Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis

Abramovici, Adi; Gandley, Robin E.; Clifton, R. G.; Leveno, Kenneth J.; Myatt, Leslie; Wapner, Ronald J.; Thorp, John M.; Mercer, B; Peaceman, Alan M.; Samuels, Philip; Sciscione, Anthony; Harper, Margaret; Saade, George R.; Sorokin, Yoram

doi:10.1111/1471-0528.13201

Cited by 32 publications

(29 citation statements)

References 39 publications

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“…We propose the differences are explained by the antioxidant effects of omega-3 supplementation combating the oxidative stress caused by cigarette toxins. This is further supported by the similar findings of Abramovici et al 31 who showed supplementation with vitamins C and E, which are antioxidants, reduced the risk of preterm birth in smokers but not nonsmokers. Since smokers have lower serum levels of omega-3 fatty acids and vitamins C and E, 19, 32 this may explain why supplementation has a preferential effect in smokers compared to nonsmokers.…”

Section: Commentsupporting

confidence: 80%

The effect of omega-3 supplementation on pregnancy outcomes by smoking status

Kuper

Abramovici

Jauk

et al. 2017

American Journal of Obstetrics and Gynecology

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BACKGROUND Smoking during pregnancy is associated with adverse maternal and neonatal outcomes such as preterm delivery, intrauterine growth restriction, stillbirth, and low birth weight. Since smoking causes oxidative stress, some have suggested using antioxidants to counteract the effects of oxidative stress. Smokers have lower serum levels of omega-3 fatty acids, an important antioxidant, and thus, investigating whether omega-3 supplementation in smokers reduces adverse maternal and neonatal outcomes represents an important area of research. OBJECTIVE To investigate whether the antioxidant effect of omega-3 fatty acid supplementation on the incidence of adverse pregnancy outcomes differs between smokers and nonsmokers. STUDY DESIGN Secondary analysis of a multicenter randomized controlled trial of omega-3 supplementation for preterm delivery prevention in women with a singleton pregnancy and a history of a prior singleton spontaneous preterm delivery. Subjects were randomized to begin omega-3 or placebo prior to 22 weeks which was continued until delivery. All women received 17 alpha-hydroxyprogesterone caproate intramuscularly weekly beginning between 16 to 20 weeks of gestation and continued until 36 weeks of gestation or delivery, whichever occurred first. The primary outcome was spontaneous preterm delivery. Secondary outcomes were indicated preterm delivery, any preterm delivery (spontaneous and indicated), pregnancy-associated hypertension (gestational hypertension and preeclampsia), a neonatal composite (retinopathy of prematurity, intraventricular hemorrhage grade III or IV, patent ductus arteriosus, necrotizing enterocolitis, sepsis, respiratory morbidity, or perinatal death), low birth weight (<2500 grams), small for gestational age (less than the 10th percentile), and neonatal intensive care unit or intermediate nursery admission. The study population was stratified into smokers and nonsmokers, and the incidence of each outcome was compared by omega-3 supplementation versus placebo in each subgroup. Zelen tests were performed to test for homogeneity of effect in smokers and nonsmokers. RESULTS Of 851 subjects included in the analysis, 136 (16%) smoked. Baseline characteristics between omega-3 and placebo groups did not differ in smokers or nonsmokers. Omega-3 supplementation was associated with a lower risk of spontaneous preterm delivery in smokers (RR 0.56, 95% CI 0.36–0.87) but not in nonsmokers (RR 1.04, 95% CI 0.84–1.29); p-value for interaction = 0.013. Low birth weight was also less frequent in smokers receiving omega-3 supplementation (RR 0.57, 95% CI 0.36–0.90) compared to nonsmokers (RR 0.93, 95% CI 0.71–1.24); p-value for interaction = 0.047. The effect on other secondary outcomes did not differ significantly between smokers and nonsmokers. CONCLUSION Omega-3 supplementation in smokers may have a protective effect against recurrent spontaneous preterm delivery and low birth weight.

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Section: Commentsupporting

confidence: 80%

The effect of omega-3 supplementation on pregnancy outcomes by smoking status

Kuper

Abramovici

Jauk

et al. 2017

American Journal of Obstetrics and Gynecology

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“…The effect of maternal smoking on newborn lung function was also associated with the maternal genotype for the α5 nAChR receptor gene (rs16969968) (p<0.001 for interaction), which is the α5 nAChR structural polymorphism that has the strongest link to lung disease (55) (Figure 3). This study was not powered to examine preterm births between the randomized groups, but a large trial (56) of vitamin C (1000 mg) and vitamin E (400 IU) supplementation during pregnancy found a reduction in preterm birth (RR 0.76; 95% CI 0.58-0.99) and placental abruption in the treated versus untreated smokers.…”

Section: Potential Approaches For Primary Preventionmentioning

confidence: 99%

Pulmonary Effects of Maternal Smoking on the Fetus and Child: Effects on Lung Development, Respiratory Morbidities, and Life Long Lung Health

McEvoy

Spindel

2017

Paediatric Respiratory Reviews

160

136

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SummaryMaternal smoking during pregnancy is the largest preventable cause of abnormal in-utero lung development. Despite well known risks, rates of smoking during pregnancy have only slightly decreased over the last ten years, with rates varying from 5-40% worldwide resulting in tens of millions of fetal exposures. Despite multiple approaches to smoking cessation about 50% of smokers will continue to smoke during pregnancy. Maternal genotype plays an important role in the likelihood of continued smoking during pregnancy and the degree to which maternal smoking will affect the fetus. The primary effects of maternal smoking on offspring lung function and health are decreases in forced expiratory flows, decreased passive respiratory compliance, increased hospitalization for respiratory infections, and an increased prevalence of childhood wheeze and asthma. Nicotine appears to be the responsible component of tobacco smoke that affects lung development, and some of the effects of maternal smoking on lung development can be prevented by supplemental vitamin C. Because nicotine is the key agent for affecting lung development, e-cigarette usage during pregnancy is likely to be as dangerous to fetal lung development as is maternal smoking.

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“…42 Vitamin C/E supplementation also reduced placental abruption and preterm birth in women who smoked. 43 Similarly, administration of polyphenols found in pomegranate juice 44 has been shown to reduce placental oxidative stress while the carot- linked to reduced SOD activity in the placenta, one report has found that plasma levels of SOD1 and SOD3 are increased in this disease. 46 Superoxide dismutase activity has also been shown to be reduced in placentas of preterm and IUGR babies with corresponding reductions in both copper and zinc reported.…”

Section: Oxidative Stressmentioning

confidence: 98%

“…111 Additional benefits in smokers. 43 Active transport across the placenta most likely by SVCT2 (Sodium-dependent vitamin C transporter 2) but also by glucose transporters. 112 When in combination with Vitamin E, reduced placental oxidative stress in isolated placentas 42 Vitamin D Hypothesized to improve brain structure and function.…”

Section: Mgmentioning

confidence: 99%

Placental adaptations to micronutrient dysregulation in the programming of chronic disease

Hofstee

McKeating

Perkins

et al. 2018

Clin Exp Pharma Physio

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Poor nutrition during pregnancy is known to impair foetal development and increase the risk of chronic disease in offspring. Both macronutrients and micronutrients are required for a healthy pregnancy although significantly less is understood about the role of micronutrients in the programming of chronic disease. This is despite the fact that modern calorie rich diets are often also deficient in key micronutrients. The importance of micronutrients in gestational disorders is clearly understood but how they impact long term disease in humans requires further investigation. In contrast, animal studies have demonstrated how diets high or low in specific micronutrients influence offspring physiology. Many of these studies highlight the importance of the placenta in determining disease risk. This review will explore the effects of individual vitamins, minerals and trace elements on offspring disease outcomes and discuss several key placental adaptations that are affected by multiple micronutrients. These placental adaptations include micronutrient induced dysregulation of oxidative stress, altered methyl donor availability and its impact on epigenetic mechanisms as well as endocrine dysfunction. Critical gaps in our current knowledge and the relative importance of different micronutrients at different gestational ages will also be highlighted. Finally, this review will discuss the need for further studies to characterise the micronutrient status of Australian women of reproductive age and correlate micronutrient status to placental adaptations, pregnancy complications and offspring disease.

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Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis

Cited by 32 publications

References 39 publications

The effect of omega-3 supplementation on pregnancy outcomes by smoking status

The effect of omega-3 supplementation on pregnancy outcomes by smoking status

Pulmonary Effects of Maternal Smoking on the Fetus and Child: Effects on Lung Development, Respiratory Morbidities, and Life Long Lung Health

Placental adaptations to micronutrient dysregulation in the programming of chronic disease

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