Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial.

Abstract

BACKGROUND:

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.

METHODS:

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.

FINDINGS:

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).

INTERPRETATION:

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.

• Authors: L C Chappell, P T Seed, A L Briley, F J Kelly, R Lee, B J Hunt, K Parmar, S J Bewley, A H Shennan, P J Steer, L Poston
• Journal: Lancet (London, England) (Lancet) Vol. 354 Issue 9181 Pg. 810-6 (Sep 04 1999) ISSN: 0140-6736 [Print] England
• PMID: 10485722 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antioxidants
• Plasminogen Activator Inhibitor 1
• Plasminogen Activator Inhibitor 2
• Vitamin E
• Ascorbic Acid

Topics

• Adult
• Antioxidants (therapeutic use)
• Ascorbic Acid (therapeutic use)
• Cohort Studies
• Female
• Humans
• Oxidative Stress
• Plasminogen Activator Inhibitor 1 (blood)
• Plasminogen Activator Inhibitor 2 (blood)
• Pre-Eclampsia (diagnostic imaging, etiology, prevention & control)
• Pregnancy
• Risk Factors
• Ultrasonography, Doppler
• Ultrasonography, Prenatal
• Vitamin E (therapeutic use)