undetermined etiologic origin, usually diagnosed during the second half of pregnancy, with clinical features of hypertension, proteinuria, and edema. No cure for preeclampsia exists, except premature delivery. There is increasing evidence that oxidative stress is an important contributing factor to the pathogenesis of preeclampsia. Oxidative stress is defined as an imbalance between reactive oxygen species (ROS), such as nitric oxide (NO*), superoxide anion (O2*-), and hydrogen peroxide (H2O2), and antioxidants, favouring an overabundance of ROS. The consequence of an overproduction of ROS can be observed as increased levels of markers of oxidative stress, such as lipid peroxides. Pregnant women affected by preeclampsia may have abnormal ROS production, particularly NO* and O2*-, abnormal levels of antioxidant defences, and increased placental lipid peroxidation. Several observations suggest that decreased bioavailability of endothelium-derived NO*, due to oxidative destruction of NO* by ROS, might contribute to the impaired endothelium-dependent vasodilatory responses and multisystemic pathology of preeclampsia, a phenomenon in which antioxidant vitamins may play a beneficial role. This review focuses on the rationale for vitamins C and E supplementation toward prevention of preeclampsia, with an emphasis on the limit of our scientific knowledge concerning the deleterious oxidative events taking place in this pathology.

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Hydrogen Peroxide; Lipid Peroxidation; Nitric Oxide; Oxidative Stress; Pre-Eclampsia; Pregnancy; Reactive Oxygen Species; Superoxides; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Estrogens; Female; Humans; Oxidation-Reduction; Pre-Eclampsia; Pregnancy; Thioredoxin-Disulfide Reductase; Thioredoxins; Vitamin E

Pre-eclampsia is one of the major indications for elective premature delivery. Several lines of evidence suggest that pre-eclampsia is associated with a state of oxidative stress, offering hope of prevention by antioxidant supplementation. It was recently shown by the present authors that supplementation with vitamin C and E from early in pregnancy leads to a reduction in the incidence of the disease in "high-risk" women.

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Oxidative Stress; Pre-Eclampsia; Pregnancy; Vitamin E

Nearly 600 000 women die every year from pregnancy related conditions and the maternal mortality rates (MMR = deaths per 100 000 live births) in developing countries may be as high as 1000 compared with less than ten in industrialised countries. In the light of the striking impact of deficiencies of micronutrients such as vitamin A and zinc on immune function, morbidity and mortality in children it seems reasonable to suggest that such deficiencies might play a contributing role in the high rates of morbidity and mortality in mothers. Hitherto, there has been rather little published on the contribution of malnutrition to maternal morbidity or mortality but recent results of micronutrient supplementation show a major effect of vitamin A or beta carotene supplementation on maternal mortality in Nepal and an impressive effect of a multiple micronutrient mixture on pregnancy outcome in Tanzania. There is now data showing that subclinical mastitis, a potential risk factor for mother to child transmission of HIV by increasing levels of virus in breast milk, is influenced by maternal diet in Tanzania and feeding patterns in South Africa. Considering the massive tragedy of maternal mortality the recent data provides opportunities for new, innovative nutritional interventions for the reduction of the global burden of maternal morbidity and mortality.

Topics: Ascorbic Acid; Developing Countries; Female; Folic Acid; Humans; Maternal Mortality; Maternal Welfare; Micronutrients; Morbidity; Nutrition Disorders; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Parasitic; Puerperal Infection; Risk; Vitamin A; Zinc

The etiology and pathogenesis of the pregnancy syndrome preeclampsia remain poorly understood. There is substantial evidence to suggest that the diverse manifestations of preeclampsia, including altered vascular reactivity, vasospasm, and discrete pathology in many organ systems, are derived from pathologic changes within the maternal vascular endothelium. With the theme of endothelial cell dysfunction emphasized, this review focuses on the role of oxidative stress (an imbalance favoring oxidant over antioxidant forces) in the pathogenesis of preeclampsia. Data are summarized regarding 1) the role of the placenta in preeclampsia; 2) evidence and mechanisms of oxidative stress in the preeclampsia placenta; 3) markers of oxidative stress in the maternal circulation; and 4) the potential role of maternal dyslipidemia in generation of oxidative stress. A recurrent theme is that free radical reactions, promoted by "cross-talk" between the diseased placenta and maternal dyslipidemia, promote a vicious cycle of events that make cause and effect difficult to distinguish but likely contribute to the progression of preeclampsia.

Topics: Ascorbic Acid; Endothelium, Vascular; Female; Free Radicals; Genetic Predisposition to Disease; Humans; Lipid Peroxidation; Lipids; Lipoproteins, LDL; Oxidative Stress; Placenta; Pre-Eclampsia; Pregnancy; Reactive Oxygen Species; Superoxide Dismutase; Tumor Necrosis Factor-alpha

Topics: Ascorbic Acid; Birth Weight; Body Height; Body Weight; Calcium, Dietary; Diet; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Eclampsia; Energy Transfer; Female; Germany, West; Humans; Lactation; Maternal Mortality; Nutritional Physiological Phenomena; Obesity; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Prenatal Care; Vitamin A; Vitamin B Complex; Vitamin D; Vitamin E; Vitamin K

To determine whether vitamin C in the first three days postpartum reduces pulmonary oedema (PE) assessed by lung ultrasound in patients with severe preeclampsia.. Randomised, placebo-controlled, double-blind trial.. Tertiary perinatal centre.. Consecutively admitted patients with singleton pregnancies complicated by severe preeclampsia.. Thirty-four patients received vitamin C (1.5 g/6 h) (n = 17) or placebo (n = 17) at days 1, 2, and 3 postdelivery. Mann-Whitney-U test was used to compare vitamin C vs placebo groups. A p ≤ 0.05 was considered statistically significant.. Lung ultrasound was performed once daily in the first three days following delivery. Echo Comet Score (ECS) on day 1 postdelivery was the primary outcome studied and was obtained using the 28-rib interspaces technique. ECS on days 2 and 3 postdelivery were secondary outcomes.. There was no significant difference in ECS on day 1 (median 23 (inter-quartile range (IQR) 21-61) vs 18 (IQR 8-35); p = 0.31). All ultrasound examinations on day 1 were performed within six hours from delivery. On days 2 and 3, ECS was significantly lower in vitamin C group compared to placebo (8 (IQR 3-14) vs 35 (IQR 15-78); p = 0.03 and 5 (IQR 3-10) vs 18 (IQR 18-44); p = 0.04, respectively).. A single dose of intravenous vitamin C did not reduce PE in postpartum patients with severe preeclampsia on day 1 after delivery. Repeated doses, however, seem to have a delayed effect with a reduction in PE detected on ultrasound on days 2 and 3 following delivery.. This trial is registered at ClinicalTrials.gov: ID NCT03451266 (https://clinicaltrials.gov/ct2/show/NCT03451266?term=NCT03451266&draw=2&rank=1).

Topics: Ascorbic Acid; Double-Blind Method; Female; Humans; Lung; Pre-Eclampsia; Pregnancy; Pulmonary Edema

Objectives Preeclampsia is a hypertensive disorder associated with pregnancy and is the leading cause of both maternal and neonatal morbidity and mortality. Recent reports suggest that free radical-induced endothelial cell injury might be an etiologic factor in the pathogenesis of preeclampsia. The aim of this study was to determine the protective effects of vitamins C and E for the prevention of preeclampsia. Methods This clinical trial was conducted in the year 2018 in the clinical centers of Lorestan University of Medical Sciences. One hundred and sixty nulliparous women aged 18-38 years without any risk factors for preeclampsia were divided into two groups. The first group received a 400-IU/day dose of vitamin E orally and a 1000-mg/day dose of vitamin C with iron tablets during 20-24 weeks of pregnancy, while the control group received only iron tablets. Finally, the data were analyzed using descriptive statistics and frequency distribution tables. Results The incidence of preeclampsia in the control group was 17.5% and in the intervention group was 5%, which was significantly different. The mean systolic pressures before and after intervention were 99.43 ± 7.8 and 12.44 ± 19.1, respectively, in the control group, and 99.3 ± 8.3 and 106.12 ± 13.25, respectively, in the intervention group (P < 0.001). The mean diastolic pressures before and after intervention in the control group were 62.7 ± 13.6 and 62.7 ± 4.7 (P < 0.001), respectively. Conclusion The results of this study show that vitamins C and E have protective effects against preeclampsia by alleviating the overall blood pressure.

Topics: Adult; Antioxidants; Ascorbic Acid; Blood Pressure; Female; Humans; Parity; Pre-Eclampsia; Pregnancy; Vitamin E; Young Adult

To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB).. A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity.. Of 9,867 women, 10.4% (. Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.

Topics: Adolescent; Adult; Ascorbic Acid; Birth Weight; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Small for Gestational Age; Intensive Care Units, Neonatal; Logistic Models; Male; Multivariate Analysis; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Respiratory Distress Syndrome, Newborn; Retrospective Studies; United States; Vitamin E; Young Adult

Smoking and pre-eclampsia (PE) are associated with increases in preterm birth, placental abruption and low birthweight. We evaluated the relationship between prenatal vitamin C and E (C/E) supplementation and perinatal outcomes by maternal self-reported smoking status focusing on outcomes known to be impacted by maternal smoking.. A secondary analysis of a multi-centre trial of vitamin C/E supplementation starting at 9-16 weeks in low-risk nulliparous women with singleton gestations.. We examined the effect of vitamin C/E by smoking status at randomisation using the Breslow-Day test for interaction.. The trial's primary outcomes were PE and a composite outcome of pregnancy-associated hypertension (PAH) with serious adverse outcomes. Perinatal outcomes included preterm birth and abruption.. There were no differences in baseline characteristics within subgroups (smokers versus nonsmokers) by vitamin supplementation status. The effect of prenatal vitamin C/E on the risk of PE (P = 0.66) or PAH composite outcome (P = 0.86) did not differ by smoking status. Vitamin C/E was protective for placental abruption in smokers (relative risk [RR] 0.09; 95% CI 0.00-0.87], but not in nonsmokers (RR 0.92; 95% CI 0.52-1.62) (P = 0.01), and for preterm birth in smokers (RR 0.76; 95% CI 0.58-0.99) but not in nonsmokers (RR 1.03; 95% CI 0.90-1.17) (P = 0.046).. In this cohort of women, smoking was not associated with a reduction in PE or the composite outcome of PAH. Vitamin C/E supplementation appears to be associated with a reduction in placental abruption and preterm birth among smokers.

Topics: Abruptio Placentae; Adolescent; Adult; Ascorbic Acid; Dietary Supplements; Double-Blind Method; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Pregnancy; Premature Birth; Smoking; Vitamin E; Vitamins; Young Adult

The anti-oxidant and proangiogenic protein haptoglobin (Hp) is believed to be important for implantation and pregnancy, although its specific role is not known. The three phenotypes (1-1, 2-1 and 2-2) differ in structure and function. Hp 2-2 is associated with increased vascular stiffness in other populations. We examined whether Hp phenotype is associated with abnormal uterine artery Doppler (UAD) in pregnancy.. We conducted a secondary analysis of a preeclampsia prediction cohort nested within a larger placebo-controlled randomized clinical trial of antioxidants for prevention of preeclampsia. We determined Hp phenotype in 2184 women who completed UAD assessments at 17 weeks gestation. Women with notching were re-evaluated for persistent notching at 24 weeks' gestation. Logistic regression was used to assess differences in UAD indices between phenotype groups.. Hp phenotype did not significantly influence the odds of having any notch (p = 0.32), bilateral notches (p = 0.72), or a resistance index (p = 0.28) or pulsatility index (p = 0.67) above the 90th percentile at 17 weeks' gestation. Hp phenotype also did not influence the odds of persistent notching at 24 weeks (p = 0.25).. Hp phenotype is not associated with abnormal UAD at 17 weeks' gestation or with persistent notching at 24 weeks.

Topics: Adult; Antioxidants; Ascorbic Acid; Cohort Studies; Ethnicity; Female; Haptoglobins; Humans; Phenotype; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Racial Groups; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Uterine Artery; Vitamin E; Young Adult

Oxidative stress plays a role in the pathogenesis of pre-eclampsia. Supplementing women with antioxidants during pregnancy may reduce oxidative stress and thereby prevent or delay the onset pre-eclampsia. The objective of this study was to evaluate the effect of supplementing vitamin C in pregnancy on the incidence of pre-eclampsia, at Mulago hospital, Kampala, Uganda.. This was a (parallel, balanced randomization, 1:1) placebo randomized controlled trial conducted at Mulago hospital, Department of Obstetrics and Gynecology. Participants included in this study were pregnant women aged 15-42 years, who lived 15 km or less from the hospital with gestational ages between 12-22 weeks. The women were randomized to take 1000mg of vitamin C (as ascorbic acid) or a placebo daily until they delivered. The primary outcome was pre-eclamsia. Secondary outcomes were: severe pre-eclampsia, gestational hypertension, preterm delivery, low birth weight and still birth delivery. Participants were 932 pregnant women randomized into one of the two treatment arms in a ratio of 1:1. The participants, the care providers and those assessing the outcomes were blinded to the study allocation.. Of the 932 women recruited; 466 were randomized to the vitamin and 466 to the placebo group. Recruitment of participants was from November 2011 to June 2012 and follow up was up to January 2013. Outcome data was available 415 women in the vitamin group and 418 women in the placebo group.There were no differences in vitamin and placebo groups in the incidence of pre-eclampsia (3.1% versus 4.1%; RR 0.77; 95% CI: 0.37-1.56), severe pre-eclampsia (1.2% versus 1.0%; RR 1.25; 95% CI: 0.34-4.65), gestational hypertension(7.7% versus 11.5%; RR 0.67; 95% CI: 0.43-1.03), preterm delivery (11.3% versus 12.2%; RR 0.92; 95% CI: 0.63-1.34), low birth weight (11.1% versus 10.3%; RR 1.07; 95% CI: 0.72-1.59) and still birth delivery (4.6% versus 4.5%; RR 1.01; 95% CI: 0.54-1.87).. Supplementation with vitamin C did not reduce the incidence of pre-eclampsia nor did it reduce the adverse maternal or neonatal outcomes. We do not recommend the use of vitamin C in pregnancy to prevent pre-eclampsia.. This study was registered at the Pan African Clinical Trial Registry, PACTR201210000418271 on 25th October 2012.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Dietary Supplements; Double-Blind Method; Female; Humans; Incidence; Pre-Eclampsia; Pregnancy; Premature Birth; Severity of Illness Index; Stillbirth; Uganda; Young Adult

The phenotype of the antioxidant and pro-angiogenic protein haptoglobin (Hp) predicts cardiovascular disease risk and treatment response to antioxidant vitamins in individuals with diabetes. Our objective was to determine whether Hp phenotype influences pre-eclampsia risk, or the efficacy of vitamins C and E in preventing pre-eclampsia, in women with type-1 diabetes.. This is a secondary analysis of a randomised controlled trial in which women with diabetes received daily vitamins C and E, or placebo, from 8 to 22 weeks of gestation until delivery.. Twenty-five antenatal metabolic clinics across the UK (in north-west England, Scotland, and Northern Ireland).. Pregnant women with type-1 diabetes.. Hp phenotype was determined in white women who completed the study and had plasma samples available (n = 685).. Pre-eclampsia.. Compared with Hp 2-1, Hp 1-1 (OR 0.59, 95% CI 0.30-1.16) and Hp 2-2 (OR 0.93, 95% CI 0.60-1.45) were not associated with significantly decreased pre-eclampsia risk after adjusting for treatment group and HbA1c at randomisation. Our study was not powered to detect an interaction between Hp phenotype and treatment response; however, our preliminary analysis suggests that vitamins C and E did not prevent pre-eclampsia in women of any Hp phenotype (Hp 1-1, OR 0.77, 95% CI 0.22-2.71; Hp 2-1, OR 0.81, 95% CI 0.46-1.43; Hp 2-2, 0.67, 95% CI 0.34-1.33), after adjusting for HbA1c at randomisation.. The Hp phenotype did not significantly affect pre-eclampsia risk in women with type-1 diabetes.

Topics: Antioxidants; Ascorbic Acid; Diabetes Mellitus, Type 1; Female; Haptoglobins; Humans; Odds Ratio; Oxidative Stress; Phenotype; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Risk Factors; Vitamin E

To develop clinical risk tools for preeclampsia and small for gestational age (SGA) in high-risk women.. Individual risk scores based on clinical risk factors were calculated using logistic regression and validated in 1687 women with obesity in first pregnancy, chronic hypertension, or previous preeclampsia.. The risk of preeclampsia varied from 7% in obese primiparae without hypertension to 30% when previous preeclampsia and chronic hypertension occurred together. A prediction model incorporating these risk factors had a sensitivity of 48 and 89% for preeclampsia delivered <34 weeks' gestation.. Multiple clinical risk factors increase the risk of preeclampsia and SGA.

Topics: Adult; Ascorbic Acid; Female; Forecasting; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Assessment; Risk Factors; Vitamin E; Vitamins

Oxidative stress could play a role in the development of preeclampsia. There is some evidence to suggest that vitamin C and E supplements can reduce the risk of the disorder. We hypothesized its beneficial role in a group of pregnant women with essential hypertension.. In this randomized controlled trial, we enrolled 50 pregnant women with essential hypertension. We assigned the women 1000 mg vitamin C and 400 IU natural vitamin E (RRR α tocopherol; n = 25), daily from the second trimester of pregnancy until delivery or no supplementation (n = 25). Our primary endpoint was development of superimposed preeclampsia, and main secondary endpoints were aggravation of hypertension, need for admission, need to increase antihypertensive drugs, and small size for gestational age (

Topics: Adult; Antioxidants; Ascorbic Acid; Female; Humans; Hypertension; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Risk Factors; Treatment Outcome; Vitamin E

We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women.. In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions.. Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99; 95% confidence interval, 0.78-1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes.. Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.

Topics: Adult; Antioxidants; Ascorbic Acid; Dietary Supplements; Double-Blind Method; Female; Fetal Death; Fetal Membranes, Premature Rupture; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Pregnancy; Prenatal Care; Risk; Risk Factors; Vitamin E

Oxidative stress has been proposed as a mechanism linking the poor placental perfusion characteristic of preeclampsia with the clinical manifestations of the disorder. We assessed the effects of antioxidant supplementation with vitamins C and E, initiated early in pregnancy, on the risk of serious adverse maternal, fetal, and neonatal outcomes related to pregnancy-associated hypertension.. We conducted a multicenter, randomized, double-blind trial involving nulliparous women who were at low risk for preeclampsia. Women were randomly assigned to begin daily supplementation with 1000 mg of vitamin C and 400 IU of vitamin E or matching placebo between the 9th and 16th weeks of pregnancy. The primary outcome was severe pregnancy-associated hypertension alone or severe or mild hypertension with elevated liver-enzyme levels, thrombocytopenia, elevated serum creatinine levels, eclamptic seizure, medically indicated preterm birth, fetal-growth restriction, or perinatal death.. A total of 10,154 women underwent randomization. The two groups were similar with respect to baseline characteristics and adherence to the study drug. Outcome data were available for 9969 women. There was no significant difference between the vitamin and placebo groups in the rates of the primary outcome (6.1% and 5.7%, respectively; relative risk in the vitamin group, 1.07; 95% confidence interval [CI], 0.91 to 1.25) or in the rates of preeclampsia (7.2% and 6.7%, respectively; relative risk, 1.07; 95% CI, 0.93 to 1.24). Rates of adverse perinatal outcomes did not differ significantly between the groups.. Vitamin C and E supplementation initiated in the 9th to 16th week of pregnancy in an unselected cohort of low-risk, nulliparous women did not reduce the rate of adverse maternal or perinatal outcomes related to pregnancy-associated hypertension (ClinicalTrials.gov number, NCT00135707).

Topics: Adult; Antioxidants; Ascorbic Acid; Double-Blind Method; Drug Combinations; Female; Humans; Hypertension, Pregnancy-Induced; Oxidative Stress; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, First; Treatment Failure; Vitamin E; Young Adult

Results of several trials of antioxidant use during pregnancy have not shown a reduction in pre-eclampsia, but the effect in women with diabetes is unknown. We aimed to assess whether supplementation with vitamins C and E reduced incidence of pre-eclampsia in women with type 1 diabetes.. We enrolled women from 25 UK antenatal metabolic clinics in a multicentre randomised placebo-controlled trial. Eligibility criteria were type 1 diabetes preceding pregnancy, presentation between 8 weeks' and 22 weeks' gestation, singleton pregnancy, and age 16 years or older. Women were randomly allocated in a 1:1 ratio to receive 1000 mg vitamin C and 400 IU vitamin E (alpha-tocopherol) or matched placebo daily until delivery. The randomisation sequence was stratified by centre with balanced blocks of eight patients. All trial personnel and participants were masked to treatment allocation. The primary endpoint was pre-eclampsia, which we defined as gestational hypertension with proteinuria. Analysis was by modified intention to treat. This study is registered, ISRCTN27214045.. Between April, 2003, and June, 2008, 762 women were randomly allocated to treatment groups (379 vitamin supplementation, 383 placebo). The primary endpoint was assessed for 375 women allocated to receive vitamins, and 374 allocated to placebo. Rates of pre-eclampsia did not differ between vitamin (15%, n=57) and placebo (19%, 70) groups (risk ratio 0.81, 95% CI 0.59-1.12). No adverse maternal or neonatal outcomes were reported.. Supplementation with vitamins C and E did not reduce risk of pre-eclampsia in women with type 1 diabetes. However, the possibility that vitamin supplementation might be beneficial in women with a low antioxidant status at baseline needs further testing.. The Wellcome Trust.

Topics: Adult; Antioxidants; Ascorbic Acid; Diabetes Mellitus, Type 1; Female; Humans; Oxidative Stress; Pre-Eclampsia; Pregnancy; Vitamin E; Young Adult

Prenatal antioxidant supplementation might influence fetal lung growth and development and reduce infant respiratory morbidity. The aim of this study was to test the hypothesis that infants of mothers at risk of pre-eclampsia who were randomised to receive high-dose vitamins C and E (1000 mg vitamin C and 400 IU RRR α-tocopherol daily) during pregnancy would have better respiratory outcomes than infants whose mothers were randomised to receive placebo.. Respiratory outcomes to 2 years of age were documented using questionnaires and, in a subset, by recording their healthcare utilisation and calculating the cost of care data.. 330 women who had taken vitamin supplementation and 313 who had taken placebo completed the respiratory questionnaire (386 and 366 infants, respectively). There were no significant differences between the two groups in the proportions diagnosed with asthma. 54 women who had taken vitamin supplementation and 45 who had taken placebo took part in the healthcare utilisation study (65 and 53 infants, respectively). On average, infants of mothers receiving vitamin supplementation had 2.6 (99% CI 0.8 to 5.1) times more A&E/outpatient visits and 3.2 (99% CI 0.2 to 6.9) times more GP visits than infants of mothers receiving placebo, and their costs of care were £226 (99% CI £27 to £488) more for outpatient admissions, £57 (99% CI £3 to £123) more for GP visits and £22 (99% CI £3 to £50) more for medications.. High-dose antenatal vitamin C and E supplementation does not improve infant respiratory outcome and is associated with increased healthcare utilisation and cost of care.

Topics: Adult; Antioxidants; Ascorbic Acid; Birth Weight; Child Health Services; Dietary Supplements; Drug Administration Schedule; Female; Health Care Costs; Health Services; Humans; Infant, Newborn; Infant, Premature; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prenatal Care; Respiration Disorders; Risk Factors; Treatment Outcome; Vitamin E

To determine if vitamin C and E supplementation in high-risk pregnant women with low nutritional status reduces pre-eclampsia.. Multicentred, randomised, controlled, double-blinded trial.. Antenatal care clinics and Hospitals in four countries.. Pregnant women between 14 and 22 weeks' gestation.. Randomised women received 1000 mg vitamin C and 400 iu of vitamin E or placebo daily until delivery.. Pre-eclampsia, low birthweight, small for gestational age and perinatal death.. Six hundred and eighty-seven women were randomised to the vitamin group and 678 to the placebo group. Groups had similar gestational ages (18.1; SD 2.4 weeks), socio-economic, clinical and demographical characteristics and blood pressure at trial entry. Risk factors for eligibility were similar, except for multiple pregnancies: placebo group (14.7%), vitamins group (11.8%). Previous pre-eclampsia, or its complications, was the most common risk factor at entry (vitamins 41.6%, placebo 41.3%). Treatment compliance was 87% in the two groups and loss to follow-up was low (vitamins 2.0%, placebo 1.3%). Supplementation was not associated with a reduction of pre-eclampsia (RR: 1.0; 95% CI: 0.9-1.3), eclampsia (RR: 1.5; 95% CI: 0.3-8.9), gestational hypertension (RR: 1.2; 95% CI: 0.9-1.7), nor any other maternal outcome. Low birthweight (RR: 0.9; 95% CI: 0.8-1.1), small for gestational age (RR: 0.9; 95% CI: 0.8-1.1) and perinatal deaths (RR: 0.8; 95% CI: 0.6-1.2) were also unaffected.. Vitamins C and E at the doses used did not prevent pre-eclampsia in these high-risk women.

Topics: Adult; Ascorbic Acid; Developing Countries; Dietary Supplements; Double-Blind Method; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Small for Gestational Age; Nutritional Status; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prenatal Care; Prenatal Nutritional Physiological Phenomena; Treatment Outcome; Vitamin E; Young Adult

Prospective contemporaneous data on the outcome of pregnancies in women with chronic hypertension are sparse. Indices of maternal and perinatal morbidity and mortality were determined in 822 women with chronic hypertension with data prospectively collected and rigorously validated. The incidence of superimposed preeclampsia was 22% (n=180) with early-onset preeclampsia (

Topics: Adult; Antioxidants; Ascorbic Acid; Chronic Disease; Female; Humans; Hypertension; Morbidity; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prevalence; Prospective Studies; Risk Factors; Smoking; Vitamin E

To study whether antioxidant supplementation will reduce the incidence of preeclampsia among patients at increased risk.. A randomized, placebo-controlled, double-blind clinical trial was conducted at four Brazilian sites. Women between 12 0/7 weeks and 19 6/7 weeks of gestation and diagnosed to have chronic hypertension or a prior history of preeclampsia were randomly assigned to daily treatment with both vitamin C (1,000 mg) and vitamin E (400 International Units) or placebo. Analyses were adjusted for clinical site and risk group (prior preeclampsia, chronic hypertension, or both). A sample size of 734 would provide 80% power to detect a 40% reduction in the risk of preeclampsia, assuming a placebo group rate of 21% and alpha=.05. The alpha level for the final analysis, adjusted for interim looks, was 0.0458.. Outcome data for 707 of 739 randomly assigned patients revealed no significant reduction in the rate of preeclampsia (study drug, 13.8% [49 of 355] compared with placebo, 15.6% [55 of 352], adjusted risk ratio 0.87 [95.42% confidence interval 0.61-1.25]). There were no differences in mean gestational age at delivery or rates of perinatal mortality, abruptio placentae, preterm delivery, and small for gestational age or low birth weight infants. Among patients without chronic hypertension, there was a slightly higher rate of severe preeclampsia in the study group (study drug, 6.5% [11 of 170] compared with placebo, 2.4% [4 of 168], exact P=.11, odds ratio 2.78, 95% confidence interval 0.79-12.62).. This trial failed to demonstrate a benefit of antioxidant supplementation in reducing the rate of preeclampsia among patients with chronic hypertension and/or prior preeclampsia.. ClinicalTrials.gov, www.ClinicalTrials.gov, NCT00097110. I.

Topics: Adult; Antioxidants; Ascorbic Acid; Double-Blind Method; Female; Humans; Hypertension; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Vitamin E

Oxidative stress could play a part in pre-eclampsia, and there is some evidence to suggest that vitamin C and vitamin E supplements could reduce the risk of the disorder. Our aim was to investigate the potential benefit of these antioxidants in a cohort of women with a range of clinical risk factors.. We did a randomised, placebo-controlled trial to which we enrolled 2410 women identified as at increased risk of pre-eclampsia from 25 hospitals. We assigned the women 1000 mg vitamin C and 400 IU vitamin E (RRR alpha tocopherol; n=1199) or matched placebo (n=1205) daily from the second trimester of pregnancy until delivery. Our primary endpoint was pre-eclampsia, and our main secondary endpoints were low birthweight (<2.5 kg) and small size for gestational age (<5th customised birthweight centile). Analyses were by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN 62368611 .. Of 2404 patients treated, we analysed 2395 (99.6%). The incidence of pre-eclampsia was similar in treatment placebo groups (15% [n=181] vs 16% [n=187], RR 0.97 [95% CI 0.80-1.17]). More low birthweight babies were born to women who took antioxidants than to controls (28% [n=387] vs 24% [n=335], 1.15 [1.02-1.30]), but small size for gestational age did not differ between groups (21% [n=294] vs 19% [n=259], 1.12 [0.96-1.31]).. Concomitant supplementation with vitamin C and vitamin E does not prevent pre-eclampsia in women at risk, but does increase the rate of babies born with a low birthweight. As such, use of these high-dose antioxidants is not justified in pregnancy.

Topics: Adult; Antioxidants; Ascorbic Acid; Female; Humans; Infant, Newborn; Male; Oxidative Stress; Pre-Eclampsia; Pregnancy; Risk Factors; Treatment Outcome; Vitamin E

Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain.. We conducted a multicenter, randomized trial of nulliparous women between 14 and 22 weeks of gestation. Women were assigned to daily supplementation with 1000 mg of vitamin C and 400 IU of vitamin E or placebo (microcrystalline cellulose) until delivery. Primary outcomes were the risks of maternal preeclampsia, death or serious outcomes in the infants (on the basis of definitions used by the Australian and New Zealand Neonatal Network), and delivering an infant whose birth weight was below the 10th percentile for gestational age.. Of the 1877 women enrolled in the study, 935 were randomly assigned to the vitamin group and 942 to the placebo group. Baseline characteristics of the two groups were similar. There were no significant differences between the vitamin and placebo groups in the risk of preeclampsia (6.0 percent and 5.0 percent, respectively; relative risk, 1.20; 95 percent confidence interval, 0.82 to 1.75), death or serious outcomes in the infant (9.5 percent and 12.1 percent; relative risk, 0.79; 95 percent confidence interval, 0.61 to 1.02), or having an infant with a birth weight below the 10th percentile for gestational age (8.7 percent and 9.9 percent; relative risk, 0.87; 95 percent confidence interval, 0.66 to 1.16).. Supplementation with vitamins C and E during pregnancy does not reduce the risk of preeclampsia in nulliparous women, the risk of intrauterine growth restriction, or the risk of death or other serious outcomes in their infants. (Controlledtrials.com number, ISRCTN00416244.).

Topics: Adult; Antioxidants; Ascorbic Acid; Dietary Supplements; Female; Fetal Death; Fetal Growth Retardation; Humans; Hypertension; Infant Mortality; Infant, Newborn; Infant, Small for Gestational Age; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn; Risk; Vitamin E

We sought to determine the effect of supplemental antioxidant vitamins C and E on the rate of preeclampsia in high-risk pregnant women.. Women at risk for preeclampsia (previous preeclampsia, chronic hypertension, pregestational diabetes, or multifetal gestation) were recruited at 14 to 20 weeks' gestation and randomly assigned to receive either 1000 mg of vitamin C and 400 IU of vitamin E or placebo daily in addition to their regular prenatal vitamins. The primary outcome was the occurrence of preeclampsia. An estimated sample size of 220 women in each arm was determined to be necessary to demonstrate a 50% reduction in the rate of preeclampsia.. Funding was terminated after 109 women had been recruited; 9 were lost to follow-up or withdrew. We analyzed data from the remaining 100 women to look for differences in outcome and to estimate the required sample size for future studies. The rate of preeclampsia was not different: 17.3% in women who received supplemental vitamins C and E, versus 18.8% in the placebo group. Assuming a baseline rate of preeclampsia in the placebo group between 15% and 20%, we can estimate that 500 to 950 women in each arm will be required to show a clinically important reduction in the rate of preeclampsia.. The potential benefit of vitamin C and E supplementation to prevent preeclampsia in women with clinical risk factors is smaller than we estimated. Future studies of antioxidant vitamin supplementation in this population will require more than 500 women in each arm.

Topics: Adult; Ascorbic Acid; Dietary Supplements; Double-Blind Method; Female; Humans; Pre-Eclampsia; Pregnancy; Risk Factors; Vitamin E

We have previously reported a reduced incidence of preeclampsia in women who were at risk and were taking vitamin C (1000 mg/d) and vitamin E (400 IU/d) supplements. In this study, we determined whether supplementation in the same cohort was associated with an improvement in indices of placental dysfunction and oxidative stress toward values determined in women who were at low risk of preeclampsia.. Seventy-nine women who were at high risk and who were taking vitamin supplements and 81 who were taking placebos were compared with 32 women who were at low risk and who were not taking supplements who were studied simultaneously.. Indices of oxidative stress and placental function were abnormal in the placebo group. When the placebo group was compared with the women who were at low risk, ascorbic acid, plasminogen activator inhibitor-2, and placenta growth factor concentrations were decreased; and 8-epi-prostaglandin F(2alpha),leptin, and the plasminogen activator inhibitor-1/-2 ratio were increased. In the group that received vitamin supplements, ascorbic acid, 8-epi-prostaglandin F(2alpha), leptin, and plasminogen activator inhibitor-1/-2 values were similar to women who were at low risk.. Antioxidant supplementation in women who were at risk of preeclampsia was associated with improvement in biochemical indices of the disease.

Topics: Adult; Ascorbic Acid; Dietary Supplements; Endometrium; Female; Humans; Leptin; Oxidative Stress; Placenta; Placenta Growth Factor; Placental Insufficiency; Plasminogen Activator Inhibitor 1; Plasminogen Activator Inhibitor 2; Pre-Eclampsia; Pregnancy; Pregnancy Proteins; Risk; Vitamin E

The aim of the present study was to measure serum urate, tocopherol and ascorbate and to calculate total radical trapping antioxidant potential (TRAP) in pre-eclampsia.. Study samples were taken from 25 pre-eclamptic, 25 normotensive pregnant and 25 non-pregnant healthy females for measuring uric acid, vitamin C and E, total sulfhydryl group. Also lipid peroxidation product malonaldehyde (MDA), the superoxide generation (NBT reduction) were estimated and TRAP was calculated. Data were analyzed statistically using Student's t-test.. Pre-eclamptic women had significantly increased MDA levels, superoxide generation and uric acid levels as compared to control subjects (P<0.001). Vitamin C and E and total thiols were lower in pre-eclampsia as compared to control subjects (P<0.001). TRAP was significantly higher in pre-eclampsia.. TRAP provides a means of assessing the total capacity of the chain-breaking antioxidants to prevent lipid peroxidation in plasma.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Biomarkers; Female; Free Radicals; Humans; Lipid Peroxidation; Malondialdehyde; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Third; Probability; Reference Values; Sensitivity and Specificity; Uric Acid; Vitamin E

Oxidative stress has been implicated in the pathophysiology of pre-eclampsia. This randomised controlled trial investigated the effect of supplementation with vitamins C and E in women at increased risk of the disorder on plasma markers of vascular endothelial activation and placental insufficiency and the occurrence of pre-eclampsia.. 283 women were identified as being at increased risk of pre-eclampsia by abnormal two-stage uterine-artery doppler analysis or a previous history of the disorder and were randomly assigned vitamin C (1000 mg/day) and vitamin E (400 IU/day) or placebo at 16-22 weeks' gestation. Plasma markers of endothelial activation (plasminogen-activator inhibitor 1 [PAI-1]) and placental dysfunction (PAI-2) were measured every month until delivery. Pre-eclampsia was assessed by the development of proteinuric hypertension. Analyses were done by intention to treat, and in the cohort who completed the study.. Supplementation with vitamins C and E was associated with a 21% decrease in the PAI-1/PAI-2 ratio during gestation (95% CI 4-35, p=0.015). In the intention-to-treat cohort, pre-eclampsia occurred in 24 (17%) of 142 women in the placebo group and 11 (8%) of 141 in the vitamin group (adjusted odds ratio 0.39 [0.17-0.90], p=0.02). In the cohort who completed the study (81 placebo group, 79 vitamin group), the odds ratio for pre-eclampsia was 0.24 (0.08-0.70, p=0.002).. Supplementation with vitamins C and E may be beneficial in the prevention of pre-eclampsia in women at increased risk of the disease. Multicentre trials are needed to show whether vitamin supplementation affects the occurrence of pre-eclampsia in low-risk women and to confirm our results in larger groups of high-risk women from different populations.

Topics: Adult; Antioxidants; Ascorbic Acid; Cohort Studies; Female; Humans; Oxidative Stress; Plasminogen Activator Inhibitor 1; Plasminogen Activator Inhibitor 2; Pre-Eclampsia; Pregnancy; Risk Factors; Ultrasonography, Doppler; Ultrasonography, Prenatal; Vitamin E

To determine whether antioxidant therapy alters the disease process in severe early onset pre-eclampsia, in support of the hypothesis that increased lipid peroxides and reactive oxygen species production-play an important role in the pathogenesis of the disease.. Randomised, double-blind, placebo controlled trial.. Two tertiary care, referral hospitals in Johannesburg, South Africa.. Women with severe pre-eclampsia diagnosed between 24 and 32 weeks of gestation.. Combined antioxidant treatment with vitamin E (800 IU/day), vitamin C (1000 mg/day), and allopurinol (200 mg/day).. 1. prolongation of pregnancy and 2, biochemical assessment of lipid peroxides and antioxidants.. data on maternal complications, side effects of treatment, infant outcomes and regular assessment of haematologic and renal parameters.. The proportion of women delivered within 14 days in the antioxidant group was 52% (14/27) compared with 76% (22/29) in the placebo group (relative risk 0.68, 95% confidence interval 0.45-1.04). One woman in each group had eclampsia. Eleven women (42%) in the antioxidant and 16 (59%) in the placebo group required two antihypertensives for blood pressure control. Trial medications were well tolerated with few side effects. Lipid peroxide levels were not significantly altered in the antioxidant and placebo groups. Serum uric acid levels decreased and vitamin E levels increased significantly.. The results of this explanatory randomised trial do not encourage the routine use of antioxidants against pre-eclampsia. However, further research with modified strategies such as earlier initiation of therapy or different combinations seem worthwhile.

Topics: Adolescent; Adult; Allopurinol; Antioxidants; Ascorbic Acid; Double-Blind Method; Drug Monitoring; Drug Therapy, Combination; Female; Humans; Lipid Peroxides; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Uric Acid; Vitamin E

Haemoglobin variants and preeclampsia (PE) are associated with adverse fatal events of which oxidative stress may be an underlying factor. Oxidative stress (OS) among preeclamptic women with haemoglobin variants has been well established. It is, however, unclear whether haemoglobin variants induce OS to aggravate the risk of adverse foeto-maternal outcomes in pregnant women with preeclampsia. We measured the levels of OS biomarkers and determined the association between haemoglobin variants, and adverse foeto-maternal outcomes among pregnant women with PE.. This multi-centre prospective study recruited 150 PE women from three major health facilities in both Bono and Bono east regions of Ghana from April to December 2019. Haemoglobin variants; HbAS, HbSS, HbSC, HbCC, and HbAC were determined by haemoglobin electrophoresis. OS biomarkers such as malondialdehyde (MDA), catalase (CAT), vitamin C, and uric acid (UA) along with haematological and biochemical parameters were estimated using standard protocol. Adverse pregnancy complications (APCs) such as post-partum haemorrhage (PPH), HELLP (Haemolysis, Elevated liver enzymes, Low platelet count) syndrome, preterm delivery, neonatal intensive care unit (NICU) admission, and neonatal jaundice were recorded.. Of the 150 pregnant women with preeclampsia, the distribution of haemoglobin AA, AS, AC, CC, SS and SC phenotypes were 66.0%, 13.3%, 12.7%, 3.3%, 3.3% and 1.3%, respectively. The most prevalent foeto-maternal outcomes among PE women were NICU admission (32.0%) followed by PPH (24.0%), preterm delivery (21.3%), HELLP syndrome (18.7%), and neonatal jaundice (18.0%). Except for vitamin C level which was significantly higher in patients with at least a copy of Haemoglobin S variant than those with at least a copy of Haemoglobin C variant (5.52 vs 4.55; p = 0.014), levels of MDA, CAT, and UA were not statistically significantly different across the various haemoglobin variants. Multivariate logistic regression model showed that participants with HbAS, HbAC, having at least a copy of S or C and participants with HbCC, SC, SS had significantly higher odds of neonatal jaundice, NICU admission, PPH and HELLP syndrome compared to participants with HbAA.. Reduced levels of vitamin C are common among preeclamptics with at least one copy of the HbC variant. Haemoglobin variants in preeclampsia contribute to adverse foeto-maternal outcomes with Haemoglobin S variants being the most influencing factor for PPH, HELLP, preterm labour, NICU admission, and neonatal jaundice.

Topics: Ascorbic Acid; Biomarkers; Female; Ghana; HELLP Syndrome; Hemoglobin, Sickle; Humans; Infant, Newborn; Jaundice, Neonatal; Oxidative Stress; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Premature Birth; Prospective Studies

Diets dense in fruits and vegetables are associated with a reduced risk of preeclampsia, but pathways underlying this relationship are unclear. Dietary antioxidants may contribute to the protective effect.. We determined the extent to which the effect of dietary fruit and vegetable density on preeclampsia is because of high intakes of dietary vitamin C and carotenoids.. We used data from 7572 participants in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (8 United States medical centers, 2010‒2013). Usual daily periconceptional intake of total fruits and total vegetables was estimated from a food frequency questionnaire. We estimated the indirect effect of ≥2.5 cups/1000 kcal of fruits and vegetables through vitamin C and carotenoid on the risk of preeclampsia. We estimated these effects using targeted maximum likelihood estimation and an ensemble of machine learning algorithms, adjusting for confounders, including other dietary components, health behaviors, and psychological, neighborhood, and sociodemographic factors.. Participants who consumed ≥2.5 cups of fruits and vegetables per 1000 kcal were less likely than those who consumed <2.5 cups/1000 kcal to develop preeclampsia (6.4% compared with 8.6%). After confounder adjustment, we observed that higher fruit and vegetable density was associated with 2 fewer cases of preeclampsia (risk difference: -2.0; 95% CI: -3.9, -0.1)/100 pregnancies compared with lower density diets. High dietary vitamin C and carotenoid intake was not associated with preeclampsia. The protective effect of high fruit and vegetable density on the risk of preeclampsia and late-onset preeclampsia was not mediated through dietary vitamin C and carotenoids.. Evaluating other nutrients and bioactives in fruits and vegetables and their synergy is worthwhile, along with characterizing the effect of individual fruits or vegetables on preeclampsia risk.

Topics: Ascorbic Acid; Carotenoids; Diet; Female; Fruit; Humans; Pre-Eclampsia; Pregnancy; United States; Vegetables; Vitamins

Topics: Ascorbic Acid; Double-Blind Method; Female; Humans; Postpartum Period; Pre-Eclampsia; Pregnancy; Pulmonary Edema

Topics: Ascorbic Acid; Double-Blind Method; Female; Humans; Peripartum Period; Pre-Eclampsia; Pregnancy; Pulmonary Edema

To investigate the relationship between vitamin C intake and IL-6 level as a biomarker of oxidative stress during pregnancy.. Fourty pregnant women during third trimester were grouped into preeclampsia and non-preeclampsia, and surveyed using a Food Frequency Questionnaire. The ELISA assay for IL-6 expression was performed. Univariate and bivariate analyses were conducted using SPSS software ver. 20.. Subjects in preeclampsia group were shown to consume slightly more vitamin C than the non-preeclampsia group, with median values of 76.37 (28.05 - 96.88) mg and 68.87 (8.57 - 198.53) mg, respectively (p = 0.36). A nonparametric correlation test showed no significant association between vitamin C and total IL-6 level, with p = 0.36 and r = -0.15. There was also no difference between vitamin C consumption and IL-6 level for each group, with r = -0.14 and r = -0.20, respectively.. There was no statistically significant association between vitamin C intake and IL-6 level in women during third trimester of pregnancy (p = 0.36).

Topics: Ascorbic Acid; Case-Control Studies; Female; Humans; Interleukin-6; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Vitamins

Preeclampsia and gestational diabetes mellitus (GDM) are the most common clinical conditions in pregnancy that could result in adverse in utero environments. Fetal exposure to poor environments may raise the long-term risk of postnatal disorders, while epigenetic modifications could be involved. Recent research has implicated involvement of 5-hydroxymethylcytosine (5hmC), a DNA base derived from 5-methylcytosine, via oxidation by ten-eleven translocation (TET) enzymes, in DNA methylation-related plasticity. Here, we show that the TET2 expression and 5hmC abundance are significantly altered in the umbilical veins of GDM and preeclampsia. Genome-wide profiling of 5hmC revealed its specific reduction on intragenic regions from both GDM and preeclampsia compared to healthy controls. Gene Ontology analysis using loci bearing unique GDM- and preeclampsia-specific loss-of-5hmC indicated its impact on several critical biological pathways. Interestingly, the substantial alteration of 5hmC on several transposons and repetitive elements led to their differential expression. The alteration of TET expression, 5hmC levels and 5hmC-mediated transposon activity was further confirmed using established hypoxia cell culture model, which could be rescued by vitamin C, a known activator of TET proteins. Together, these results suggest that adverse pregnancy environments could influence 5hmC-mediated epigenetic profile and contribute to abnormal development of fetal vascular systems that may lead to postnatal diseases.

Topics: 5-Methylcytosine; Adult; Ascorbic Acid; Diabetes, Gestational; Dioxygenases; DNA Methylation; DNA Transposable Elements; DNA-Binding Proteins; Epigenesis, Genetic; Female; Gene Expression Regulation, Developmental; Humans; Pre-Eclampsia; Pregnancy; Proto-Oncogene Proteins

Preeclampsia is an important pregnancy-specific multisystem disorder characterized by the onset of hypertension and proteinuria. It is of unknown etiology and involves serious risks for the pregnant women and fetus. One of the main factors involved in the pathophysiology of preeclampsia is oxidative stress, where excess free radicals produce harmful effects, including damage to macromolecules such as lipids, proteins and DNA. In addition, the sulfhydryl delta-aminolevulinate dehydratase enzyme (δ-ALA-D) that is part of the heme biosynthetic pathway in pro-oxidant conditions can be inhibited, which may result in the accumulation of 5-aminolevulinic acid (ALA), associated with the overproduction of free radicals, suggesting it to be an indirect marker of oxidative stress. As hypertensive pregnancy complications are a major cause of morbidity and mortality maternal and fetal where oxidative stress appears to be an important factor involved in preeclampsia, the aim of this study was to evaluate the activity of δ-ALA-D and classic oxidative stress markers in the blood of pregnant women with mild and severe preeclampsia. The analysis and quantification of the following oxidative stress markers were performed: thiobarbituric acid-reactive species (TBARS); presence of protein and non-protein thiol group; quantification of vitamin C; Catalase and δ-ALA--D activities in samples of blood of pregnant women with mild preeclampsia (n=25), with severe preeclampsia (n=30) and in a control group of healthy pregnant women (n=30). TBARS was significantly higher in women with preeclampsia, while the presence of thiol groups, levels of vitamin C, catalase and δ-ALA-D activity were significantly lower in groups of pregnant women with preeclampsia compared with healthy women. In addition, the results showed no significant difference between groups of pregnant women with mild and severe preeclampsia. The data suggest a state of increased oxidative stress in pregnant women with preeclampsia compared to healthy pregnant women, which may be related to the complications of this disease.

Topics: Adult; Ascorbic Acid; Biomarkers; Case-Control Studies; Catalase; Down-Regulation; Female; Humans; Oxidative Stress; Porphobilinogen Synthase; Pre-Eclampsia; Pregnancy; Severity of Illness Index; Sulfhydryl Compounds; Thiobarbituric Acid Reactive Substances; Young Adult

Despite the volume of knowledge and daily reports on pre-eclampsia, its pathogenesis is still yet to be ascertained. Oxidative stress (oxidant (free radical) in excess of antioxidant) injury is one of the recently suggested pathogenetic mechanisms. This study, however, was designed to determine second and third trimesters of plasma malondialdehyde (product of free radical attack on membrane lipid) and vitamins C and E in pre-eclamptic Nigerian women.. A Total of 100 subjects, each for pre-eclamptic, apparently normal and non-pregnant women qualified for the study. Venous blood samples were taken in the second and third trimesters of pregnancy and at the point of contact for non-pregnant women. Variables were analyzed using SPSS version 16, taking level of significance to be 0.05.. Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71µmol/l) was found to be significantly higher than the one in the second trimester (1.65±0.62µmol/l) (p<0.0001). For pre-eclamptic subjects, the malondialdehyde in the third trimester (3.13±0.61µmol/l) was also higher than the malondialdehyde in the second trimester (3.00±1.21µmol/l). The mean vitamin C values for subjects with normal pregnancy were similar in the second and third trimesters (38.25±19.66 vs. 38.66±19.40; p=0.882). For subjects with pre-eclampsia, the mean Vit C values were also similar in the 2(nd) and 3(rd) trimesters (35.05±18.37 vs. 37.20±24.44µmol/l; p=0.175). Mean vitamin E values in the second and third trimesters were also similar for subjects with normal pregnancy (28.62±13.85 vs. 28.50±13.35µmol/l; p=0.950). A similar finding was observed in pre-eclamptic subjects (25.09±12.79 vs. 28.00±14.83µmol/l; p=0.067).. There was an increased product of membrane lipid attack (malondialdehyde) with no change in plasma levels of vitamins C and E as pregnancy advances into the third trimester of both normal and pre-eclamptic pregnancies. Antioxidant vitamins may not be useful in stopping the progression of free radical attack on membrane lipid to control pre-eclampsia.

Topics: Adult; Antioxidants; Ascorbic Acid; Female; Humans; Lipid Peroxidation; Malondialdehyde; Membrane Lipids; Nigeria; Oxidative Stress; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prospective Studies; Vitamin E; Young Adult

Topics: Antioxidants; Ascorbic Acid; Calcium, Dietary; Dietary Supplements; Female; Humans; Mothers; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk

Haptoglobin's (Hp) antioxidant and pro-angiogenic properties differ between the 1-1, 2-1, and 2-2 phenotypes. Hp phenotype affects cardiovascular disease risk and treatment response to antioxidant vitamins in some non-pregnant populations. We previously demonstrated that preeclampsia risk was doubled in white Hp 2-1 women, compared to Hp 1-1 women. Our objectives were to determine whether we could reproduce this finding in a larger cohort, and to determine whether Hp phenotype influences lack of efficacy of antioxidant vitamins in preventing preeclampsia and serious complications of pregnancy-associated hypertension (PAH). This is a secondary analysis of a randomized controlled trial in which 10,154 low-risk women received daily vitamin C and E, or placebo, from 9-16 weeks gestation until delivery. Hp phenotype was determined in the study prediction cohort (n = 2,393) and a case-control cohort (703 cases, 1,406 controls). The primary outcome was severe PAH, or mild or severe PAH with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclampsia, fetal growth restriction, medically indicated preterm birth or perinatal death. Preeclampsia was a secondary outcome. Odds ratios were estimated by logistic regression. Sampling weights were used to reduce bias from an overrepresentation of women with preeclampsia or the primary outcome. There was no relationship between Hp phenotype and the primary outcome or preeclampsia in Hispanic, white/other or black women. Vitamin supplementation did not reduce the risk of the primary outcome or preeclampsia in women of any phenotype. Supplementation increased preeclampsia risk (odds ratio 3.30; 95% confidence interval 1.61-6.82, p<0.01) in Hispanic Hp 2-2 women. Hp phenotype does not influence preeclampsia risk, or identify a subset of women who may benefit from vitamin C and E supplementation to prevent preeclampsia.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Case-Control Studies; Dietary Supplements; Female; Genetic Association Studies; Haptoglobins; Humans; Odds Ratio; Phenotype; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Treatment Outcome; Vitamin E; Young Adult

Topics: Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Vitamin E

Vitamin C alone or in combination with vitamin E has been proposed to prevent pre-eclampsia. In this study, we assayed the plasma vitamin C in women of reproductive age in Kampala and assessed its association with pre-eclampsia.. Participants in this study were 215 women with pre-eclampsia, 400 women with normal pregnancy attending antenatal clinic and 200 non-pregnant women attending family planning clinic at Mulago Hospital's Department of Obstetrics and Gynaecology from 1st May 2008 to 1st May 2009. Plasma vitamin C was assayed using the acid phosphotungstate method; differences in the means of plasma vitamin C were determined by ANOVA.. Mean plasma vitamin C levels were 1.72 (SD 0.68)×10(3)μg/l in women with pre-eclampsia, 1.89 (SD 0.73)×10(3)μg/l in women with normal pregnancy and 2.64 (SD 0.97)×10(3)μg/l in non-pregnant women. Plasma vitamin C was lower in women with pre-eclampsia than in women with normal pregnancy (P=0.005) and non-pregnant women (P<0.001).. Health workers need to advise women of reproductive age on foods that are rich in vitamin C, as this may improve the vitamin status and possibly reduce the occurrence of pre-eclampsia.

Topics: Adult; Analysis of Variance; Ascorbic Acid; Ascorbic Acid Deficiency; Case-Control Studies; Colorimetry; Family Planning Services; Female; Humans; Maternal Health Services; Pre-Eclampsia; Pregnancy; Uganda; Young Adult

To determine the antioxidant levels of subrural Nigerian population where pre-eclampsia and eclampsia is the leading cause of maternal mortality.. Prospective case control study done at Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria. Plasma level of vitamin C and E were evaluated in 80 pre-eclamptic patientswhich were compared with normotensive 80 pregnant women matched as controls.. Pre-eclampsia was associated with significant reduction in levels of vitamin C and E (p < 0.05). However, the correlation between the blood pressure (severity) and reduction in antioxidants level was not statistically significant.. Pre-eclampsia at Irrua in Nigeria is associated with significant reduction in plasma antioxidants level similar to some reports from the other parts of the world.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Biomarkers; Case-Control Studies; Female; Hospitals, Teaching; Humans; Nigeria; Pre-Eclampsia; Pregnancy; Prospective Studies; Vitamin E; Vitamin E Deficiency; Young Adult

Oxidative stress is widely implicated in failed reproductive performance, including infertility, miscarriage, diabetes-related congenital malformations, and preeclampsia. Maternal obesity is a strong risk factor for preeclampsia, and in a recent study we observed oxidative stress in the oocytes of obese animals before pregnancy as well as in early-stage embryos. This adds to the growing evidence that investigators need to focus more on the preconceptual period in efforts to prevent pregnancy disorders, including those related to oxidative stress. Our research has also focused on the role of free radicals and antioxidant capacity in preeclampsia. By measuring markers of lipid peroxidation and antioxidant capacity, we obtained unequivocal evidence for oxidative stress in this disorder. Partial failure of the process of placentation has been implicated, and recent findings suggest that ischemia-reperfusion in the placenta may contribute to oxidative stress in trophoblasts. Endoplasmic reticulum stress in the placenta may also play a role. Randomized controlled trials have been conducted by our group as well as others to determine whether early supplementation with vitamins C and E in women at risk of preeclampsia is beneficial, but these trials have shown no evidence that these supplements can prevent preeclampsia. Whether this indicates that an inappropriate antioxidant strategy was used or supplementation was administered too late in gestation to be beneficial is not known. Other potential approaches for preventing preeclampsia through amelioration of oxidative stress include the use of supplements in the preconceptual period, selenium supplements, antiperoxynitrite strategies, and statins.

Topics: Antioxidants; Ascorbic Acid; Biomarkers; Dietary Supplements; Endoplasmic Reticulum Stress; Female; Free Radicals; Humans; Lipid Peroxidation; Male; Oxidative Stress; Placentation; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Ectopic; Randomized Controlled Trials as Topic; Risk Factors; Trophoblasts; Vitamin E

Oxidative stress plays a role in the aetiology of pre-eclampsia and vitamin C may prevent pre-eclampsia.. To determine the association between plasma vitamin C and pre-eclampsia in Mulago Hospital, Kampala, Uganda.. This case-control study was conducted at Mulago Hospital from 1(st) May 2008 to 1(st) May 2009; 207 women were the cases and 352 women were the controls. Plasma vitamin C was assayed in the women using a colorimetric method. An independent t test was used to find the difference in the means of plasma vitamin C and logistic regression was used to find the association between plasma vitamin C and pre-eclampsia.. The mean plasma vitamin C was 1.7(SD=0.7) × 10(3) µg/L in women with pre-eclampsia and 1.9(SD=0.7) × 10(3) µg/L in women with normal pregnancy (P=0.005). Women with low plasma vitamin C were at an increased risk of pre-eclampsia (OR 2.91, 95% CI: 1.56-5.44).. There was a strong association between low plasma vitamin C, and pre-eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala. Health workers need to advise women at risk in the antenatal period about diet, especially foods which are rich in vitamin C to probably reduce pre-eclampsia.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Case-Control Studies; Female; Hospitals, Teaching; Humans; Odds Ratio; Oxidative Stress; Pre-Eclampsia; Pregnancy; Prenatal Care; Risk Factors; Socioeconomic Factors; Uganda; Young Adult

Topics: Antioxidants; Ascorbic Acid; Diabetes Mellitus, Type 1; Female; Humans; Oxidative Stress; Pre-Eclampsia; Pregnancy; Vitamin E

Topics: Ascorbic Acid; Dose-Response Relationship, Drug; Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Primary Prevention; Treatment Outcome; Vitamin E

Topics: Administration, Oral; Animals; Antioxidants; Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Vitamin E

Preeclampsia is a pregnancy-specific disease characterised by maternal hypertension that is preceded by endothelial cell activation and an inappropriate inflammatory response. The exact cause of preeclampsia is unclear but this disease is known to be induced by a placental factor and it is hypothesised that oxidative stress may also contribute to its pathogenesis. We have shown that dead trophoblasts shed from the placenta can be phagocytosed by endothelial cells and that phagocytosis of necrotic, but not apoptotic, trophoblasts leads to endothelial cells activation. Since phagocytosis may be accompanied by an oxidative burst which may lead to damage/activation of the phagocyte, in this study we have investigated whether the antioxidant vitamin C can protect endothelial cells that phagocytose necrotic trophoblasts from activation. We demonstrate that treatment of phagocytosing endothelial cells with vitamin C induced an increase in the phagocytosis of necrotic trophoblasts but that activation of the phagocytosing endothelial cells was prevented. Treatment of phagocytosing endothelial cells with vitamin C also prevented the increase in IL-6 secretion that normally accompanies phagocytosis of necrotic trophoblasts. Thus treatment of endothelial cells with vitamin C appears to modify both the phagocytosis of necrotic trophoblasts and the response of the endothelial cells to the necrotic trophoblastic material.

Topics: Adult; Antioxidants; Ascorbic Acid; Cell Line, Tumor; Choriocarcinoma; Endothelial Cells; Female; Humans; Interleukin-6; Necrosis; Phagocytosis; Pre-Eclampsia; Pregnancy; Trophoblasts; Umbilical Veins; Young Adult

Neutrophils infiltrate systemic vasculature of women with preeclampsia, so we tested the hypothesis that factors in plasma of preeclamptic women activate endothelial cells to produce IL-8 resulting in transendothelial migration of neutrophils. Neutrophil migration was studied using the Transwell system. An endothelial cell line was grown to confluence on the inserts and treated with 10% plasma from normal nonpregnant (NNP), normal pregnant (NP) and preeclamptic (PE) women or with an oxidizing solution containing linoleic acid (OxLA). Compared to medium control, NNP plasma or NP plasma, PE plasma significantly stimulated IL-8 and neutrophil migration which was inhibited by vitamins E and C or IL-8 neutralizing antibody. Compared to medium control or LA, OxLA stimulated IL-8 and neutrophil migration which was inhibited by vitamins E and C or IL-8 antibody.. Factors present in plasma of preeclamptic women stimulate transendothelial migration of neutrophils which is due to induction of oxidative stress and production of IL-8.

Topics: Adult; Antioxidants; Ascorbic Acid; Cell Line; Cell Migration Assays, Leukocyte; Cell Movement; Coculture Techniques; Endothelial Cells; Female; Humans; Interleukin-8; Linoleic Acid; Neutrophils; Oxidation-Reduction; Oxidative Stress; Pre-Eclampsia; Pregnancy; Vitamin E

Pre-eclampsia is a significant health problem and is the leading cause of maternal and perinatal mortality and morbidity. Low birth weight and prematurity are very common in pre-eclamptic mothers. Pre-eclampsia is associated with oxidative stress in the maternal circulation. To observe the effect of pre-eclampsia on neonates, this study was designed to explore oxidative stress and anti-oxidant status in the fetal circulation in pre-eclampsia.. For this purpose, we collected cord bloods during delivery from Bangabandhu Sheikh Mujib Medical University. Twenty samples were collected from uncomplicated (normotensive) mothers and 15 samples were collected from pre-eclamptic mothers (maternal age matched). Thiobarbituric acid reactive substances (TBARS), lipid hydroperoxide, protein carbonyl value, lipid profile, total anti-oxidant status (TAS), vitamin C, serum total protein and albumin were measured.. It was observed that TBARS and lipid hydroperoxide were significantly (P < 0.001) increased, protein carbonyl content were also significantly (P < 0.001) increased but total anti-oxidant status (P < 0.001) and vitamin C level were significantly (P < 0.05) decreased in cord blood from pre-eclamptic mother compared to control group. Cholesterol, TG, LDL level was elevated and HDL were lowered in cord blood in pre-eclamptic group compared to normotensive group. In pre-eclamptic group, cord blood total protein, albumin and globulin level were significantly decreased compared to control group.. As pre-eclampsia is associated with increased oxidative stress and decreased anti-oxidant status, the results of these investigations suggest that oxidative stress and antioxidant status are altered towards proatherogenic level in cord blood of pre-eclamptic women which may ultimately be responsible for different complications of newborn babies of pre-eclamptic mothers.

Topics: Adult; Antioxidants; Ascorbic Acid; Case-Control Studies; Cholesterol; Female; Fetal Blood; Humans; Infant, Newborn; Lipid Peroxides; Male; Oxidative Stress; Placenta; Pre-Eclampsia; Pregnancy; Thiobarbituric Acid Reactive Substances

It has been suggested that vitamin C, alone or in combination with vitamin E, may protect against pre-eclampsia, whereas the safety of high-dose vitamin E supplements has been questioned. We investigated dietary intakes of vitamins C and E to see if they correlated with the incidence of pre-eclampsia.. Prospective cohort study.. The Danish National Birth Cohort; a population-based pregnancy cohort; analyses were based on 57 346 pregnancies.. Vitamin intake was estimated from a food frequency questionnaire completed in gestational week 25, recording intake from diet and supplements during the previous four weeks. Pre-eclampsia diagnoses were obtained from the Danish National Patient Registry; we worked with two entities, 'pre-eclampsia (all types)' and 'severe pre-eclampsia/eclampsia/HELLP'. We adjusted for confounding factors by logistic regression.. A small increase in the incidence of severe disease was also seen in the group of women (64, n = 49 373) with a high intake of vitamin E from supplements and dietary sources.. The incidence of 'pre-eclampsia (all types)' did not correlate with dietary vitamin C and E intake. There was a decreasing trend (P = 0.01) in the incidence of 'severe pre-eclampsia/eclampsia/HELLP' with increasing dietary vitamin C intake; with an intake of 130-170 mg/day as reference, odds ratios ranged from 1.21 (95% confidence interval 0.83 to 1.75) for an intake below 70 mg/day to 0.70 (0.40 to 1.23) for an intake exceeding 275 mg/day (total n = 57 346). For vitamin E intake aggregated from diet and supplements (n = 49 373), with an intake of 10.5-13.5 mg/day as reference, the 'severe pre-eclampsia/eclampsia/HELLP' odds ratio was 1.46 (1.02 to 2.09) for an intake exceeding 18 mg/day.. Low dietary intake of vitamin C was associated with a trend towards an increased incidence of either severe pre-eclampsia, eclampsia or HELLP. A small increase in the incidence of severe disease was also seen in the group of women with a high intake of vitamin E from supplements and dietary sources.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Denmark; Exercise; Female; Humans; Parity; Pre-Eclampsia; Pregnancy; Prospective Studies; Risk Factors; Smoking; Socioeconomic Factors; Vitamin E; Young Adult

The aims of this study were to measure the degree of oxidative stress and alterations in plasminogen activator inhibitor (PAI) type 1 and PAI-2 ratio in women with early-onset and late-onset preeclampsia.. A case-control study was conducted in women with early-onset (24-32 weeks' gestation; n=18) and late-onset (35-42 weeks' gestation; n=20) preeclampsia and in control pregnant women at corresponding gestational weeks. Placenta, urine, and serum samples were collected.. In early-onset preeclampsia, the median placental concentration of 8-iso-prostaglandin (PG)-F2alpha was higher and the PAI-1 to PAI-2 ratio higher than in early controls. These values did not differ between women with late-onset preeclampsia and their corresponding controls. Serum concentrations of 8-iso-PGF2alpha and vitamins C and E did not differ between cases and controls.. Early-onset but not late-onset preeclampsia is associated with increased placental oxidative stress and increased PAI-1 to PAI-2 ratio.

Topics: Adult; Ascorbic Acid; Case-Control Studies; Dinoprost; Female; Humans; Oxidative Stress; Plasminogen Activator Inhibitor 1; Plasminogen Activator Inhibitor 2; Pre-Eclampsia; Pregnancy; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Dietary Supplements; Drug Therapy, Combination; Female; Humans; Oxidative Stress; Pre-Eclampsia; Pregnancy; Vitamin E

Preeclampsia (PE) is a multisystem disorder that remains a major cause of maternal and foetal morbidity and death. To date, no treatment has been found that prevents the development of the disease. Endothelial dysfunction is considered to underlie its clinical manifestations, such as maternal hypertension, proteinuria and edema; and oxidative stress has been increasingly postulated as a major contributor to endothelial dysfunction in PE. A large body of research has investigated the potential role of antioxidant nutrients in the prevention of PE in women at high increased risk of the disease. Therefore, the present study was primary designed to assess the potential benefit of antioxidant supplementation on markers of placental oxidative stress in an in vitro model of PE, since we previously found that endothelin-1 (ET-1) is able to trigger the placental secretion of stress molecules. In this regard, we evaluated the effects of vitamin C, vitamin E and N-acetylcysteine (NAC), alone or in combination, in placental villi culture after exposure to ET-1. The effect of antioxidant nutrients on trophoblast cells proliferation and vitality was also evaluated. The results obtained suggest that in a pathophysiological condition, such as PE, the deleterious effect of reactive oxygen species may be counteract by an antioxidant therapy, and there is the need to investigate the optimum dosing and timing of antioxidants administration, since an inappropriate antioxidant treatment in pregnant women may have deleterious consequences, reducing placental cells proliferation until to cell death.

Topics: Acetylcysteine; Adult; Antioxidants; Ascorbic Acid; Cell Line, Tumor; Cell Proliferation; Cell Survival; Endothelin-1; Female; Glutathione; Humans; Lipid Peroxidation; Malondialdehyde; Oxidative Stress; Placenta; Pre-Eclampsia; Pregnancy; Vitamin E; Young Adult

Circulating levels of activin A are significantly increased in women with preeclampsia when compared with those with a normal pregnancy. The mechanisms underlying these increased levels are unknown. We undertook these studies to explore whether oxidative stress might be the mechanism. We exposed trophoblast explants, human umbilical vein endothelial cells (HUVECs) and peripheral blood monocytes to oxidative stress in vitro using xanthine/xanthine oxidase (X/XO), measuring activin A and isoprostane in conditioned media and mRNA for activin beta(A) in explants and HUVECs. We also measured isoprostane and activin A in serum from 21 women with preeclampsia and from 20 women with a normal pregnancy. Treatment with X/XO significantly increased 8-isoprostane production from placental explants, HUVECs and monocytes, indicative of oxidative stress, and significantly increased activin A output from placental explants (139.1 +/- 27.4 per mg wet weight vs 322.9 +/- 89.7 pg/ml per mg wet weight, P = 0.02) and from HUVECs (1.2 +/- 0.2 vs 3.2 +/- 1.8 ng/ml, P = 0.04). There was no effect on activin A output from monocytes. X/XO significantly increased beta(A) mRNA in placental explants but not in HUVECs. Maternal plasma levels of 8-isoprostane and activin A were significantly higher in women with preeclampsia when compared with controls (333.8 +/- 70 vs 176.3 +/- 26.2 pg/ml, P = 0.04 and 49.5 +/- 7 vs 13.1 +/- 1.2 ng/ml, P < 0.001 respectively). In the women with preeclampsia, but not in those with a normal pregnancy, circulating levels of 8-isoprostane and activin A were significantly and positively correlated (r(2) = 0.72; P < 0.001). These data suggest that oxidative stress may be one of the mechanisms underlying increased circulating activin A in preeclampsia.

Topics: Activins; Adult; Antioxidants; Ascorbic Acid; Case-Control Studies; Cells, Cultured; Endothelial Cells; Female; Humans; Isoprostanes; Monocytes; Oxidative Stress; Placenta; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Superoxide Dismutase; Tissue Culture Techniques; Trophoblasts; Umbilical Veins; Uterus; Vitamin A; Vitamins

Preeclampsia is a potentially fatal complication of human pregnancy characterized by hypertension, proteinuria, and edema. Placental oxidative stress is a key element in the pathogenesis of the syndrome and results in the release of a cocktail of factors, including proinflammatory cytokines and apoptotic debris, that in turn cause activation of the maternal endothelium. The intermediary molecular mechanisms underlying this release are unknown, but they represent a potential target for therapeutic interventions. We examined activation of signaling pathways during hypoxia-reoxygenation of villous explants in vitro. Hypoxia-reoxygenation activated the p38 and stress-activated protein kinase mitogen-activated protein kinase (MAPK) and the nuclear factor-kappaB pathways. Downstream consequences included increased tissue concentrations and secretion of tumor necrosis factor-alpha and interleukin-1 beta, increased expression of cyclooxygenase-2, and increased apoptosis. Administration of vitamins C and E to explants blocked activation of the p38 and stress-activated protein kinase MAPK and nuclear factor-kappaB pathways. Vitamin administration or p38 pathway inhibition also reduced cyclooxygenase-2 expression, tumor necrosis factor-alpha and interleukin-1 beta secretion, and the levels of apoptosis. We conclude that oxidative stress is a potent inducer of placental synthesis and release of proinflammatory factors. Most of these effects are mediated through the p38 MAPK and nuclear factor-kappaB pathways and can be effectively blocked by vitamins C and E in vitro.

Topics: Antioxidants; Apoptosis; Ascorbic Acid; Blotting, Western; Chorionic Villi; Cytokines; Female; Humans; Immunohistochemistry; JNK Mitogen-Activated Protein Kinases; NF-kappa B; Organ Culture Techniques; Oxidative Stress; p38 Mitogen-Activated Protein Kinases; Pre-Eclampsia; Pregnancy; Signal Transduction; Vitamin E

To measure the plasma oxidant, lipid peroxidation and antioxidants, ascorbate, to magnify the prooxidants and antioxidants status as a marker of pre-eclampsia.. Included in the study were 50 preeclamptic and 100 normotensive pregnant women of singleton gestations in their third trimester, presented in Allavi Hospitals in Ardabil province of Iran from August 2004 to April 2005. Among these patients plasma malonaldehyde (MDA) and vitamin C concentration were analyzed. Blood samples (5 ml) were collected aseptically in heparin bulb. Spectrophotometric methods were employed to determine the plasma concentrations of vitamin C. The Statistical Package for Social Sciences software was used to analyze the data.. In preeclampsia, significant increase in prooxidant MDA was observed as compared to controls. A significant fall in antioxidants vitamin C was noted in preeclampsia as compared to control. The MDA showed a significant balance to the level of vitamin C.. Administration of regular nutritive supplementation containing reducing systems like vitamin C should help in maintaining the equilibrium during normal pregnancy and theoretically in preeclampsia too but to what extent they help in clinical practice is still being investigated.

Topics: Adult; Antioxidants; Ascorbic Acid; Biomarkers; Female; Homeostasis; Humans; Iran; Malondialdehyde; Oxidants; Pre-Eclampsia; Pregnancy

Oxidative stress plays an important role in the pathophysiology of preeclampsia. In a case-control study of 99 women with preeclampsia and 99 controls, we assessed maternal plasma oxidized low-density lipoprotein (oxidized LDL) in relation to preeclampsia risk. Logistic regression procedures were used to derive odds ratios (OR) and 95 % confidence intervals (CI). Plasma oxidized LDL was determined using enzyme immunoassay. Maternal plasma oxidized LDL was significantly positively correlated with lipids in both cases and controls. After adjusting for nulliparity, pre-pregnancy body mass index, physical inactivity, family history of chronic hypertension and plasma vitamin C concentrations, women who had elevated oxidized LDL concentrations ( > or = 50 U/l) experienced a 2.9-fold increased risk of preeclampsia when compared with women having lower oxidized LDL concentrations (95 % CI 1.4-5.9). The risk of preeclampsia was markedly increased in women who had both elevated oxidized LDL and elevated triglyceride concentrations (OR=8.9, 95 % CI 3.1-26.2). Women with both elevated oxidized LDL and low vitamin C concentrations experienced a 9.8-fold increased risk of preeclampsia (95 % CI 3.0-32.2). Our results confirm the role of oxidative stress in the pathogenesis of preeclampsia. Prospective studies are needed to determine if elevated oxidized LDL concentrations can predict the occurrence of preeclampsia.

Topics: Adolescent; Adult; Ascorbic Acid; Body Mass Index; Case-Control Studies; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Female; Humans; Lipoproteins, LDL; Odds Ratio; Pre-Eclampsia; Pregnancy; Risk Factors; Triglycerides

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Treatment Failure; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Vitamin E

To compare the levels of 3 oxidative stress markers (glutathione peroxidase [GPX], superoxide dismutase [SOD], and malondialdehyde [MDA]) and 2 antioxidants (vitamin C and lycopene) in healthy and pre-eclamptic pregnant women.. Circulating levels of GPX, SOD, MDA, vitamin C and lycopene were measured in 50 healthy pregnant women and 50 women with pre-eclampsia (PE) (41 with mild PE and 9 with severe PE) attending the antenatal clinic or admitted to the maternity ward of the All-India Institute of Medical Sciences, New Delhi, India.. The levels of GPX, SOD and MDA were significantly higher in women with PE than in controls, and the increase was higher in women with severe PE (P<0.001 using analysis of variance and the Kruskal Wallis test). The levels of vitamin C and lycopene were significantly lower in women with PE than in controls, with a greater decrease in women with severe PE.. Increased levels of oxidative stress markers and decreased levels of antioxidants in pre-eclamptic women suggest that oxidative stress markers play a significant role in the pathophysiology of pre-eclampsia, and that supplemental dietary antioxidants may have a beneficial role in the prevention of pre-eclampsia in women at high-risk for this condition.

Topics: Adult; Antioxidants; Ascorbic Acid; Carotenoids; Dietary Supplements; Female; Humans; Lycopene; Malondialdehyde; Oxidative Stress; Pre-Eclampsia; Pregnancy; Superoxide Dismutase

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Patient Selection; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Bias; Female; Humans; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Statistics as Topic; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Stereoisomerism; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Dietary Supplements; Female; Humans; Pre-Eclampsia; Pregnancy

Topics: Antioxidants; Ascorbic Acid; Dietary Supplements; Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Vitamin E

Activation products from neutrophils and the complement system might cause endothelial dysfunction, which is central to the aetiology of pre-eclampsia. This study aimed to investigate the activity of myeloperoxidase (MPO), and its association with advanced oxidation protein products (AOPP), in women with pre-eclampsia and eclampsia.. Twenty-one pregnant women with pre-eclampsia, 11 pregnant women with eclampsia and 19 healthy pregnant women were studied. Serum levels of malondialdehyde (MDA), AOPP, ascorbic acid (AA) and activities of MPO and catalase (CAT) were measured using a colorimetric method.. The MDA level was significantly higher in the pre-eclampsia (3.15+/-0.28 nmol/mL) and eclampsia (4.01+/-0.66 nmol/mL) groups than in controls (1.85+/-0.18 nmol/mL); the difference between MDA levels in the pre-eclampsia and eclampsia groups was not statistically significant. MPO activity was significantly higher in the eclampsia (347.59+/-88.06 U/L) group than in the pre-eclampsia (196.17+/-30.8) and control (93.22+/-9.52) groups, and there was also no significant difference in these levels between the pre-eclampsia and control groups. CAT activity was significantly higher in the pre-eclampsia (166.35+/-31.75 U/L) and eclampsia (166.98+/-40.31 U/L) groups than in controls (81.28+/-7.41 U/L), and AA level was significantly higher in the pre-eclampsia (0.54+/-0.15 mg/dL) group than in controls (0.18+/-0.01 mg/dL); the differences in AA and CAT activity between the pre-eclampsia and eclampsia groups were not statistically significant. AOPP levels did not change significantly among the control, pre-eclampsia and eclampsia groups (106.88+/-5.62, 98.89+/-6.47, 111.89+/-6.8 micromol/L, respectively).. We suggest that increased oxidative stress might contribute to the pathophysiological mechanisms of pre-eclampsia and eclampsia, and that AA and CAT might have a protective role via free radical-scavenging properties. However, further study is needed.

Topics: Adult; Ascorbic Acid; Catalase; Eclampsia; Female; Granulocyte Colony-Stimulating Factor; Humans; Interleukin-3; Malondialdehyde; Oxidative Stress; Peroxidase; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Recombinant Fusion Proteins; Recombinant Proteins

S-nitrosoalbumin (SNO-Alb) is a major reservoir of releasable nitric oxide (NO) in plasma. In preeclampsia, a pregnancy-specific disorder associated with endothelial dysfunction, we previously found significant elevations in plasma SNO-Alb concentrations and decreased plasma ascorbate (Asc) levels. This increased SNO-Alb may result from low-plasma Asc if Asc, along with transition metals (eg, copper [Cu]) are necessary for release of NO from S-nitrosothiols. We propose that vasodilator effects of SNO-Alb, mediated by release of NO, are fully realized only when Asc/Cu availability is sufficient. Relaxation responses to SNO-Alb or the control reduced human serum albumin (SH-Alb), and responses to pooled plasma from normal or preeclamptic pregnancies were examined in isolated mouse arteries. Arteries preconstricted with phenylephrine were exposed to SNO-Alb or SH-Alb at physiologically relevant concentrations. When free Cu was added in excess (10 mumol/L), NO release was not dependent on Asc. However, when Cu was added at lower (physiological) levels, NO release was dependent on Asc. The addition of Asc and Cu to SNO-Alb stimulated vasodilatory responses in isolated arteries >90%, whereas no change in the SH-Alb (5%) response was observed. Preeclampsia plasma with higher levels of SNO-Alb caused arteries to relax 44.1+/-4.7%, whereas normal pregnancy plasma caused 11.9+/-4.2% relaxation (P=0.007). These data indicate that SNO-Alb alone or in plasma can act as a potent vasodilator, and that sufficient Asc/Cu promotes this action. We suggest that the higher circulating levels of SNO-Alb, in women with preeclampsia, reflect a deficiency in Asc/Cu-mediated release of NO from SNO-Alb.

Topics: Adult; Animals; Ascorbic Acid; Copper; Female; Humans; Mesenteric Arteries; Mice; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Donors; Nitroso Compounds; Oxadiazoles; Oxidative Stress; Phenylephrine; Pre-Eclampsia; Pregnancy; Quinoxalines; Serum Albumin, Bovine; Vasodilation

Preeclampsia is one of the most serious complications of pregnancy. Free radical damage has been implicated in the pathophysiology of this condition. In this study, we aimed to measure the antioxidant capacity in plasma samples from normotensive and preeclamptic pregnant women to evaluate their antioxidant status using a more recently developed automated measurement method.. Our study group contained 42 women, 24 of whom had preeclampsia, while 18 had normotensive pregnancies. We measured the total plasma antioxidant capacity for all patients, as well as the levels of four major individual plasma antioxidant components; albumin, uric acid, ascorbic acid and bilirubin, and as a reciprocal measure, their total plasma peroxide levels.. Statistically significant differences (determined using Student's t-test) were noted between the normotensive and the preeclamptic groups for their total antioxidant responses and their vitamin C levels (1.31 +/- 0.12 mmol versus 1.06 +/- 0.41 mmol Trolox eq./L; 30.2 +/- 17.83 micromol/L versus 18.1 +/- 11.37 micromol/L, respectively), which were both considerably reduced in the preeclamptic patients. In contrast, the total plasma peroxide levels were significantly elevated in this group (49.8 +/- 14.3 micromol/L versus 38.8 +/- 9.6 micromol/L).. We found a decreased total antioxidant response in preeclamptic patients using a simple, rapid and reliable automated colorimetric assay, which may suitable for use in any routine clinical biochemistry laboratory, and considerably facilitates the assessment of this useful clinical parameter. We suggest that this novel method may be used as a routine test to evaluate and follow up of the levels of oxidative stress in preeclampsia.

Topics: Adult; Antioxidants; Ascorbic Acid; Autoanalysis; Bilirubin; Colorimetry; Female; Humans; Oxidative Stress; Peroxides; Pre-Eclampsia; Pregnancy; Serum Albumin; Uric Acid

Pre-eclampsia, formerly called pregnancy-induced hypertension, refers to the new onset of hypertension (SBP > or = 140 mmHg or DBP > or = 90 mmHg) and proteinuria (> or = 0.3 g protein in a 24-hour urine specimen or 1+ on dipstick) after 20 weeks of gestation in a previously normotensive women. It is a life-threatening, multi-organ involvement disease and remains the leading cause of maternal death. Its clinical manifestations are the result of generalized vasospasm, activation of the coagulation system, and changes in several humoral and autoregulatory systems related to volume and blood pressure control. Pre-eclampsia is responsible for high perinatal mortality and morbidity rates, primarily due to early termination of pregnancy. Fetus growth restriction, oligohyrdramnios and non-reassuring fetal status are the consequences of chronic placental hypoperfusion. Pre-eclampsia does not appear to accelerate fetal maturation, as once believed. Delivery remains the definitive treatment of choice for pre-eclampsia and should be timely. Cesarean section is not necessary and reserved for the obstetrical indications only. The expectant management may be considered for women remote from term (< 32 to 34 weeks of gestation) with stable and uncomplicated severe disease. The supportive management such as blood pressure control, seizure prevention, and fetal well-being assessment are also important to ensure the satisfactory outcome. To date, no screening test has been proved to be reliable and cost-effective. The prevention of pre-eclampsia with antioxidant therapy (vitamin C, E) has shown promise, but large, randomized trials are needed. Although controversy exists, calcium supplementation has shown no benefit in large trials, and most evidence suggests little or no benefit for low-dose aspirin as prevention in women in the low-risk category.

Topics: Antihypertensive Agents; Antioxidants; Ascorbic Acid; Aspirin; Blood Pressure; Female; Humans; Hypertension; Pre-Eclampsia; Pregnancy; Risk Factors; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Infant, Newborn; Infant, Premature; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Pregnant Women; Primary Prevention; United Kingdom; Vitamin E; Women's Health

Topics: Ascorbic Acid; Calcium; Female; Fish Oils; Humans; Pre-Eclampsia; Pregnancy

Oxidative stress plays an important role in the pathophysiology of preeclampsia.. In a case-control study of 109 women with preeclampsia and 259 controls, maternal dietary and plasma vitamin C in relation to preeclampsia risk were assessed. Dietary intake during the periconceptional period and pregnancy was ascertained using a semiquantitative food frequency questionnaire. Logistic regression procedures were used to derive odds ratios (OR) and 95% confidence intervals (CI). Plasma ascorbic acid was determined using automated enzymatic procedures.. After adjusting for maternal age, parity, prepregnancy body mass index, and energy intake, women who consumed <85 mg of vitamin C daily (below the recommended dietary allowance), as compared with others, experienced a doubling in preeclampsia risk (OR = 2.1; 95% CI = 1.1-3.9). The OR for extreme quartiles of plasma ascorbic acid (<42.5 vs > or = 63.3 micromol/liter) was 2.3 (95% CI = 1.1-4.6). Compared with women in the highest quartile, those with plasma ascorbic acid <34.6 micromol/liter (lowest decile) experienced a 3.8-fold increased risk of preeclampsia (95% CI = 1.7-8.8).. Our results, if confirmed, would suggest that current public health efforts to increase intake of fruits and vegetables rich in vitamin C and other antioxidants may reduce the risk of preeclampsia.

Topics: Adolescent; Adult; Ascorbic Acid; Case-Control Studies; Female; Humans; Logistic Models; Pre-Eclampsia; Pregnancy; Risk Factors; Surveys and Questionnaires; Washington

Preeclampsia is believed to result from release of placental factors that damage maternal vascular endothelium. However, because most studies have been conducted during pregnancy, it has not been possible to separate maternal from placental mechanisms underlying endothelial dysfunction in preeclampsia.. To determine whether endothelial function is impaired in nonpregnant women with previous preeclampsia and whether endothelial dysfunction is mediated by oxidative stress.. Case-control study conducted at 3 hospital maternity units in London, England, between July 1997 and June 2000.. A total of 113 women with previous preeclampsia (n = 35 with recurrent episodes; n = 78 with a single episode) and 48 women with previous uncomplicated pregnancies, all of whom were at least 3 months (median, 3 years) postpartum.. Brachial artery flow-mediated (endothelium-dependent) and glyceryl trinitrate-induced (endothelium-independent) dilatation were compared between previously preeclamptic women and controls. To investigate oxidative stress, these measurements were repeated after administration of ascorbic acid, 1 g intravenously, in 15 cases and 15 controls.. Mean (SD) flow-mediated dilatation was lower in women with previous preeclampsia compared with controls (recurrent group, 0.9% [4.1%]; single-episode group, 2.7% [3.5%]; and control group, 4.7% [4.3%]; P<.001). In contrast, glyceryl trinitrate-induced dilatation was similar in the 3 groups (recurrent, 19.5% [5.9%]; single-episode, 21.0% [8.0%]; and control, 21.0% [8.3%]; P =.65). Impaired flow-mediated dilatation in previously preeclamptic women was not accounted for by recognized vascular risk factors. Ascorbic acid administration increased flow-mediated dilatation in previously preeclamptic women (baseline, 2.6% [3.3%]; after administration, 5.6% [3.0%]; P =.001) but not in controls (baseline, 6.2% [3.3%]; after administration, 6.7% [5.0%]; P =.72).. Our results indicate that endothelial function is impaired in women with previous preeclampsia and is not explained by established maternal risk factors but is reversed by antioxidant ascorbic acid administration.

Topics: Adult; Antioxidants; Ascorbic Acid; Blood Flow Velocity; Brachial Artery; Case-Control Studies; Endothelium, Vascular; Female; Humans; Nitroglycerin; Oxidative Stress; Pre-Eclampsia; Pregnancy; Regional Blood Flow; Risk Factors; Ultrasonography; Vasodilation; Vasodilator Agents

Topics: Ascorbic Acid; Female; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Treatment Outcome; Vitamin E

The objective of this study was to test the hypothesis that maternal plasma, cord plasma and placental tissue lipid peroxidation products are increased and antioxidants are decreased in women with pre-eclampsia.. Placenta, maternal and cord plasma were collected at delivery from 29 normal, 21 pre-eclamptic and six eclamptic women. Plasma was collected from 21 non-pregnant matched controls. The analyses were measured by HPLC and colorimetric assay.. Plasma maternal concentrations of uric acid, LPO, MDA, ascorbic acid, vitamin E and cholesterol were not significantly different in pre-eclampsia as compared with normal pregnancy. Plasma concentrations of ascorbic acid and vitamin E were not significantly different in normal pregnancy as compared with the non-pregnant controls. Cord plasma concentrations of MDA were significantly higher in eclampsia (1.16+/-0.26 micromol/l) as compared with normal pregnancy (0.79+/-0.05 micromol/l, p<0.02) and pre-eclampsia (0.83+/-0.05 micromol/l, p<0.05). Cord plasma concentrations of vitamin E were significantly higher in eclampsia (21.3+/-7.5 micromol/l) as compared with normal pregnancy (10.2+/-1.1 micromol/l, p<0.01) and pre-eclampsia (10.4+/-1.8 micromol/l, p<0.04). Placental concentrations of LPO, MDA and ascorbic acid were not significantly different in pre-eclampsia as compared with normal pregnancy. Plasma cord concentrations of LPO and placental concentrations of vitamin E were undetected for normal pregnant, pre-eclamptic and eclamptic women respectively. Uric acid concentrations were significantly increased in eclampsia as compared with the non-pregnant controls (p<0.0001), normal pregnant controls (p<0.0001) and pre-eclampsia (p<0.008).. The findings in this study do not show any evidence of deficiency in the maternal protective antioxidant systems or increased production of lipid peroxidation products, LPO and MDA in African women with pre-eclampsia as compared with normal pregnancy. However, there was evidence of increased cord plasma concentrations of MDA and vitamin E in eclampsia as compared with normal pregnancy and pre-eclampsia. The placenta may be effective in removing MDA. The antioxidant uric acid serves as a protective role whilst the antioxidant and oxidant capacity in the different study groups remained unchanged.

Topics: Adolescent; Adult; Ascorbic Acid; Black People; Case-Control Studies; Cholesterol; Eclampsia; Female; Fetal Blood; Humans; Lipid Peroxides; Malondialdehyde; Oxidative Stress; Placenta; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pre-Eclampsia; Pregnancy; Vitamin E

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Vaginosis, Bacterial

Topics: Analysis of Variance; Antioxidants; Ascorbic Acid; Enzyme Inhibitors; Female; Fetus; Humans; Muscle, Smooth, Vascular; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Placenta; Pre-Eclampsia; Pregnancy; Vasoconstriction

Topics: Antioxidants; Ascorbic Acid; Chromosomes, Human, Pair 2; Female; Humans; Microsatellite Repeats; Pre-Eclampsia; Pregnancy; Risk Factors

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Lipid Peroxidation; Melatonin; Mitochondria; NADP; Placenta; Pre-Eclampsia; Pregnancy; Thiobarbituric Acid Reactive Substances

Vascular endothelial damage has been implicated in the pathophysiology of preeclampsia. Lipid peroxidation may be involved in the process and essential nutrients that can scavenge free radicals, such as vitamin E and C, operate in concert. Antioxidant vitamins E and C were estimated in 30 preeclamptic and 30 normotensive pregnant women. Significantly lowered levels of vitamins E and C were observed in preeclamptic women as compared to controls (P<0.001 and P<0.05 respectively). In patients with preeclampsia antioxidant nutrients may be utilized to a greater extent to counteract free radical-mediated cell disturbances, resulting in a reduction in serum antioxidant levels.

Topics: Adolescent; Adult; Antioxidants; Ascorbic Acid; Birth Weight; Blood Pressure; Delivery, Obstetric; Female; Gestational Age; Humans; Pre-Eclampsia; Pregnancy; Proteinuria; Vitamin E

To compare the antioxidant nutrients and lipid peroxide levels in preeclampsia and normal pregnant women.. Antioxidant nutrients (vitamin A and E) were measured by high-pressure liquid chromatography, vitamin C was measured by the dinitrophenyl hydrazine method, lipid peroxides were measured by the malondialdehyde method in 20 severe preeclampsia, 30 mild preeclampsia and 60 normal pregnant women as controls.. Vitamin C levels in severe and mild preeclampsia were significantly less than those in control group. The corrected vitamin E and vitamin A levels were significantly decreased only in severe preeclampsia. While the lipid peroxide levels in both mild and severe preeclampsia were significantly increased when compared with the nomal pregnancy.. Preeclampsia is associated with the imbalance between lipid peroxides and antioxidant nutrients (vitamin C and E). The imbalances favour lipid peroxides with the increasing severity of preeclampsia.

Topics: Adult; Ascorbic Acid; Case-Control Studies; Chromatography, High Pressure Liquid; Female; Humans; Lipid Peroxides; Pre-Eclampsia; Pregnancy; Vitamin A; Vitamin E; Vitamins

To investigate antioxidant activity of sera and the plasma blood levels of two potent antioxidant in women with pre-eclampsia and normotensive pregnancies.. The antioxidant activity of sera and the blood levels of ascorbic acid and alpha-tocopherol were assayed in women with normal pregnancies (n = 33), mild pre-eclampsia (n = 8), and severe pre-eclampsia (n = 16) between 20 and 40 weeks' gestation. Ascorbic acid and alpha-tocopherol concentrations were analyzed by high-performance liquid chromatography. Antioxidant activity of sera was measured as the percent inhibition of spontaneous autoxidation of a standard brain homogenate.. Plasma levels of ascorbic acid in women with mild and severe pre-eclampsia were significantly lower than normal pregnancies (P < 0.05). Sera alpha-tocopherol levels were significantly decreased only in severe pre-eclampsia (P < 0.05). Sera antioxidant activity were significantly decreased in mild (73%) and severe (51%) pre-eclampsia compared with normal (86%) pregnancies (P = 0.02, P = 0.000, respectively).. In women with pre-eclampsia, sera antioxidant activity and antioxidant level of plasma are decreased when compared with normotensive pregnancies. Impaired antioxidant activity and the reduction of antioxidant levels which increase the level of lipid peroxidation products may cause peroxidative damage of vascular endothelium and result in clinical symptoms of pre-eclampsia.

Topics: Adult; Antioxidants; Ascorbic Acid; Case-Control Studies; Chromatography, High Pressure Liquid; Female; Humans; Lipid Peroxidation; Pre-Eclampsia; Pregnancy; Vitamin E

To determine the changes in plasma levels of lipid peroxide, vitamin E and vitamin C in women with preeclampsia and to investigate their relationship with diastolic blood pressure.. Cross sectional study consisting of 22 preeclamptic and 21 healthy pregnant women. Fasting venous blood samples were collected during the antepartum period and plasma levels of malondialdehyde, alpha-tocopherol and ascorbic acid were measured.. In the preeclamptic group malondialdehyde, a lipid peroxidation product, was significantly increased, while vitamins E and C were significantly decreased compared to healthy pregnant women. A strong correlation was detected between malondialdehyde and antioxidant factors (vitamins E and C) with blood pressure.. Our findings are consistent with previous studies suggesting that lipid peroxidation is an important factor in the pathogenesis of preeclampsia. In preeclampsia, antioxidant nutrients are excessively utilised to counteract the cellular changes mediated by free radicals.

Topics: Adult; Antioxidants; Ascorbic Acid; Blood Pressure; Cross-Sectional Studies; Female; Humans; Lipid Peroxidation; Malondialdehyde; Pre-Eclampsia; Pregnancy; Vitamin E

To investigate placental lipid peroxidation products and antioxidative enzymes after vitamin C and/or E infusions into the maternal circulation of normal and preeclamptic placentas perfused in vitro.. Placentas from 29 normal and six preeclamptic women delivered between 27 and 41 weeks of gestation were used in the study.. Neither vitamin C (500 microM) nor vitamin E (50 microM) had any effect on placental lipid peroxidation or antioxidative enzymes in normal placentas. Vitamin C infused in preeclamptic placentas decreased peroxidation potential, as an indicator of lipid peroxidation to the same level it was in normal placentas (812 vs. 649 mV/mgprot; p=0.420). The activity of superoxide dismutase (SOD) was lower (1350 vs. 2030 ng/mgprot; p=0.023) in preeclamptic placentas, and the activities of glutathione peroxidase (0.22 vs. 0.08 micromol/min x mgprot; p=0.010) and glutathione-S-transferase (19.8 vs. 13.1 micromol/min x mgprot; p=0.016) were higher in preeclamptic compared to normal placentas.. In this study, based on in vitro perfused normal and preeclamptic placentas, exogenous antioxidative vitamins had no effect on lipid peroxidation or endogenous antioxidative enzymes in normal placenta, but reduced placental lipid peroxidation and could potentiate the activity of some endogenous placental antioxidative enzymes in preeclamptic placenta.

Topics: Ascorbic Acid; Enzyme Activation; Female; Glutathione Peroxidase; Glutathione Transferase; Humans; In Vitro Techniques; Lipid Peroxidation; Placenta; Pre-Eclampsia; Pregnancy; Reference Values; Superoxide Dismutase; Vitamin E

Lipid peroxidation and the antioxidant system were investigated in the plasma and placenta of normal and preeclamptic pregnant women. A significant increase in thiobarbituric acid reactive substance (TBARS), significant decreases in total thiol (t-SH) content and superoxide dismutase (SOD) activity, and unchanged vitamin C levels and glutathione peroxidase (GPx) activity were observed in the plasma of preeclamptic women compared to women with normal pregnancies. In placentas from preeclamptic women TBARS levels were significantly elevated, while glutathione and vitamin C levels and GPx, glutathione S-transferase and SOD activities were decreased. After delivery, the elevated TBARS values decreased significantly and the reduced SOD activity and t-SH contents increased significantly. We concluded that preeclampsia is associated with an imbalance between lipid peroxides and the antioxidant system.

Topics: Adult; Antioxidants; Ascorbic Acid; Case-Control Studies; Female; Glutathione Peroxidase; Humans; Lipid Peroxidation; Placenta; Pre-Eclampsia; Pregnancy; Sulfhydryl Compounds; Superoxide Dismutase; Thiobarbituric Acid Reactive Substances

An imbalance between oxidants and antioxidants in the circulation is blamed to cause preeclampsia and eclampsia. In this study plasma ascorbic acid level was analysed in 13 eclamptic, 14 mild preeclamptic, 12 severe preeclamptic and 20 uncomplicated pregnancies to see whether there is any correlation with blood pressure, proteinuria, serum triglyceride level, erythrocyte fragility and leukocyte count. Plasma ascorbic acid level was normal and had no significant difference among the groups. Fasting serum triglyceride level was significantly higher in the study group than in the control group but it did not differ among the three study groups. Erythrocyte fragility was found to be increased in all three study groups. Blood leukocyte count was increased in the study groups, especially in the eclampsia group. However, plasma ascorbic acid level and erythrocyte fragility were found to have no significant correlation with blood pressure and proteinuria. It was concluded that though the ascorbic acid levels were normal in both the study and the control groups, erythrocyte fragility increased probably due to an elevation in peroxide and free radical levels in preeclampsia and eclampsia groups, but without any correlation with the severity of the clinical picture.

Topics: Adult; Apgar Score; Ascorbic Acid; Blood Pressure; Eclampsia; Female; Gestational Age; Humans; Leukocyte Count; Osmotic Fragility; Pre-Eclampsia; Pregnancy; Triglycerides

There is evidence that oxidative stress accompanies preeclampsia and plasma ascorbate concentrations are reported to be decreased in the disorder. We tested the hypothesis that an ascorbate-oxidizing activity is increased in plasma from women with preeclampsia relative to normal pregnancy. Electron paramagnetic resonance (EPR) spectroscopy was used to determine (1) plasma functional reserves of ascorbate and total thiols, (2) temporal changes in ascorbate and thiol concentrations during incubation of whole blood in vitro, and (3) ascorbate radical signal kinetics in plasma after equalization of ascorbate concentrations. High-pressure liquid chromatography (HPLC) was used to measure plasma alpha-tocopherol. Ascorbate concentrations were 50% lower in preeclampsia relative to normal pregnancy plasma but thiols and alpha-tocopherol did not differ. The elapsed time prior to half-consumption of plasma ascorbate was decreased approximately three-fold during incubation of whole blood from preeclamptics. No concomitant decrease in thiols was evident. The initial ascorbate radical signal amplitude was greater in preeclampsia plasma and then, in contrast to normal pregnancy plasma, decreased progressively. The iron chelator, deferoxamine had no effect on plasma ascorbate radical formation. We conclude that an ascorbate-oxidizing activity is increased in preeclampsia plasma which might contribute to vascular dysfunction in the disorder.

Topics: Adult; Ascorbic Acid; Chromatography, High Pressure Liquid; Deferoxamine; Electron Spin Resonance Spectroscopy; Female; Free Radicals; Humans; Iron Chelating Agents; Oxidative Stress; Pre-Eclampsia; Pregnancy; Sulfhydryl Compounds; Vitamin E

Topics: Antioxidants; Ascorbic Acid; beta Carotene; Carotenoids; Female; Humans; Pre-Eclampsia; Pregnancy; Vitamin E

Plasma and cerebrospinal fluid total peroxyl radical-trapping antioxidative parameter (TRAP) and the main antioxidant components of TRAP (vitamin E, ascorbic acid, uric acid, protein sulfhydryl groups, and the unidentified antioxidant proportion) were analyzed in 11 preeclamptic parturients, 9 healthy parturients with an uncomplicated pregnancy, and 10 healthy nonpregnant women. In addition, the possible effects of ongoing labor were studied in 10 healthy parturients. The samples of plasma and cerebrospinal fluid (CSF) were collected at cesarean section (pregnant women) or minor surgical procedure (nonpregnant women). Normal pregnancy or ongoing labor induced no significant changes in total TRAP, as compared with nonpregnant women, but significant changes in the percentage contributions of individual antioxidants were noted in plasma and CSF. In preeclampsia, a significant increase in TRAP was noted in both plasma and CSF. This increase was mainly due to an increased proportion of uric acid and unidentified antioxidants in plasma samples, and an increased proportion of unidentified antioxidants in CSF. The concentration of CSF ascorbic acid was decreased in preeclampsia, and a negative correlation between CSF ascorbic acid and blood pressure was observed.

Topics: Antioxidants; Ascorbic Acid; Female; Humans; Labor, Obstetric; Peroxides; Pre-Eclampsia; Pregnancy; Sulfhydryl Compounds; Uric Acid; Vitamin E

Our purpose was to investigate the plasma levels of three potent antioxidant nutrients in women with preeclampsia.. Fasting venous blood samples were collected from 30 women with preeclampsia and from 44 women with uncomplicated pregnancies. The criteria for recruitment included age 15 to 35 years, gestational age 28 to 42 weeks, singleton pregnancy, intact membranes, absence of labor contractions, and absence of any other medical complication concurrent with preeclampsia. Reduced ascorbic acid, alpha-tocopherol, and beta-carotene levels were assayed with high-pressure liquid chromatography.. Plasma levels of reduced ascorbic acid were significantly decreased in patients with mild and severe preeclampsia (p < 0.01). Plasma alpha-tocopherol and beta-carotene levels were significantly decreased only in severe preeclampsia compared with controls (p < 0.05 and p < 0.05, respectively).. In patients with preeclampsia antioxidant nutrients may be utilized to a greater extent to counteract free radical-mediated cell disturbances, resulting in a reduction in antioxidant plasma levels. Water-soluble antioxidant nutrients may initially be consumed, followed by lipid-soluble antioxidants.

Topics: Adolescent; Adult; Ascorbic Acid; beta Carotene; Carotenoids; Case-Control Studies; Female; Humans; Pilot Projects; Pre-Eclampsia; Pregnancy; Vitamin E

Levels of histamine and total ascorbic acid (L-ascorbic acid plus dehydroascorbic acid) in the peripheral blood of women in pre-eclampsia have been measured. The results show that blood histamine is increased both in the moderate and severe form of pre-eclampsia. Blood ascorbic acid on the other hand is increased only in the severe form of pre-eclampsia. The rise in histamine values may be in response to the rising blood pressure in pre-eclampsia. The rise in ascorbic acid values may reflect the reduced maternal blood volume and/or restricted transport of ascorbic acid from maternal to fetal tissues.

Topics: Adult; Ascorbic Acid; Biological Transport; Blood Pressure; Female; Gestational Age; Histamine; Humans; Pre-Eclampsia; Pregnancy

Topics: Ascorbic Acid; Female; Humans; Placenta; Pre-Eclampsia; Pregnancy

Topics: Adult; Amino Acids; Ascorbic Acid; Diet Therapy; Diuretics; Female; Humans; Italy; Liver Extracts; Pre-Eclampsia; Pregnancy; Thiamine Pyrophosphate

Topics: Ambulatory Care; Ascorbic Acid; Female; Fetus; Folic Acid; Humans; Niacinamide; Pre-Eclampsia; Pregnancy; Vitamin B 12

Topics: Ascorbic Acid; Breast Feeding; Female; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Milk, Human; Pre-Eclampsia; Pregnancy; Thiamine

Topics: Abruptio Placentae; Ascorbic Acid; Blood Chemical Analysis; Female; Hemolysis; Humans; Metabolism; Pre-Eclampsia; Pregnancy

Topics: Ascorbic Acid; Female; Glutathione; Humans; Pre-Eclampsia; Pregnancy; Toxemia; Vitamins

Topics: Ascorbic Acid; Female; Humans; Hypertension; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Testosterone; Thiamine Pyrophosphate; Vitamins

Topics: Anti-Allergic Agents; Ascorbic Acid; Female; Flavonoids; Histamine H1 Antagonists; Humans; Pre-Eclampsia; Pregnancy; Prenatal Care; Vitamins

Topics: Arthritis; Ascorbic Acid; Female; Humans; Pre-Eclampsia; Pregnancy; Toxemia; Vitamins