World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre‐eclampsia in populations of low nutritional status from developing countries

Abstract

Objective To determine if vitamin C and E supplementation in high-risk pregnant women with low nutritional status reduces pre-eclampsia.Design Multicentred, randomised, controlled, double-blinded trial.Setting Antenatal care clinics and Hospitals in four countries.Population Pregnant women between 14 and 22 weeks' gestation.Method Randomised women received 1000 mg vitamin C and 400 iu of vitamin E or placebo daily until delivery.Main outcome measures Pre-eclampsia, low birthweight, small for gestational age and perinatal death.Results 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 preeclampsia (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.Conclusion Vitamins C and E at the doses used did not prevent pre-eclampsia in these high-risk women.

Antioxidant Status in Normal Pregnancy and Preeclampsia upon Multivitamin-Mineral Supplementation in the Region of Vojvodina

“…Unfortunately, and following a promising preliminary report [30] the results of three double blinded randomized controlled trials failed to corroborate the earlier observation [31], [32]. It should be noted, however, that two of these trials were performed in well-nourished populations, but even in communities at risk of poor nutritional status in developing countries there was no observed benefit in preventing PE [33]. The results of the observed parameters in the PE group have been markedly different to the other two observed groups.…”

Vitamins C and E for the prevention of pre‐eclampsia: time to give up the ghost*

“…Why do Shehmar et al 1 refuse to see the evidence in front of them and persist in attacking not only our paper but also those by Bojahr et al, Brummer et al, Wattiez et al and Karaman et al, all highly respected authorities in this field? 3,4 We strongly suggest that they invest more time and effort in honing their surgical skills and lowering complications rates, instead of trying to discredit all published studies under the false pretenses that they were retrospective designs.…”

“…Indeed, Shehmar et al 1 state that with well-trained supporting theater staff, the same learning curve can be achieved anywhere. But is it not our moral duty to ensure our staffs are well trained to operate on patients in the best possible conditions and with the lowest possible complication rates?…”

Formation of neurodegenerative aggresome and death-inducing signaling complex in maternal diabetes-induced neural tube defects

“…Previous efforts to reduce embryonic malformations in diabetic embryopathy have focused on amelioration of oxidative stress using antioxidants (1). However, the effectiveness of antioxidants in humans remains questionable, as multiple large-scale human trials that have used antioxidants (i.e., vitamin C and vitamin E) to treat other diseases (i.e., preeclampsia, cardiovascular disease) have revealed unsatisfactory results (58)(59)(60). Although the reasons for this failure have not been identified, it is speculated that other cellular stress conditions (i.e., ER stress), which may not be affected by antioxidant therapies, may be involved (60).…”