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O xidative stress has been implicated as a cause of the endothelial damage seen in preeclampsia. This randomized, placebo-controlled double-blind trial involving 4 Brazilian clinical sites examined whether dietary antioxidant supplementation would reduce the incidence of preeclampsia in patients at increased risk because of the presence chronic hypertension or a history of preeclampsia.Patients were 12 to 19 weeks pregnant at enrollment and were randomly assigned to receive 1000 mg vitamin C and 400 IU vitamin E daily or placebo. Patients took 2 gel capsules containing one-half of each medication daily from enrollment to delivery or the diagnosis of preeclampsia. They were followed at periodic prenatal visits at which time blood pressure, weight, and urinary protein excretion were measured. The primary outcome was the development of preeclampsia (blood pressure of 140/90 mm Hg and 300 mg/24 h urinary protein); secondary outcomes were severity of preeclampsia (severe vs. not severe using usual internationally agreed upon criteria), gestational hypertension, abruptio placentae, premature rupture of the membranes, preterm birth, and small for gestational age, and low-birth-weight infants.Data were available for 707 of 753 women (patients were excluded due to loss to follow-up or withdrawal of consent), of whom 355 received the antioxidant vitamins and 352 placebo. The 2 groups were similar in demographic characteristics. Of those with chronic hypertension, 52.8% were receiving antihypertensive therapy when they became pregnant. Compliance rates were 84.5% and 86.9% for the vitamin and placebo groups, respectively. In the vitamin group, 13.9% of patients developed preeclampsia compared with 15.6% in the placebo group. Within both groups, no significant differences in the frequency of preeclampsia between treatment or placebo groups were noted. Only the mean arterial pressure at enrollment was significantly associated with the development of preeclampsia. In patients without chronic hypertension, 6% of the study group and 2.4% in the placebo group developed severe preeclampsia, not a significant difference. No patient died. Two patients in each group developed HELLP syndrome.Rates of gestational diabetes (3.4% vs. 3.7%), abruptio placentae (1.1% vs. 2.3%), induction of labor (14.6% vs. 18.3%), and cesarean delivery (66.0% vs. 67.6%) were not significantly different between the study and placebo groups, respectively, Premature rupture of the membranes occurred more frequently in the study patients than in the placebo group (10.6% vs. 5.5%, P = 0.015) The groups did not differ significantly in the rate of fetal and neonatal deaths, preterm delivery, low birth weight, small for gestational age, low Apgar scores at 1 and 5 minutes, and neonatal morbidities. Seven patients in the study group and 6 in the placebo group stopped taking the pills because of perceived side effects, including itching, eczema, vomiting, abdominal pain with or without diarrhea, headache, constipation, malaise, and diminished vision. One fetus in t...

This study showed that the experimental model used led to mild hyperglycemia during pregnancy, although it did not lead to increased macrosomic fetus rates. The hyperglycemic maternal environment caused metabolic alterations, including increased triglyceride and total cholesterol concentrations, and elevated oxidative stress, contributing to increase fetal visceral anomalies.

BackgroundIn 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.ObjectiveTo evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.MethodsDesign: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.ResultsOver the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.ConclusionsThis safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

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