Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial
- PMID: 10485722
- DOI: 10.1016/S0140-6736(99)80010-5
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.
Comment in
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Is oxidative stress the link in the two-stage model of pre-eclampsia?Lancet. 1999 Sep 4;354(9181):788-9. doi: 10.1016/S0140-6736(99)80002-6. Lancet. 1999. PMID: 10485715 No abstract available.
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Antioxidants and pre-eclampsia.Lancet. 2000 Jan 1;355(9197):64-5. doi: 10.1016/s0140-6736(99)00223-8. Lancet. 2000. PMID: 10615906 No abstract available.
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Antioxidants and pre-eclampsia.Lancet. 2000 Jan 1;355(9197):65. doi: 10.1016/S0140-6736(05)72003-1. Lancet. 2000. PMID: 10615907 No abstract available.
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Antioxidants and pre-eclampsia.Lancet. 2000 Jan 1;355(9197):65-6. doi: 10.1016/S0140-6736(05)72004-3. Lancet. 2000. PMID: 10615908 No abstract available.
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Prevention of pre-eclampsia.Lancet. 2001 May 12;357(9267):1534. doi: 10.1016/S0140-6736(00)04694-8. Lancet. 2001. PMID: 11386294 No abstract available.
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Vitamin C and vitamin E in pregnant women at risk of pre-eclampsia.Lancet. 2006 Jul 15;368(9531):198; author reply 199-200. doi: 10.1016/S0140-6736(06)69030-2. Lancet. 2006. PMID: 16844478 No abstract available.
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Vitamin C and vitamin E in pregnant women at risk of pre-eclampsia.Lancet. 2006 Jul 15;368(9531):198; author reply 199-200. doi: 10.1016/S0140-6736(06)69029-6. Lancet. 2006. PMID: 16844479 No abstract available.
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