Combined Vitamin C and E Supplementation During Pregnancy For Preeclampsia Prevention: A Systematic Review

Polyzos, Nikolaos P.; Mauri, Davide; Tsappi, Maria; Tzioras, Spyridon; Kamposioras, Konstantinos; Cortinovis, Ivan; Casazza, Giovanni

doi:10.1097/01.ogx.0000256787.04807.da

Cited by 78 publications

(44 citation statements)

References 7 publications

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“…With oxidative stress being widely implicated in pathophysiological pregnancy, attention has been focused on the potential benefits of other antioxidant dietary interventions, such as vitamins C and E and selenium. Vitamin C and E supplementation reduces the levels of circulating markers of endothelial activation and lipid peroxidation (Chappell et al 2002); however, meta-analyses have failed to demonstrate that this provides any clinical benefits (Rumbold & Crowther 2005a, 2005b, Polyzos et al 2007, Roberts et al 2010 and may even increase the rates of adverse pregnancy outcomes (Poston et al 2006, Klemmensen et al 2009). Clinical studies of selenium supplementation, an important component of the antioxidant glutathione peroxidase, in pregnancy are still awaited.…”

Section: Discussionmentioning

confidence: 99%

Differential effects of docosahexaenoic acid on preterm and term placental pro-oxidant/antioxidant balance

2013

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Docosahexaenoic acid (DHA) supplementation in pregnancy may confer some clinical benefits; however, this compound can exert pro-oxidant effects. In this study, we investigated the effects of DHA on pro-oxidant/antioxidant balance in term and preterm placental explants, assessing oxidative stress marker concentrations, antioxidant capacity and pro-inflammatory cytokine production. Term (nZ8) and preterm (nZ9) placental explants were exposed to lipopolysaccharide (LPS, 1 ng/ml), DHA (1, 10 and 100 mM), and DHA and LPS simultaneously or pre-treated with DHA for 24 h prior to LPS treatment. The production of malondialdehyde (MDA, lipid peroxidation), 8-hydroxy-2-deoxy guanosine (8-OHdG, oxidative DNA damage) and pro-inflammatory cytokines (tumour necrosis factor a (TNFa), interleukin 6 and interferon-g) and total antioxidant capacity were measured. DHA at a concentration of 100 mM induced oxidative stress in term placentas, while at all the three concentrations, it induced oxidative stress in preterm placentas. DHA and LPS resulted in reduced MDA levels in term (P!0.005) and preterm (PZ0.004) placentas and reduced 8-OHdG levels in preterm placentas (PZ0.035). DHA pre-treatment, but not co-treatment with LPS, reduced 8-OHdG levels (P!0.001) in term placentas. DHA increased antioxidant capacity only in term placentas (P!0.001), with lower antioxidant capacity being observed overall in preterm placentas compared with term placentas (P%0.001). In term placentas, but not in preterm ones, DHA co-treatment and pre-treatment reduced LPS-induced TNFa levels. The ability of DHA to alter placental pro-oxidant/antioxidant balance is dependent on the DHA concentration used and the gestational age of the placental tissue. DHA has a greater capacity to increase oxidative stress in preterm placentas, but it offers greater protection against inflammation-induced oxidative stress in term placentas. This appears to be a result of DHA altering placental antioxidant capacity. These data have implications for the timing and concentration of DHA supplementation in pregnancy.

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Section: Discussionmentioning

confidence: 99%

Differential effects of docosahexaenoic acid on preterm and term placental pro-oxidant/antioxidant balance

2013

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“…70 Given the abnormally low plasma vitamin C concentrations reported in preeclampsia, a combination of vitamins C and E has been postulated as a prophylactic strategy for prevention of preeclampsia. 71 However, there is no evidence that high doses of vitamin C and vitamin E (1000 mg and 400 IU, respectively) combined reduce the occurrence of preeclampsia. 72 In particular, some randomized controlled trials involving a large number of pregnant women have shown a lack of benefit in women receiving antioxidants, 73e76 as reported in Table 1.…”

Section: Role Of Antioxidants In Preeclampsiamentioning

confidence: 99%

Micronutrients in pregnancy: Current knowledge and unresolved questions

et al. 2011

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One-carbon metabolism Pregnancy Liposoluble vitamins Minerals s u m m a r yMicronutrient status is increasingly recognized to play an important role in the health and well-being of pregnant women and in the development and long-term health of the offspring. On 26th e 28th February 2009, The Child Health Foundation invited leading experts in this area to a scientific workshop at Obergurgl, Austria to review and critically discuss current knowledge, to identify issues that may need to be addressed in future recommendations, and to highlight priorities and opportunities for future research. This report summarizes updated key conclusions of the workshop with regards to micronutrients' intake and physiological role related to mother, placenta and fetus, as well as relevance for adverse pregnancy and long-term outcomes.

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“…Recent meta-analysis of all eligible vitamin C and E supplementation trials in preeclampsia has concluded that "the available evidence does not support the combined vitamin C and E supplementation during pregnancy for the prevention of preeclampsia." 35 With the overwhelming evidence of increased oxidative stress during preeclampsia, the reasons for lack of beneficial effects of antioxidant vitamins are unclear. Possible explanations for these inconsistencies could be differences in study population and criteria for patient selection, etc.…”

Section: Hoffmann Et Al Tempol Ameliorates Preeclampsia In Bph/5 Micementioning

confidence: 99%

Chronic Tempol Prevents Hypertension, Proteinuria, and Poor Feto-Placental Outcomes in BPH/5 Mouse Model of Preeclampsia

et al. 2008

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Abstract-Recently we described a mouse model, BPH/5, that spontaneously develops the hallmark clinical features of preeclampsia. BPH/5 exhibit impaired placentation before the onset of hypertension and proteinuria, supporting a causal role for the placenta in the pathogenesis of preeclampsia. Here we tested the hypothesis that an increase in reactive oxygen species (ROS) early in pregnancy results in placental abnormalities leading to the maternal symptoms of preeclampsia. We further hypothesized that chronic antioxidant therapy would ameliorate both feto-placental abnormalities and maternal symptoms. ROS levels measured by dihydroethidium revealed significant increases in oxidative stress in BPH/5 placentas at midgestation compared with C57 controls. This increase in ROS was correlated with reduced expression and activity of cytoplasmic superoxide dismutase in early and midgestation BPH/5 placentas. These abnormalities in placental oxidant factors occurred before the onset of maternal symptoms, suggesting a possible causal link between increased ROS and maternal and feto-placental pathology in this model. In support of this, chronic treatment of BPH/5 with the superoxide dismutase-mimetic Tempol throughout gestation significantly improved fetal growth and survival. Furthermore, Tempol ameliorated pregnancy-induced increases in blood pressure and proteinuria in BPH/5 mothers. We confirmed that Tempol radical was present in plasma, and it normalized ROS levels in all placental zones in BPH/5. These data for the first time demonstrate an important causative role for increased ROS in the placenta in the pathogenesis of preeclampsia in a model that spontaneously develops the disease. The results also strongly suggest the potential utility of antioxidant therapy in treating preeclampsia. (Hypertension. 2008;51:1058-1065.)

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Combined Vitamin C and E Supplementation During Pregnancy For Preeclampsia Prevention: A Systematic Review

Cited by 78 publications

References 7 publications

Differential effects of docosahexaenoic acid on preterm and term placental pro-oxidant/antioxidant balance

Differential effects of docosahexaenoic acid on preterm and term placental pro-oxidant/antioxidant balance

Micronutrients in pregnancy: Current knowledge and unresolved questions

Chronic Tempol Prevents Hypertension, Proteinuria, and Poor Feto-Placental Outcomes in BPH/5 Mouse Model of Preeclampsia

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