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Huang T, Lu F. Genetically predicted circulating concentrations of micronutrients and risk of hypertensive disorders of pregnancy: a Mendelian randomization study. Arch Gynecol Obstet 2024; 310:1019-1025. [PMID: 38194093 DOI: 10.1007/s00404-023-07331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Epidemiological studies examining the association between circulating micronutrients and the risk of hypertensive disorders during pregnancy (HDP) have produced inconsistent results. Therefore, we conducted a Mendelian randomization (MR) analysis to evaluate the potential causal relationship between micronutrients and HDP. METHODS Nine micronutrients (beta-carotene, vitamin B6, vitamin B12, calcium, zinc, selenium, copper, folate, and phosphorus) were selected as the exposure factors. Summary data for gestational hypertension (14,727 cases and 196,143 controls) and preeclampsia/eclampsia (7212 cases and 174,266 controls) were extracted from the FinnGen consortium. The MR analysis employed the inverse variance weighted method and conducted a range of sensitivity analyses. RESULTS The inverse variance weighted method indicated no significant causal relationship between nine genetically predicted micronutrient concentrations and gestational hypertension, as well as preeclampsia/eclampsia. Sensitivity analyses suggested the absence of pleiotropy. CONCLUSION There is no strong evidence to support the causation between circulating micronutrients and hypertensive disorder during pregnancy.
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Affiliation(s)
- Ting Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Fan Lu
- Department of Emergency, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
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Hernandez-Castro I, Rifas-Shiman SL, Lin PID, Chavarro JE, Gold DR, Zhang M, Mueller NT, James-Todd T, Coull B, Hivert MF, Oken E, Cardenas A. First trimester prenatal metal mixtures, vitamins, and hypertensive disorders of pregnancy in the project viva cohort. ENVIRONMENT INTERNATIONAL 2024; 190:108909. [PMID: 39079333 DOI: 10.1016/j.envint.2024.108909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/25/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) such as preeclampsia and gestational hypertension are major contributors to maternal and child morbidity and mortality. Previous studies have reported associations with selected metals and vitamins but are limited in sample size and non-prospective study designs. We evaluated prospective associations of metal mixtures with HDP and tested interactions by vitamins. STUDY DESIGN We measured first trimester (median = 10.1 weeks) concentrations of essential (copper, magnesium, manganese, selenium, zinc) and nonessential (arsenic, barium, cadmium, cesium, mercury, lead) metals in red blood cells (n = 1,386) and vitamins (B12 and folate) in plasma (n = 924) in Project Viva, a pre-birth US cohort. We collected diagnosis of HDP by reviewing medical records. We used multinomial logistic regression and Bayesian Kernel Machine Regression to estimate individual and joint associations of metals with HDP and interactions by vitamins, after adjusting for key covariates. RESULTS The majority of participants were non-Hispanic white (72.5 %), never smokers (68.5 %) with a mean (SD) age of 32.3 (4.6) years. Fifty-two (3.8 %) developed preeclampsia and 94 (6.8 %) gestational hypertension. A doubling in first trimester erythrocyte copper was associated with 78 % lower odds of preeclampsia (OR=0.22, 95 % confidence interval: 0.08, 0.60). We also observed significant associations between higher erythrocyte total arsenic and lower odds of preeclampsia (OR=0.80, 95 % CI: 0.66, 0.97) and higher vitamin B12 and increased odds of gestational hypertension (OR=1.79, 95 % CI: 1.09, 2.96), but associations were attenuated after adjustment for dietary factors. Lower levels of the overall metal mixture and essential metal mixture were associated with higher odds of preeclampsia. We found no evidence of interactions by prenatal vitamins or between metals. CONCLUSION Lower levels of a first-trimester essential metal mixture were associated with an increased risk of preeclampsia, primarily driven by copper. No associations were observed between other metals and HDP after adjustment for confounders and diet.
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Affiliation(s)
- Ixel Hernandez-Castro
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Pi-I D Lin
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mingyu Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Noel T Mueller
- Department of Epidemiology, Colorado School of Public Health, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Tamarra James-Todd
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Andres Cardenas
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA, USA.
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Cui H, Zhang N, An J, Zeng X, Zhao Y, Sun X, Bu H, Wang H. Maternal folic acid supplementation to prevent preeclampsia: a systematic review and meta-analysis. Complement Ther Med 2024; 82:103052. [PMID: 38763206 DOI: 10.1016/j.ctim.2024.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024] Open
Abstract
OBJECTIVE The purpose of this systematic review was to examine the association between folic acid supplementation during pregnancy and the risk of preeclampsia. METHODS Relevant studies were included by searching Embase, PubMed, Scope, Web of science, Cochrane Library databases. Studies were reviewed according to prespecified inclusion and exclusion criteria. Study characteristics were summarized, and study quality was assessed. Risk ratios (RR) and 95% confidence intervals (CI) were used as indicators of effect to assess the relationship between folic acid supplementation and risk of preeclampsia. RESULTS The protocol of this study was prospectively registered with the PROSPERO (registration No. CRD42022380636). A total of nine studies were included, divided into three groups according to the type of study, containing a total of 107 051 and 105 222 women who were supplemented and not supplemented with folic acid during pregnancy. The results showed that folic acid supplementation during pregnancy could not be proven to reduce the risk of preeclampsia. CONCLUSION The results of the study suggest that folic acid supplementation alone is not associated with a decreased risk of pre-eclampsia,but the inferences are somewhat limited by the low methodological quality of the included literature, and therefore higher quality studies are needed to prove this point.
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Affiliation(s)
- Huaixing Cui
- Graduate School of Tianjin University of Chinese Medicine, China
| | - Naijin Zhang
- Graduate School of Tianjin University of Chinese Medicine, China
| | - JiaLi An
- Graduate School of Tianjin University of Chinese Medicine, China
| | - Xianyue Zeng
- Graduate School of Tianjin University of Chinese Medicine, China
| | - Ye Zhao
- Department of Public Health, International College, Krirk University, Bangkok 10220, Thailand
| | - Xuan Sun
- Graduate School of Tianjin University of Chinese Medicine, China
| | - Huaien Bu
- School of public health, Tianjin University of Chinese Medicinec, China.
| | - Hongwu Wang
- School of public health, Tianjin University of Chinese Medicinec, China.
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Deady C, McCarthy FP, Barron A, McCarthy CM, O’Keeffe GW, O’Mahony SM. An altered gut microbiome in pre-eclampsia: cause or consequence. Front Cell Infect Microbiol 2024; 14:1352267. [PMID: 38774629 PMCID: PMC11106424 DOI: 10.3389/fcimb.2024.1352267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Hypertensive disorders of pregnancy, including pre-eclampsia, are a leading cause of serious and debilitating complications that affect both the mother and the fetus. Despite the occurrence and the health implications of these disorders there is still relatively limited evidence on the molecular underpinnings of the pathophysiology. An area that has come to the fore with regard to its influence on health and disease is the microbiome. While there are several microbiome niches on and within the body, the distal end of the gut harbors the largest of these impacting on many different systems of the body including the central nervous system, the immune system, and the reproductive system. While the role of the microbiome in hypertensive disorders, including pre-eclampsia, has not been fully elucidated some studies have indicated that several of the symptoms of these disorders are linked to an altered gut microbiome. In this review, we examine both pre-eclampsia and microbiome literature to summarize the current knowledge on whether the microbiome drives the symptoms of pre-eclampsia or if the aberrant microbiome is a consequence of this condition. Despite the paucity of studies, obvious gut microbiome changes have been noted in women with pre-eclampsia and the individual symptoms associated with the condition. Yet further research is required to fully elucidate the role of the microbiome and the significance it plays in the development of the symptoms. Regardless of this, the literature highlights the potential for a microbiome targeted intervention such as dietary changes or prebiotic and probiotics to reduce the impact of some aspects of these disorders.
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Affiliation(s)
- Clara Deady
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Fergus P. McCarthy
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- The Infant Research Centre, University College Cork, Cork, Ireland
| | - Aaron Barron
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Cathal M. McCarthy
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Gerard W. O’Keeffe
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Cork Neuroscience Centre, University College Cork, Cork, Ireland
| | - Siobhain M. O’Mahony
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
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Xu Z, Li Y, Liu Y, Liu S, Zhang L, Wang J, Su S, Liu L, Meng L, Zhu H, Sun J, Shao L, Li L, Zhai Y, Li G, Cao Z. Diverse associations observed between pregnancy complications and RBC or plasma folates determined by an in-house developed LC-MS/MS method. Ann Med 2023; 55:2265381. [PMID: 37824254 PMCID: PMC10572033 DOI: 10.1080/07853890.2023.2265381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND As folates are essential for embryonic development and growth, it is necessary to accurately determine the levels of folates in plasma and red blood cells (RBCs) for clinical intervention. The aims of this study were to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for quantitation of folates in plasma and RBCs and to examine the association between plasma and RBC folate concentrations and gestational diabetes mellitus (GDM), gestational hypertension (GH) and preeclampsia (PE). METHODS With the in-house developed LC-MS/MS, a retrospective cross-sectional study was conducted. The healthy pregnant women of first- (n = 147), second- (n = 84) and third-trimester (n = 141) or the women diagnosed with GDM (n = 84), GH (n = 58) or PE (n = 23), that were aged between 22 and 46 years old and registered at our institute, were subjected for measurement of folic acid (FA) and 5-methyltetrahydrofolate (5-MTHF), followed by appropriate statistical association analysis. RESULTS The assay for simultaneous quantitation of FA and 5-MTHF in plasma and RBCs was linear, stable, with imprecision less than 15% and recoveries within ±10%. The lower limits of quantification for FA and 5-MTHF measurement in whole blood were 0.57 and 1.09 nmol/L, and in plasma were 0.5 and 1 nmol/L, respectively. In the association analysis, the patients with lower RBC folate level (<906 nmol/L) presented higher risks of PE development (OR 4.861 [95% CI 1.411-16.505]) by logistic regression and restricted cubic spline (RCS) regression in a nonlinear fashion. In addition, higher level of plasma folates in pregnancy was significantly associated with GH risk but may be protective for the development of GDM. CONCLUSIONS The in-house developed LC-MS/MS method for folates and metabolites in plasma or RBC showed satisfactory analytical performance for clinical application. Further, the levels of folates and metabolites were diversely associated with GDM, GH and PE development.
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Affiliation(s)
- Zhengwen Xu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Youran Li
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Ying Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | | | - Lin Zhang
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Jing Wang
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Shaofei Su
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Lin Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Lanlan Meng
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Hongyuan Zhu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Jingru Sun
- Health Biotech Co. Ltd, Beijing, PR China
| | - Lijun Shao
- Health Biotech Co. Ltd, Beijing, PR China
| | - Lin Li
- Health Biotech Co. Ltd, Beijing, PR China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Guanghui Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Division of Endocrinology and Metabolism, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, PR China
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Movendane Y, Sipalo MG, Chan LCZ. Advances in Folic Acid Biosensors and Their Significance in Maternal, Perinatal, and Paediatric Preventive Medicine. BIOSENSORS 2023; 13:912. [PMID: 37887105 PMCID: PMC10605181 DOI: 10.3390/bios13100912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
Auxotrophic primates like human beings rely on exogenous dietary vitamin B9 supplementation to meet their metabolic demands. Folates play a crucial role in nucleotide synthesis and DNA methylation. Maternal folate deficiency causes several pregnancy-related complications, perinatal defects, and early childhood cognitive impairments. New evidence suggests excess FA is a potential risk factor resulting in unfavourable genomic and epigenomic alterations. Thus, it is essential to revisit the need to consistently monitor maternal folate levels during pregnancy. Yet, to date, no point-of-care folate-monitoring biosensor is commercially available. Here, we critically appraise the advances in folate biosensors to understand the translational gaps in biosensor design. Further, our review sheds light on the potential role of folate biosensors in strengthening maternal, perinatal, and child healthcare.
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Affiliation(s)
- Yogesh Movendane
- Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-04, Singapore 138634, Singapore;
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
| | - Mbozu G. Sipalo
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Leon C. Z. Chan
- Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-04, Singapore 138634, Singapore;
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Du Y, Li J, Qu P, Dang S. Nonlinear Relationship Between Maternal and Cord Blood Vitamin B 12 and Folate from a Chinese Population-Based Study. Int J Womens Health 2023; 15:1405-1415. [PMID: 37701181 PMCID: PMC10493199 DOI: 10.2147/ijwh.s420206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose There remains a data gap on vitamin B12 and folate level in maternal and child populations. This study aimed to assess the status of vitamin B12 and folate in maternal serum (MS) and umbilical cord serum (UCS). Materials and Methods This was a planned secondary analysis of a case-control study. A total of 858 pregnant women during late pregnancy and their newborns in the hospitals of China were included. Maternal peripheral venous blood and neonatal umbilical cord blood were collected to determine serum vitamin B12 and folate concentration. Relationship of vitamin B12 or folate concentration between MS and UCS was assessed by a quantile regression model and the non-linear relationship between them was examined. Results Nutritional status of serum folate was better than that of vitamin B12. Prevalence of deficiency in MS vitamin B12 and folate was 73.4% and 14.2%, respectively and these figures were about 17.8% and 0.1% in UCS. Both vitamin B12 and folate levels in UCS were significantly higher than those in MS (vitamin B12: 321.0 pg/mL vs 158.3 pg/mL, folate: 16.5 ng/mL vs 7.0 ng/mL, P <0.001). The median UCS-MS ratio of vitamin B12 and folate was 2.0 (95% CI: 1.94-2.06) and 2.4 (95% CI: 2.30-2.53), respectively. The levels of folate and vitamin B12 in UCS increased nonlinearly with their increase in MS which presented an inverted U-shaped curve. Conclusion Deficiency in vitamin B12 and folate in the women during late pregnancy in China is prevalent. Nutritional status of the two vitamins in umbilical cord serum is correlated nonlinearly with that in maternal serum. Folic acid supplementation may be accompanied with vitamin B12 to improve status of vitamin B12 and folate during pregnancy.
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Affiliation(s)
- Yujiao Du
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, People’s Republic of China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, People’s Republic of China
| | - Pengfei Qu
- Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, 710003, People’s Republic of China
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, People’s Republic of China
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Tesfa E, Munshea A, Nibret E, Gizaw ST. Determinants of pre-eclampsia among pregnant women attending antenatal care and delivery services at Bahir Dar public hospitals, northwest Ethiopia: A case-control study. Health Sci Rep 2023; 6:e1440. [PMID: 37519426 PMCID: PMC10372301 DOI: 10.1002/hsr2.1440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/09/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
Background and Aims Pre-eclampsia (PE) is a pregnancy-related syndrome that occurs after 20 weeks of pregnancy. The current study was designed to evaluate the determinants of PE in pregnant women following antenatal and delivery services. Methods An institution-based case-control study was performed in governmental hospitals of Bahir Dar city. The data were collected using an interview-administered questionnaire and analyzed by SPSS version 20 software. Bivariate and multivariable logistic regression models were utilized for the analysis of variables. A p < 0.05 was used to declare the level of significance. Results In this study, the mean ages (in years) of cases and controls were 28.20 ± 5.66 and 27.52 ± 4.70, respectively. Factors such as: being primiparous (adjusted odds ratio [AOR]: 3.19 at 95% confidence interval [CI]: 1.71, 5.97), family history of hypertension (HTN) (AOR: 4.14 at 95% CI: 1.71, 10.05), previous history of PE (AOR: 7.97 at 95% CI: 2.42, 26.63), number of antenatal care (ANC) visits (AOR: 5.43 at 95% CI: 2.86, 10.33), not taking iron and folic acid supplement (AOR: 4.46 at 95% CI: 1.59, 12.48), body mass index ≥25 kg/m2 (AOR: 3.47 at 95% CI: 1.78, 6.77), not consuming vegetables (AOR: 1.99 at 95% CI: 1.07, 3.69) and not consuming egg, milk and milk products (AOR: 3.00 at 95% CI: 1.47, 6.11) were the determinants of PE. Conclusion In this study, different determinants of PE were identified. Hence, special attention should be given for primiparous women, women having previous history of PE and family history of HTN. Moreover, nutritional counseling should be given for pregnant women during ANC visits. Besides, higher officials should design an appropriate strategy to increase the number of mothers to complete their ANC visits and to take iron and folic acid supplements. Furthermore, to verify the determinants of PE, community-based cohort studies are warranted.
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Affiliation(s)
- Endalamaw Tesfa
- Department of Medical Biochemistry, College of Medicine and Health SciencesBahir Dar UniversityBahir DarEthiopia
- Division of Health Biotechnology, Institute of BiotechnologyBahir Dar UniversityBahir DarEthiopia
| | - Abaineh Munshea
- Division of Health Biotechnology, Institute of BiotechnologyBahir Dar UniversityBahir DarEthiopia
- Department of BiologyBahir Dar UniversityBahir DarEthiopia
| | - Endalkachew Nibret
- Division of Health Biotechnology, Institute of BiotechnologyBahir Dar UniversityBahir DarEthiopia
- Department of BiologyBahir Dar UniversityBahir DarEthiopia
| | - Solomon Tebeje Gizaw
- Department of Medical Biochemistry, College of Health ScienceAddis Ababa UniversityAddis AbabaEthiopia
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Gunabalasingam S, De Almeida Lima Slizys D, Quotah O, Magee L, White SL, Rigutto-Farebrother J, Poston L, Dalrymple KV, Flynn AC. Micronutrient supplementation interventions in preconception and pregnant women at increased risk of developing pre-eclampsia: a systematic review and meta-analysis. Eur J Clin Nutr 2023; 77:710-730. [PMID: 36352102 PMCID: PMC10335932 DOI: 10.1038/s41430-022-01232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pre-eclampsia can lead to maternal and neonatal complications and is a common cause of maternal mortality worldwide. This review has examined the effect of micronutrient supplementation interventions in women identified as having a greater risk of developing pre-eclampsia. METHODS A systematic review was performed using the PRISMA guidelines. The electronic databases MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials were searched for relevant literature and eligible studies identified according to a pre-specified criteria. A meta-analysis of randomised controlled trials (RCTs) was conducted to examine the effect of micronutrient supplementation on pre-eclampsia in high-risk women. RESULTS Twenty RCTs were identified and supplementation included vitamin C and E (n = 7), calcium (n = 5), vitamin D (n = 3), folic acid (n = 2), magnesium (n = 1) and multiple micronutrients (n = 2). Sample size and recruitment time point varied across studies and a variety of predictive factors were used to identify participants, with a previous history of pre-eclampsia being the most common. No studies utilised a validated prediction model. There was a reduction in pre-eclampsia with calcium (risk difference, -0.15 (-0.27, -0.03, I2 = 83.4%)), and vitamin D (risk difference, -0.09 (-0.17, -0.02, I2 = 0.0%)) supplementation. CONCLUSION Our findings show a lower rate of pre-eclampsia with calcium and vitamin D, however, conclusions were limited by small sample sizes, methodological variability and heterogeneity between studies. Further higher quality, large-scale RCTs of calcium and vitamin D are warranted. Exploration of interventions at different time points before and during pregnancy as well as those which utilise prediction modelling methodology, would provide greater insight into the efficacy of micronutrient supplementation intervention in the prevention of pre-eclampsia in high-risk women.
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Affiliation(s)
- Sowmiya Gunabalasingam
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Daniele De Almeida Lima Slizys
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ola Quotah
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Laura Magee
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sara L White
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | | | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Kathryn V Dalrymple
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, 4th floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Angela C Flynn
- Department of Nutritional Sciences, School of Life Course and Population Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.
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Perera N, Rudland VL, Simmons D, Price SAL. Folate Supplementation in Women with Pre-Existing Diabetes. Nutrients 2023; 15:nu15081879. [PMID: 37111098 PMCID: PMC10145371 DOI: 10.3390/nu15081879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Folate supplementation in the periconceptual period is the standard of care for the prevention of neural tube defects. To support dietary folate intake, some countries have introduced mandatory folic acid fortification of food products. Robust evidence supports the additional use of a low-dose folic acid supplement (0.4 mg/day) in all women from 2-3 months preconception until the end of the 12th week of gestation. For women with pre-existing diabetes, high-dose folic acid supplementation (5 mg/day) is recommended in some, but not all international guidelines. The recommendation is made based on consensus opinion and reflects the increased risk of neural tube defects in pregnant women with pre-existing diabetes. However, there is limited evidence to clarify the high-risk groups that benefit from high-dose folic acid versus those that do not. There are also some data to suggest that high-dose folic acid may be harmful to mothers and offspring, although this issue remains controversial. This narrative review explores the evidence that supports the recommendation for women with pre-existing diabetes to take high-dose folic acid in the periconceptual period. It explores the potential benefits of high-dose supplemental folate beyond the prevention of neural tube defects, and also the potential adverse impacts of high-dose folate use. These topics are considered with a specific focus on the issues that are pertinent to women with pre-existing diabetes. Based on the available evidence, a pragmatic approach to the use of folic acid supplements in women with pre-existing diabetes during the periconception period is suggested. The need for comprehensive preconception care that optimises glycaemic control and addresses other modifiable risk factors before pregnancy is emphasized.
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Affiliation(s)
- Nayomi Perera
- Department of Obstetric Medicine, Royal Women's Hospital, Flemington Rd, North Melbourne, VIC 3051, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Grattan St, Parkville, VIC 3010, Australia
| | - Victoria L Rudland
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Sarah A L Price
- Department of Obstetric Medicine, Royal Women's Hospital, Flemington Rd, North Melbourne, VIC 3051, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Grattan St, Parkville, VIC 3010, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Grattan St, Parkville, VIC 3010, Australia
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11
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Xiong Y, Huang J, Amoah AN, Liu B, Bo Y, Lyu Q. Folate, vitamin B 6, and vitamin B 12 intakes are negatively associated with the prevalence of hypertension: A national population-based study. Nutr Res 2023; 112:46-54. [PMID: 36965328 DOI: 10.1016/j.nutres.2023.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
We hypothesized that the prevalence of hypertension is related to B-vitamin intake in the general population, but it has not been sufficiently studied. This study aimed to investigate the intakes of dietary folate, vitamin B6, and vitamin B12 concerning hypertension in US adults. A total of 55 569 adults from National Health and Nutrition Examination Survey III and 1999-2014 were included in this study. Nutrient intake was collected from subjects through one or two 24-hour dietary reviews. Multiple logistic regression models were used to examine the relationship between these nutrient intakes and hypertension. Among male participants, dietary folate, vitamin B6, and vitamin B12 intakes were significantly and negatively associated with the prevalence of hypertension, with multivariate-adjusted odds ratios (ORs) of 0.61 (95% confidence interval [CI], 0.55-0.68), 0.65 (95% CI, 0.59-0.72), and 0.84 (95% CI, 0.75-0.95) for the highest quartile group compared with the lowest group. Results were similar for female participants, with multivariate-adjusted ORs of 0.63 (95% CI, 0.57-0.71), 0.60 (95% CI, 0.53-0.66), and 0.87 (95% CI, 0.77-0.98) for the highest quartile group. Moreover, there was a linear trend (Ptrend < .001) in both men and women that the prevalence of hypertension tended to decrease with increased intake of folate, vitamin B6, and vitamin B12; however, the decreases above the third quartile were negligible. Dietary folate, vitamin B6, and vitamin B12 were significantly associated negatively with hypertension, indicating that these nutrients might have a protective effect against hypertension in United States adults.
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Affiliation(s)
- Yuqing Xiong
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Jiamin Huang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Adwoa Nyantakyiwaa Amoah
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Bingrui Liu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Yacong Bo
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China.
| | - Quanjun Lyu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China; Department of Clinical Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China.
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12
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Kaldygulova L, Ukybassova T, Aimagambetova G, Gaiday A, Tussupkaliyev A. Biological Role of Folic Acid in Pregnancy and Possible Therapeutic Application for the Prevention of Preeclampsia. Biomedicines 2023; 11:biomedicines11020272. [PMID: 36830809 PMCID: PMC9953465 DOI: 10.3390/biomedicines11020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
The rationale and importance of folic acid supplementation during pregnancy for fetal congenital defect prevention are accepted worldwide. Moreover, a sufficient plasma concentration of folates can reduce the incidence of spontaneous abortions, and support the normal expansion of placental blood vessels, ensuring physiological placental blood flow, thus promoting appropriate fetal growth and development. Furthermore, there is emerging evidence that long-term supplementation with folic acid can effectively prevent preeclampsia. Preeclampsia is unique to the human species in complications during pregnancy, which contributes to maternal and perinatal mortality worldwide. In the pathogenesis of preeclampsia abnormal placental invasion, the excess of antiangiogenic factors and maternal-placental syndrome play a key role. Increased blood levels of homocysteine during pregnancy are associated with the risk of preeclampsia. Moreover, hyperhomocysteinemia has been proposed to be an independent risk factor for preeclampsia. Folate supplementation helps to decrease elevated levels of homocysteine; thus, the role of folic acid supplementation in pregnancy is even more important. Multiple reports suggest that folate administration decreases the level of serum homocysteine and, therefore, reduce the risk and severity of preeclampsia. However, the association between folic acid supplementation and the decreased risk of preeclampsia has been investigated with controversial conclusions. Currently, the optimal dose of folic acid that is effective for preeclampsia prevention remains uncertain. In this review, we aim to summarize the accumulated knowledge on the role of folic acid in the pathogenesis of preeclampsia, and the possible impact of folate supplementation on the decreased risk of preeclampsia.
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Affiliation(s)
- Lyazzat Kaldygulova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030012, Kazakhstan
| | - Talshyn Ukybassova
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Correspondence:
| | - Andrey Gaiday
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030012, Kazakhstan
| | - Akylbek Tussupkaliyev
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030012, Kazakhstan
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Fragoso-Bargas N, Page CM, Joubert BR, London SJ, Lee-Ødegård S, Opsahl JO, Sletner L, Jenum AK, Qvigstad E, Prasad RB, Moen GH, Birkeland KI, Sommer C. Epigenome-wide association study of serum folate in maternal peripheral blood leukocytes. Epigenomics 2023; 15:39-52. [PMID: 36974632 PMCID: PMC10072132 DOI: 10.2217/epi-2022-0427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023] Open
Abstract
Aim: To perform an epigenome-wide association study (EWAS) of serum folate in maternal blood. Methods: Cross-ancestry (Europeans = 302, South Asians = 161) and ancestry-specific EWAS in the EPIPREG cohort were performed, followed by methyl quantitative trait loci analysis and association with cardiometabolic phenotypes. Replication was attempted using maternal folate intake and blood methylation data from the MoBa study and verified if the findings were significant in a previous EWAS of maternal serum folate in cord blood. Results & conclusion: cg19888088 (cross-ancestry) in EBF3, cg01952260 (Europeans) and cg07077240 (South Asians) in HERC3 were associated with serum folate. cg19888088 and cg01952260 were associated with diastolic blood pressure. cg07077240 was associated with variants in CASC15. The findings were not replicated and were not significant in cord blood.
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Affiliation(s)
- Nicolas Fragoso-Bargas
- Department of Endocrinology, Morbid Obesity & Preventive Medicine, Oslo University Hospital, 0424, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
| | - Christian M Page
- Centre for Fertility & Health, Norwegian Institute of Public Health, 0403, Oslo, Norway
- Department of Mathematics, Faculty of Mathematics & Natural Sciences, University of Oslo, 0315, Oslo, Norway
| | - Bonnie R Joubert
- Department of Health & Human Services, Population Health Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC 27709, USA
| | - Stephanie J London
- Department of Health & Human Services, Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
| | - Sindre Lee-Ødegård
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
| | - Julia O Opsahl
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
| | - Line Sletner
- Department of Pediatric & Adolescents Medicine, Akershus University Hospital, 1478, Lørenskog, Norway
| | - Anne K Jenum
- Department of General Practice, Institute of Health & Society, University of Oslo, 0318, Oslo, Norway
| | - Elisabeth Qvigstad
- Department of Endocrinology, Morbid Obesity & Preventive Medicine, Oslo University Hospital, 0424, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
| | - Rashmi B Prasad
- Lund University Diabetes Centre, 214 28, Malmö, Sweden
- Institute for Molecular Medicine Finland FIMM, Helsinki University, 00014, Helsinki, Finland
| | - Gunn-Helen Moen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
- Institute of Molecular Biosciences, The University of Queensland, St Lucia QLD 4072, Australia
- Department of Public Health & Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science & Technology, 7491, Trondheim, Norway
- The Frazer Institute, The University of Queensland, 4102, Woolloongabba, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, BS8 1QU, Bristol, United Kingdom
| | - Kåre I Birkeland
- Department of Endocrinology, Morbid Obesity & Preventive Medicine, Oslo University Hospital, 0424, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway
| | - Christine Sommer
- Department of Endocrinology, Morbid Obesity & Preventive Medicine, Oslo University Hospital, 0424, Oslo, Norway
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Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416592. [PMID: 36554473 PMCID: PMC9779203 DOI: 10.3390/ijerph192416592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/12/2023]
Abstract
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.
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Affiliation(s)
- Valentin Simoncic
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
- Correspondence:
| | - Séverine Deguen
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
| | - Christophe Enaux
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| | - Stéphanie Vandentorren
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
- Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
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15
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A medication-wide association study (MWAS) on repurposed drugs for COVID-19 with Pre-pandemic prescription medication exposure and pregnancy outcomes. Sci Rep 2022; 12:20314. [PMID: 36433981 PMCID: PMC9700703 DOI: 10.1038/s41598-022-24218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Information on effects of medication therapies during pregnancy is lacking as pregnant patients are often excluded from clinical trials. This retrospective study explores the potential of using electronic health record (EHR) data to inform safety profiles of repurposed COVID medication therapies on pregnancy outcomes using pre-COVID data. We conducted a medication-wide association study (MWAS) on prescription medication exposures during pregnancy and the risk of cesarean section, preterm birth, and stillbirth, using EHR data between 2010-2017 on deliveries at PennMedicine. Repurposed drugs studied for treatment of COVID-19 were extracted from ClinicalTrials.gov (n = 138). We adjusted for known comorbidities diagnosed within 2 years prior to birth. Using previously developed medication mapping and delivery-identification algorithms, we identified medication exposure in 2,830 of a total 63,334 deliveries; from 138 trials, we found 31 medications prescribed and included in our cohort. We found 21 (68%) of the 31 medications were not positively associated with increased risk of the outcomes examined. With caution, these medications warrant potential for inclusion of pregnant individuals in future studies, while drugs found to be associated with pregnancy outcomes require further investigation. MWAS facilitates hypothesis-driven evaluation of drug safety across all prescription medications, revealing potential drug candidates for further research.
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16
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Association between Folic Acid Supplementation and Hypertensive Disorder Complicating Pregnancy in Jiangsu Province: A Cross-Sectional Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7255331. [PMID: 36110183 PMCID: PMC9470310 DOI: 10.1155/2022/7255331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 12/03/2022]
Abstract
Objectives To investigate the association of folic acid (FA) supplementation with hypertensive disorder complicating pregnancy (HDCP) and preeclampsia in Jiangsu Province, China. Materials and Methods In this cross-sectional study, a total of 10,662 women with infants born between January 2017 and December 2018 were enrolled in Jiangsu Province, China. Maternal women with and without FA supplement intake were compared in this study. FA supplementation included 0.4 mg FA (0.4 FA), multivitamins with 0.4 mg FA (multivitamin (MV)+0.4 FA), and multivitamins with 0.8 mg FA (MV + 0.8 FA). Associations between FA intake, FA supplement dose or duration, (MV + FA) dosage per weight, and HDCP were analysed using ANOVA, the chi-square test, and logistic regression analysis. Results Over the study follow-up period, the incidences of HDCP and preeclampsia were 3.5%, 1.4%, and 2.2%, 0.6% in the non-FA supplementation and FA supplementation groups, but only 1.5% and 0.1% in the MV + 0.8 FA group in early pregnancy. Compared with the non-FA group, HDCP and preeclampsia had the lowest risk in the MV + 0.8 FA group among the seven FA supplementation groups (HDCP: RR = 0.42, 95% CI = 0.27-0.68, P=0.001; preeclampsia: RR = 0.09, 95% CI = 0.03–0.33, P=0.001) in early pregnancy. Compared with the 0.4 FA alone group, the risk of HDCP and preeclampsia in women taking MV + 0.8 FA was significantly reduced (RR = 0.60, 95% CI = 0.41–0.87, P=0.008; preeclampsia: RR = 0.18, 95% CI = 0.06–0.60, P=0.005) in early pregnancy. (MV + FA)/BMI supplementation was associated with the risk of HDCP in early pregnancy (P trend = 0.002). Conclusions MV supplement with 0.8 mg FA during early pregnancy may be effective in reducing HDCP and preeclampsia risk. The study provided the viewpoint that (MV + FA)/BMI could be used as a reference for FA intake in pregnant women of different weights.
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Carboni L. Active Folate Versus Folic Acid: The Role of 5-MTHF (Methylfolate) in Human Health. Integr Med (Encinitas) 2022; 21:36-41. [PMID: 35999905 PMCID: PMC9380836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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18
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Hypertensive Disorders of Pregnancy. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rednic R, Marcovici I, Dragoi R, Pinzaru I, Dehelean CA, Tomescu M, Arnautu DA, Craina M, Gluhovschi A, Valcovici M, Manea A. In Vitro Toxicological Profile of Labetalol-Folic Acid/Folate Co-Administration in H9c2(2-1) and HepaRG Cells. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060784. [PMID: 35744047 PMCID: PMC9229417 DOI: 10.3390/medicina58060784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 12/30/2022]
Abstract
Background and Objectives: The consumption of dietary supplements has increased over the last decades among pregnant women, becoming an efficient resource of micronutrients able to satisfy their nutritional needs during pregnancy. Furthermore, gestational drug administration might be necessary to treat several pregnancy complications such as hypertension. Folic acid (FA) and folate (FT) supplementation is highly recommended by clinicians during pregnancy, especially for preventing neural tube birth defects, while labetalol (LB) is a β-blocker commonly administered as a safe option for the treatment of pregnancy-related hypertension. Currently, the possible toxicity resulting from the co-administration of FA/FT and LB has not been fully evaluated. In light of these considerations, the current study was aimed at investigating the possible in vitro cardio- and hepato-toxicity of LB-FA and LB-FT associations. Materials and Methods: Five different concentrations of LB, FA, FT, and their combination were used in myoblasts and hepatocytes in order to assess cell viability, cell morphology, and wound regeneration. Results: The results indicate no significant alterations in terms of cell viability and morphology in myoblasts (H9c2(2-1)) and hepatocytes (HepaRG) following a 72-h treatment, apart from a decrease in the percentage of viable H9c2(2-1) cells (~67%) treated with LB 150 nM−FT 50 nM. Additionally, LB (50 and 150 nM)−FA (0.2 nM) exerted an efficient wound regenerating potential in H9c2(2-1) myoblasts (wound healing rates were >80%, compared to the control at 66%), while LB-FT (at all tested concentrations) induced no significant impairment to their migration. Conclusions: Overall, our findings indicate that LB-FA and LB-FT combinations lack cytotoxicity in vitro. Moreover, beneficial effects were noticed on H9c2(2-1) cell viability and migration from LB-FA/FT administration, which should be further explored.
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Affiliation(s)
- Robert Rednic
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
| | - Iasmina Marcovici
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (I.M.); (C.A.D.)
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania
| | - Razvan Dragoi
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
- Correspondence: (R.D.); (I.P.)
| | - Iulia Pinzaru
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (I.M.); (C.A.D.)
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania
- Correspondence: (R.D.); (I.P.)
| | - Cristina Adriana Dehelean
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (I.M.); (C.A.D.)
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania
| | - Mirela Tomescu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
| | - Diana Aurora Arnautu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
| | - Marius Craina
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
| | - Adrian Gluhovschi
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
| | - Mihaela Valcovici
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
| | - Aniko Manea
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No.2, 300041 Timisoara, Romania; (R.R.); (M.T.); (D.A.A.); (M.C.); (A.G.); (M.V.); (A.M.)
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Perry A, Stephanou A, Rayman MP. Dietary factors that affect the risk of pre-eclampsia. BMJ NUTRITION, PREVENTION & HEALTH 2022; 5:118-133. [PMID: 35814725 PMCID: PMC9237898 DOI: 10.1136/bmjnph-2021-000399] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/03/2022] [Indexed: 12/18/2022]
Abstract
Pre-eclampsia affects 3%–5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, ω-3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25–30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia.
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Affiliation(s)
- Abigail Perry
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anna Stephanou
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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21
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Rahat B, Hamid A, Bagga R, Kaur J. Folic Acid Levels During Pregnancy Regulate Trophoblast Invasive Behavior and the Possible Development of Preeclampsia. Front Nutr 2022; 9:847136. [PMID: 35578613 PMCID: PMC9106796 DOI: 10.3389/fnut.2022.847136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundOne of the unique features of placentation is its similarity to tumorigenesis yet being very well regulated. It allows rapid proliferation, migration, and invasion of mononuclear trophoblast cells into the maternal uterus and remodeling the maternal vasculature. This pseudomalignant nature of trophoblastic cells is strictly regulated and its importance becomes evident in abnormal pregnancies that are characterized by aberrant trophoblast proliferation/invasion like preeclampsia. In addition to this, the importance of folic acid supplementation during pregnancy is well documented. We aimed to analyze the molecular and epigenetic regulation of the pseudomalignant nature of placentation via folic acid levels.MethodsPlacental tissue samples were collected from different pregnancies in three different gestational stages. We estimated the impact of folic acid levels on global methylation, LINE1 methylation, and expression of DNMTs in all three gestational stages in pregnant women and preeclampsia pregnancies. We also analyzed the effect of folic acid supplementation on trophoblastic invasion using placental derived cells viz, JEG-3 and HTR-8/SVneo cell line and verified the molecular and epigenetic mechanisms involved in this regulation.ResultsDevelopment of preeclampsia was observed to be associated with lower folate levels in placental tissue, higher global methylation level, and higher expression of DNMT1and DNMT3A. Folic acid supplementation was found to increase the invasive potential of placental trophoblasts by almost two folds which were associated with the decreased expression of tumor suppressor genes and tissue inhibitors of matrix metalloproteinases; and increased expression of oncogenes, telomerase gene, and matrix metalloproteinases. These folic acid-mediated changes were observed to be regulated by CpG methylation in the case of many genes. Folic acid supplementation was also observed to significantly decrease global methylation in placental trophoblasts related to decreasing expression of DNMT1 and DNMT3A.ConclusionLower folic acid levels are associated with preeclampsia development and folic acid supplementation regulates the invasive potential of placental trophoblasts as mediated by various epigenetic changes in the placenta suggesting the protective effect of folic acid against preeclampsia.
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Affiliation(s)
- Beenish Rahat
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abid Hamid
- Cancer Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Jammu, India
| | - Rashmi Bagga
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyotdeep Kaur
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Jyotdeep Kaur
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Ratajczak AE, Szymczak-Tomczak A, Rychter AM, Zawada A, Dobrowolska A, Krela-Kaźmierczak I. Does Folic Acid Protect Patients with Inflammatory Bowel Disease from Complications? Nutrients 2021; 13:nu13114036. [PMID: 34836291 PMCID: PMC8618862 DOI: 10.3390/nu13114036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 01/12/2023] Open
Abstract
Folic acid, referred to as vitamin B9, is a water-soluble substance, which participates in the synthesis of nucleic acids, amino acids, and proteins. Similarly to B12 and B6, vitamin B9 is involved in the metabolism of homocysteine, which is associated with the MTHFR gene. The human body is not able to synthesize folic acid; thus, it must be supplemented with diet. The most common consequence of folic acid deficiency is anemia; however, some studies have also demonstrated the correlation between low bone mineral density, hyperhomocysteinemia, and folic acid deficiency. Patients with inflammatory bowel disease (IBD) frequently suffer from malabsorption and avoid certain products, such as fresh fruits and vegetables, which constitute the main sources of vitamin B9. Additionally, the use of sulfasalazine by patients may result in folic acid deficiency. Therefore, IBD patients present a higher risk of folic acid deficiency and require particular supervision with regard to anemia and osteoporosis prevention, which are common consequences of IBD.
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Affiliation(s)
- Alicja Ewa Ratajczak
- Correspondence: (A.E.R.); (I.K.-K.); Tel.: +48-667-385-996 (A.E.R.); +48-8691-343 (I.K.-K.); Fax: +48-8691-686 (A.E.R.)
| | | | | | | | | | - Iwona Krela-Kaźmierczak
- Correspondence: (A.E.R.); (I.K.-K.); Tel.: +48-667-385-996 (A.E.R.); +48-8691-343 (I.K.-K.); Fax: +48-8691-686 (A.E.R.)
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Clinical Evaluation of Pinggan Yiqi Yangshen Recipe Combined with Labetalol Hydrochloride and Magnesium Sulfate in the Treatment of PIH. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3135043. [PMID: 34745277 PMCID: PMC8568534 DOI: 10.1155/2021/3135043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
Background To observe the clinical effect of Pinggan Yiqi Yangshen recipe combined with labetalol hydrochloride and magnesium sulfate in the treatment of pregnancy-induced hypertension (PIH). Methods A total of 126 patients with PIH diagnosed in our hospital from January 2016 to May 2018 were randomly divided into the control group and the experimental group, with 63 cases in each group. The control group was treated with labetalol combined with magnesium sulfate. On the basis of the control group, the experimental group was treated with Pinggan Yiqi Yangshen recipe. Clinical efficacy, blood pressure, renal function, and biochemical indexes were compared between the two groups. Moreover, pregnancy outcomes and adverse reactions were compared between the two groups. Results After treatment, the total effective rate in the experimental group was higher than in the control group. Blood pressure and mean arterial pressure in the experimental group were more significantly downregulated than the control group. Renal function indexes and biochemical indexes in the experimental group were more significant than those in the control group. The incidence of cesarean section, preterm birth, and abnormal fetal heart rate in the experimental group was significantly lower than that in the control group. There was no difference in the incidence of fetal distress, postpartum hemorrhage, neonatal asphyxia, and adverse reactions between the two groups. Conclusion Pinggan Yiqi Yangshen recipe combined with labetalol hydrochloride and magnesium sulfate can effectively reduce the blood pressure of patients with PIH, help patients to return to normal levels of biochemical indexes and renal function indexes, and improve pregnancy outcomes with high safety, which is worthy of further promotion and application in clinical practice.
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Shah AK, Dhalla NS. Effectiveness of Some Vitamins in the Prevention of Cardiovascular Disease: A Narrative Review. Front Physiol 2021; 12:729255. [PMID: 34690803 PMCID: PMC8531219 DOI: 10.3389/fphys.2021.729255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
By virtue of their regulatory role in various metabolic and biosynthetic pathways for energy status and cellular integrity, both hydro-soluble and lipo-soluble vitamins are considered to be involved in maintaining cardiovascular function in health and disease. Deficiency of some vitamins such as vitamin A, B6, folic acid, C, D, and E has been shown to be associated with cardiovascular abnormalities whereas supplementation with these vitamins has been claimed to reduce cardiovascular risk for hypertension, atherosclerosis, myocardial ischemia, arrhythmias, and heart failure. However, the data from several experimental and clinical studies for the pathogenesis of cardiovascular disease due to vitamin deficiency as well as therapy due to different vitamins are conflicting. In this article, we have attempted to review the existing literature on the role of different vitamins in cardiovascular disease with respect to their deficiency and supplementation in addition to examining some issues regarding their involvement in heart disease. Although both epidemiological and observational studies have shown some merit in the use of different antioxidant vitamins for the treatment of cardiovascular disorders, the results are not conclusive. Furthermore, in view of the complexities in the mechanisms of different cardiovascular disorders, no apparent involvement of any particular vitamin was seen in any specific cardiovascular disease. On the other hand, we have reviewed the evidence that deficiency of vitamin B6 promoted KCl-induced Ca2+ entry and reduced ATP-induced Ca2+-entry in cardiomyocytes in addition to decreasing sarcolemmal (SL) ATP binding. The active metabolite of vitamin B6, pyridoxal 5′-phosphate, attenuated arrhythmias due to myocardial infarction (MI) as well as cardiac dysfunction and defects in the sarcoplasmic reticulum (SR) Ca2+-transport in the ischemic-reperfused hearts. These observations indicate that both deficiency of some vitamins as well as pretreatments with different vitamins showing antioxidant activity affect cardiac function, metabolism and cation transport, and support the view that antioxidant vitamins or their metabolites may be involved in the prevention rather than the therapy of cardiovascular disease.
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Affiliation(s)
- Anureet K Shah
- School of Kinesiology, Nutrition and Food Science, California State University, Los Angeles, Los Angeles, CA, United States
| | - Naranjan S Dhalla
- Department of Physiology and Pathophysiology, St. Boniface Hospital Albrechtsen Research Centre, Max Rady College of Medicine, Institute of Cardiovascular Sciences, University of Manitoba, Winnipeg, MB, Canada
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Cobalamin and folate status in women during early pregnancy in Bhaktapur, Nepal. J Nutr Sci 2021; 10:e57. [PMID: 34422259 PMCID: PMC8358842 DOI: 10.1017/jns.2021.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/08/2022] Open
Abstract
The demand for cobalamin (vitamin B12) and folate is increased during pregnancy, and deficiency during pregnancy may lead to complications and adverse outcomes. Yet, the status of these micronutrients is unknown in many populations. We assessed the concentration of cobalamin, folate and their functional biomarkers, total homocysteine (tHcy) and methylmalonic acid (MMA), in 561 pregnant women enrolled in a community-based randomised controlled trial in Bhaktapur, Nepal. Plasma concentrations of cobalamin, folate, tHcy and MMA were measured and a combined indicator of vitamin B12 status (3cB12) was calculated. We report mean or median concentrations and the prevalence of deficiency according to commonly used cut-offs, and assessed their association with indicators of socio-economic status, and maternal and dietary characteristics by linear regression. Among the women at gestational week less than 15, deficiencies of cobalamin and folate were seen in 24 and 1 %, respectively. Being a vegetarian was associated with lower plasma cobalamin, and a higher socio-economic status was associated with a better micronutrient status. We conclude that cobalamin deficiency defined by commonly used cut-offs was common in Nepalese women in early pregnancy. In contrast, folate deficiency was rare. As there is no consensus on cut-off points for vitamin B12 deficiency during pregnancy, future studies are needed to assess the potential functional consequences of these low values.
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Abstract
Importance Nutrition patterns in pregnancy play a decisive role in the well-being of the mother and the fetus. Objective The aim of this review was to summarize and compare guidelines and recommendations on nutrition in pregnancy. Evidence Acquisition A descriptive review of major guidelines on antenatal nutrition was conducted, including the most recently published guidelines, namely, by the Australian Government Department of Health (2018); the Canadian Nutrition Working Group and Society of Obstetricians and Gynaecologists of Canada (2016); the World Health Organization (2016); the Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland (2016); the International Federation of Gynecology and Obstetrics (2015); the Academy of Nutrition and Dietetics (2014); and the National Institute for Health and Care Excellence (2008). Results There is almost universal agreement regarding macronutrient requirements during pregnancy. The WHO, FIGO, and the NICE guidelines make no recommendation on fluid intake. Almost all guidelines state that weight gain during pregnancy should be closely monitored. Folic acid supplementation is universally recommended from the preconception period, but there are controversies regarding other vitamins' supplementation. Multiple micronutrient supplementation could be an option in specific settings according only to the FIGO. Probiotics are not routinely recommended in pregnancy. Conclusions There is wide agreement among the reviewed guidelines regarding nutrition in pregnancy, but still there are controversies. Evaluation and classification of influential guidelines can be beneficial for establishing a universal consensus on nutrition during pregnancy, in order to achieve more favorable perinatal outcomes.
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Adibi JJ, Layden AJ, Birru RL, Miragaia A, Xun X, Smith MC, Yin Q, Millenson ME, O’Connor TG, Barrett ES, Snyder NW, Peddada S, Mitchell RT. First trimester mechanisms of gestational sac placental and foetal teratogenicity: a framework for birth cohort studies. Hum Reprod Update 2021; 27:747-770. [PMID: 33675653 PMCID: PMC8222765 DOI: 10.1093/humupd/dmaa063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The function of the gestational sac (GS) and the placenta in the closely related processes of embryogenesis and teratogenicity in the first trimester has been minimally described. The prevailing assumption is that direct teratogenic effects are mediated by the critical extraembryonic organ, the placenta, which either blocks or transfers exposures to the foetus. Placental transfer is a dominant mechanism, but there are other paradigms by which the placenta can mediate teratogenic effects. Knowledge of these paradigms and first trimester human developmental biology can be useful to the epidemiologist in the conduct of biomarker-based studies of both maternal and child health. OBJECTIVE AND RATIONALE Our aim is to provide a causal framework for modelling the teratogenic effects of first trimester exposures on child health outcomes mediated by the GS and placenta using biomarker data collected in the first trimester. We initially present first trimester human developmental biology for the sake of informing and strengthening epidemiologic approaches. We then propose analytic approaches of modelling placental mechanisms by way of causal diagrams using classical non-embryolethal teratogens (diethylstilboestrol [DES], folic acid deficiency and cytomegalovirus [CMV]) as illustrative examples. We extend this framework to two chronic exposures of particular current interest, phthalates and maternal adiposity. SEARCH METHODS Information on teratogens was identified by a non-systematic, narrative review. For each teratogen, we included papers that answered the five following questions: (i) why were these exposures declared teratogens? (ii) is there a consensus on biologic mechanism? (iii) is there reported evidence of a placental mechanism? (iv) can we construct a theoretical model of a placental mechanism? and (v) can this knowledge inform future work on measurement and modelling of placental-foetal teratogenesis? We prioritized literature specific to human development, the organogenesis window in the first trimester and non-embryolethal mechanisms. OUTCOMES As a result of our review of the literature on five exposures considered harmful in the first trimester, we developed four analytic strategies to address first trimester placental mechanisms in birth cohort studies: placental transfer and direct effects on the foetus (DES and maternal adiposity), indirect effects through targeted placental molecular pathways (DES and phthalates), pre-placental effects through disruptions in embryonic and extraembryonic tissue layer differentiation (folic acid deficiency), and multi-step mechanisms that involve maternal, placental and foetal immune function and inflammation (DES and CMV). WIDER IMPLICATIONS The significance of this review is to offer a causal approach to classify the large number of potentially harmful exposures in pregnancy when the exposure occurs in the first trimester. Our review will facilitate future research by advancing knowledge of the first trimester mechanisms necessary for researchers to effectively associate environmental exposures with child health outcomes.
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Affiliation(s)
- Jennifer J Adibi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexander J Layden
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rahel L Birru
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Miragaia
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaoshuang Xun
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Megan C Smith
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qing Yin
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Thomas G O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Nathaniel W Snyder
- Department of Microbiology and Immunology, Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Shyamal Peddada
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, The University of Edinburgh, Queens Medical Research Institute, Edinburgh, UK
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Mahmood S, Younas H, Younus A, Nathenial S. A narrative review on the role of folate-mediated one-carbon metabolism and its associated gene polymorphisms in posing risk to preeclampsia. Clin Exp Hypertens 2021; 43:487-504. [PMID: 34053381 DOI: 10.1080/10641963.2021.1916942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Preeclampsia (PE) presents a major obstetrical problem for mother and fetus which is characterized by the onset of hypertension and proteinuria in formerly normotensive women. Altered folate-mediated one-carbon metabolism is one of the factors for PE development either due to nutritional insufficiencies such as folate deficiency or polymorphisms in genes that code for the key enzymes of the cycle. Commonly, there are four genes in the cycle whose polymorphisms have been described in relation to PE. These factors could cause elevation of homocysteine; the toxic metabolite, which subsequently leads to the development of PE. Sufficient levels of folate have been considered important during pregnancy and may reduce the risk of development of PE. This review aims at discussing genetic polymorphisms and nutritional deficiencies as probable predisposing factors and suggests considering fetal genotypes, varied ethnicities, and interaction of various other factors involved to render better conclusiveness to the present studies.
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Affiliation(s)
- Sadia Mahmood
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Hooria Younas
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Amna Younus
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Sammar Nathenial
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
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Dhillon P, Kaur I, Singh K. Pregnancy-induced hypertension: Role of drug therapy and nutrition in the management of hypertension. PHARMANUTRITION 2021. [DOI: 10.1016/j.phanu.2021.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Li Q, Xu S, Chen X, Zhang X, Li X, Lin L, Gao D, Wu M, Yang S, Cao X, Tan T, Hu W, Guo J, Huang L, Chen R, Zhou X, Cui W, Xiong T, Gao Q, Wu Y, Hong M, Wang X, Zhang G, Zhang Y, Zhong C, Xiong G, Yang H, Yang N, Yang X, Hao L, Jin Z, Yang N. Folic Acid Supplement Use and Increased Risk of Gestational Hypertension. Hypertension 2020; 76:150-156. [DOI: 10.1161/hypertensionaha.119.14621] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current results regarding the effect of folic acid (FA) supplement use on gestational hypertension (GH) and preeclampsia are limited and inconsistent. We aimed to investigate whether FA supplement use was associated with GH and preeclampsia. Participants from the Tongji Maternal and Child Health Cohort with information on periconceptional FA supplement use and diagnosis of GH/preeclampsia were included (n=4853). Robust Poisson regression was used to assess the association of FA supplement use and GH and preeclampsia. Among the 4853 participants in this study, 1161 (23.9%) and 161 (3.3%) women were diagnosed with GH and preeclampsia, respectively. The risk ratio of developing GH was higher in women who used ≥800 µg/d FA supplement from prepregnancy through midpregnancy than nonusers (risk ratio, 1.33 [1.08–1.65]). After adjusting for social-demographic, reproductive, lifestyle factors, family history of hypertension, other supplement use, and gestational weight gain, the adverse association remained significant (risk ratio, 1.32 [1.06–1.64]). Restricting the analysis among women with normal weight, without family history of hypertension, and without gestational diabetes mellitus, the positive FA-GH association still existed. We did not find any significant association between FA supplement use and preeclampsia regardless of adjustment. High-dose (≥800 µg/d) FA supplement use from prepregnancy through midpregnancy was associated with increased risk of GH. Attention should be given to avoid the potential risk of GH due to inappropriate FA supplement use in women who are planning or capable of pregnancy.
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Affiliation(s)
- Qian Li
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Shangzhi Xu
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Xi Chen
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Xu Zhang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Xiating Li
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Lixia Lin
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Duan Gao
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Meng Wu
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Sen Yang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Xiyu Cao
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Tianqi Tan
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Wenqi Hu
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Jinrong Guo
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Li Huang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Renjuan Chen
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Xuezhen Zhou
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Wenli Cui
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Ting Xiong
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Qin Gao
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Yuanjue Wu
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Miao Hong
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Xiaoyi Wang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Guofu Zhang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Yu Zhang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Chunrong Zhong
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | | | - Hongying Yang
- Institute of Health Education, Hubei Provincial Center for Disease Control and Prevention, Hubei Provincial Academy of Preventive Medicine, P.R. China (H.Y.)
| | - Nianlan Yang
- Department of Anesthesiology & Perioperative Medicine, Medical College of Georgia, Augusta University (Nianlan Yang)
| | - Xuefeng Yang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Liping Hao
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
| | - Zhichun Jin
- Hubei Maternal and Child Health Hospital, P.R. China (Z.J.)
| | - Nianhong Yang
- From the Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, P.R. China (Q.L., S.X., X. Chen, X. Zhang, X.L., L.L., D.G., M.W., S.Y., X. Cao, T.T., W.H., J.G., L. Huang, R.C., X. Zhou, W.C., T.X., Q.G., Y.W., M.H., X.W., G.Z., Y.Z., C.Z., X.Y., L. Hao, Nianhong Yang)
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Orabona R, Zanardini C, Zatti S, Sartori E, Prefumo F. Folic Acid Supplementation in Pregnancy: A Matter of Doses? Hypertension 2020; 76:30-31. [PMID: 32520616 DOI: 10.1161/hypertensionaha.120.15009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rossana Orabona
- From the Department of Obstetrics and Gynecology, University of Brescia, Italy
| | - Cristina Zanardini
- From the Department of Obstetrics and Gynecology, University of Brescia, Italy
| | - Sonia Zatti
- From the Department of Obstetrics and Gynecology, University of Brescia, Italy
| | - Enrico Sartori
- From the Department of Obstetrics and Gynecology, University of Brescia, Italy
| | - Federico Prefumo
- From the Department of Obstetrics and Gynecology, University of Brescia, Italy
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Fogacci S, Fogacci F, Cicero AF. Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence. Nutrients 2020; 12:E378. [PMID: 32023928 PMCID: PMC7071166 DOI: 10.3390/nu12020378] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/24/2022] Open
Abstract
The aim of the present critical review is to summarize the available clinical evidence supporting the use of some dietary supplements that have been shown to lower blood pressure in hypertensive pregnant women. A systematic search strategy was carried out to identify trials in MEDLINE (National Library of Medicine, Bethesda, Maryland, MD, USA; January 1980 to September 2019) and the Cochrane Register of Controlled Trials (The Cochrane Collaboration, Oxford, UK). The terms 'nutraceuticals', 'dietary supplements', 'pregnancy', 'pre-eclampsia', 'clinical trial', and 'human' were incorporated into an electronic search strategy. The references of the identified studies and review articles were reviewed to look for additional studies of interest. We preferably selected papers that reported recent comprehensive reviews or meta-analysis, or original clinical trials of substances with blood pressure-lowering or vascular protective effect in pregnancy. There is a relative body of evidence that supports the use of calcium, vitamin D, folic acid, and resveratrol in preventing the development of hypertensive disorders in pregnancy, and evidence supporting drug treatment too. Further clinical research is advisable to identify the dosage and timing of the supplementation, the group of women that might benefit the most from this approach, and the nutraceuticals with the best cost-effectiveness and risk-benefit ratio for widespread use in clinical practice.
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Affiliation(s)
- Silvia Fogacci
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Building 2-IV Floor, Via Albertoni 15, 40138 Bologna, Italy; (S.F.); (F.F.)
| | - Federica Fogacci
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Building 2-IV Floor, Via Albertoni 15, 40138 Bologna, Italy; (S.F.); (F.F.)
| | - Arrigo F.G. Cicero
- Medical and Surgical Sciences Department, Sant’Orsola-Malpighi University Hospital, Building 2-IV Floor, Via Albertoni 15, 40138 Bologna, Italy; (S.F.); (F.F.)
- Italian Nutraceutical Society (SINut), Via Guelfa 9, 40138 Bologna, Italy
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Can Serum Iron Concentrations in Early Healthy Pregnancy Be Risk Marker of Pregnancy-Induced Hypertension? Nutrients 2019; 11:nu11051086. [PMID: 31100832 PMCID: PMC6566422 DOI: 10.3390/nu11051086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to assess the relationship between serum iron concentrations in early healthy pregnancy and the risk of pregnancy-induced hypertension. The data comes from our prospective cohort study in which we recruited healthy women in week 10–14 of single pregnancy. We examined a study group (n = 121) consisting of women subsequently developing pregnancy-induced hypertension and a control group (n = 363) of matched women remaining normotensive. We measured iron concentrations in the serum collected in 10–14 gestational week, using the ICP-MS technique (mass spectrometry with inductively coupled plasma). The odds ratios of the disease (95% confidence intervals) for iron concentrations were assessed in multivariate logistic regression. We found that the mean microelement concentration was lower in the case group compared to normotensive controls (p = 0.011). Women in the lowest quartile of iron (≤801.20 µg/L) had a 2.19-fold increase in pregnancy-induced hypertension risk compared with women in the highest quartile (>1211.75 µg/L) (odds ratio (OR) = 2.19; 95% CI: 1.24–3.88; p = 0.007). This result was sustained after adjusted for all the accepted confounders. Women in the higher Q2 quartile (801.20–982.33 µg/L) had a 17% lower risk, compared with those in the highest quartile (OR = 0.83; 95% CI: 0.65–2.32; p = 0.519).
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Carlson NS. Current Resources for Evidence-Based Practice, November 2018. J Obstet Gynecol Neonatal Nurs 2018; 47:820-829. [PMID: 30312573 DOI: 10.1016/j.jogn.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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