Depressed antioxidant status in pregnant women on iron supplements: pathologic and clinical correlates

Fetal Growth Is Associated with Amniotic Fluid Antioxidant Capacity, Oxidative Stress, Minerals and Prenatal Supplementation: A Retrospective Study

BACKGROUND

Associations of antioxidants in prenatal over-the-counter multivitamin-mineral (OTC MVM) supplements with in-utero oxidative stress (OS), antioxidant capacity, and fetal growth are limited. Our objectives were to determine if five fetal ultrasound measurements [biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight] were associated with OTC MVM supplements and with minerals, biomarkers of OS, and total antioxidant capacity in amniotic fluid (AF).

METHODS

For this retrospective study, 176 pregnant women who had undergone age-related amniocentesis for genetic testing were included. Questionnaires recorded prenatal OTC MVM supplementation (yes, no). Ultrasound measurements for early (16-20 weeks) and late (32-36 weeks) gestation were extracted from medical charts. AF concentrations for 15 minerals and trace elements and OS biomarkers in AF [nitric oxide (NO), thiobarbituric acid-reactive substances (TBARS), and ferric-reducing antioxidant power (FRAP)] were measured at 12-20 weeks of gestation. Associations of AF minerals, OS biomarkers, and ultrasound measures were analyzed using multiple linear regressions.

RESULTS

Positive associations were observed between AF TBARS and seven AF minerals/elements (calcium, copper, magnesium, nickel, strontium, zinc and iron). At 16-20 weeks, AF copper, nickel, strontium, and selenium were positively associated with BPD, HC, AC, and FL, respectively, NO was positively associated with FL, and FRAP was inversely associated with estimated weight. At 32-36 weeks, calcium was positively associated with BPD and chromium and arsenic were negatively with HC. At 16-20 weeks, higher AF FRAP was inversely associated with FL and this exposure continued to be inversely associated with estimated weight at 32-36 weeks.

CONCLUSIONS

Concentrations of AF minerals, trace elements and biomarkers of OS and in-utero antioxidant capacity were linked to specific ultrasound measurements at different stages of gestation, suggesting a complex interplay among in utero OS, antioxidant capacity, OTC MVM supplements, and fetal growth.

Role of placental barrier on trace element transfer in maternal fetal system and hypertensive disorders complicating pregnancy and gestational diabetes mellitus

BACKGROUND

Hypertensive disorders complicating pregnancy (HDCP) and gestational diabetes mellitus (GDM) can affect the placental barrier function to varying degrees. However, current studies show that the transfer and distribution characteristics of trace elements in the maternal-fetal system are still unclear. This study investigated the effect of the placental barrier on the transfer of trace elements from mother to fetus and its relationship with HDCP and GDM.

METHODS

A case-control method was used in this study. 140 pairs of samples were collected; 60 were from healthy pregnant women, and 80 were from patients with pregnancy complications. The contents of trace elements in paired samples were determined by inductively coupled plasma-mass spectrometry (ICP-MS). SPSS software was used to analyze the differences in trace element levels in matched samples of each group. The correlations were analyzed based on Pearson's correlation factor (r).

RESULTS

The distribution characteristics of Fe content in the pathological group (HDCP group and GDM group) were the same as those in the normal group (umbilical cord blood > maternal blood > placenta), but there was no significant difference in the iron content in maternal blood and cord blood of pathological group. The distribution characteristics of Mn content in the pathological group (placenta > umbilical cord blood > maternal blood) were changed compared with those in the normal group (placenta > maternal blood > umbilical cord blood). In addition, the placental Cr content and cord blood Cr and Ni content of the pathological group were higher than those of the normal group. HDCP placental Cr and GDM placental Fe levels were significantly correlated with the Apgar score.

CONCLUSIONS

The transfer of Fe and Mn and the placental barrier function of Cr and Ni in the maternal-fetal system of HDCP and GDM are significantly altered, which directly or indirectly increases the maternal and fetal health risk.

Assessment of 12 Essential and Toxic Elements in Whole Blood of Pregnant and Non-pregnant Women Living in Wuhan of China

Exposures to toxic trace elements and deficiencies of essential elements during pregnancy are associated to various birth complications. Assessment of the trace elements in pregnant women living in specific areas is important for biomonitoring. A total of 196 healthy pregnant women absent of pregnancy complications living in Wuhan of China and 210 healthy non-pregnant women were enrolled. The whole blood were collected. The toxic element chromium (Cr), arsenic (As), cadmium (Cd), mercury (Hg), thallium (Tl), and lead (Pb) and essential elements magnesium (Mg), calcium (Ca), manganese (Mn), iron (Fe), copper (Cu), and zinc (Zn) were determined by using a inductively coupled plasma mass spectrometry (ICP-MS)-based method. All the metal(loid)s, except for Cd, Hg, and Tl, showed different levels in whole blood of the pregnant women compared with the non-pregnant women (p < 0.05), among which Mg, Fe, As, and Pb were lower while Ca, Cr, Mn, Cu, and Zn were higher. Moreover, whole blood levels of Mg, Mn, Fe, Cu, and Zn showed significant variations among different gestational ages, while As and Cd showed significant variations among different maternal ages. In addition, Fe-Mg, Fe-Zn, Cu-Ca, and Hg-As were found to be correlated positively in whole blood of the pregnant women, while Fe-Ca, Zn-Ca, and Fe-Cu were correlated negatively. The systematic information of toxic and essential elements in whole blood of pregnant women living in Wuhan of China can provide important guidance for the supplementation of essential elements during pregnancy and for biomonitoring of environmental overexposure.

Oxidative Stress at Birth Is Associated with the Concentration of Iron and Copper in Maternal Serum

Oxidative stress (OS) in the foetal and neonatal periods leads to many disorders in newborns and in later life. The nutritional status of pregnant women is considered to be one of the key factors that triggers OS. We investigated the relationship between the concentration of selected mineral elements in the blood of pregnant women and the concentration of 3′nitrotyrosine (3′NT) as a marker of OS in the umbilical cord blood of newborns. The study group consisted of 57 pregnant women and their newborn children. The concentrations of magnesium (Mg), calcium (Ca), iron (Fe), zinc (Zn) and copper (Cu) in maternal serum (MS) were measured by the flame atomic absorption/emission spectrometry (FAAS/FAES) method. The concentration of 3′NT in umbilical cord serum (UCS) of newborns was determined by the ELISA method. A positive correlation between MS Fe and UCS 3′NT in male newborns was shown (rho = 0.392, p = 0.053). Significantly higher UCS 3′NT was demonstrated in newborns, especially males, whose mothers were characterized by MS Fe higher than 400 μg/dL compared to those of mothers with MS Fe up to 300 μg/dL (p < 0.01). Moreover, a negative correlation between the MS Cu and UCS 3′NT in male newborns was observed (rho = −0.509, p = 0.008). Results of the study showed the need to develop strategies to optimize the nutritional status of pregnant women. Implementation of these strategies could contribute to reducing the risk of pre- and neonatal OS and its adverse health effects in the offspring.

Altered HDL particle in sickle cell disease: decreased cholesterol content is associated with hemolysis, whereas decreased Apolipoprotein A1 is linked to inflammation

Background

Hypocholesterolemia is the most frequently encountered lipid abnormality in sickle cell disease (SCD). We enrolled pediatric patients to determine the relationships between lipid profile and parameters of hemolysis, oxidative stress and chronic inflammation in SCD.

Methods

The study involved 35 pediatric SCD patients and 19 healthy controls. Patients were crisis-free and had not received transfusions for the last 3 months. Total cholesterol, triglyceride, HDL-C, LDL-C, VLDL-C, apolipoprotein A1, apolipoprotein B, LCAT, LDH, bilirubin, haptoglobin, iron, ferritin, hemin, serum amyloid A (SAA), myeloperoxidase (MPO), uric acid, ALT and GGT levels were evaluated in patients’ blood.

Results

Patients had hypocholesterolemia depicted by lower levels of total cholesterol, HDL-C, LDL-C, as well as Apolipoprotein A1 and Apolipoprotein B compared to controls. The chronic hemolysis of SCD was evident in patients by higher LDH and bilirubin and almost undetectable haptoglobin levels. Hemin levels (as a measure of oxidized heme) were significantly increased in patients with SCD. Inflammation markers, SAA and MPO, were significantly increased in the patients as well. There were negative correlations between HDL-C and LDH, and Apo A1 and SAA. Hemin was positively correlated to MPO.

Conclusion

Hemolysis was associated with decreased HDL –C, and Inflammation was linked to decreased apolipoprotein A1 levels in our SCD patients. Therefore, we suggest that the HDL particle is altered during the course of the disease. The altered HDL in SCD may become dysfunctional and result with a slowing down of the reverse cholesterol transport.

Oxidative stress markers in hypertensive states of pregnancy: preterm and term disease

Discussion continues as to whether de novo hypertension in pregnancy with significant proteinuria (pre-eclampsia; PE) and non-proteinuric new hypertension (gestational hypertension; GH) are parts of the same disease spectrum or represent different conditions. Non-pregnant hypertension, pregnancy and PE are all associated with oxidative stress. We have established a 6 weeks postpartum clinic for women who experienced a hypertensive pregnancy. We hypothesized that PE and GH could be distinguished by markers of oxidative stress; thiobarbituric acid reactive substances (TBARS) and antioxidants (ferric ion reducing ability of plasma; FRAP). Since the severity of PE and GH is greater pre-term, we also compared pre-term and term disease. Fifty-eight women had term PE, 23 pre-term PE, 60 had term GH and 6 pre-term GH, 11 pre-existing (essential) hypertension (EH) without PE. Limited data were available from normotensive pregnancies (n = 7) and non-pregnant controls (n = 14). There were no differences in postpartum TBARS or FRAP between hypertensive states; TBARS (P = 0.001) and FRAP (P = 0.009) were lower in plasma of non-pregnant controls compared to recently-pregnant women. Interestingly FRAP was higher in preterm than term GH (P = 0.013). In PE and GH, TBARS correlated with low density lipoprotein (LDL)-cholesterol (P = 0.036); this association strengthened with inclusion of EH (P = 0.011). The 10 year Framingham index for cardiovascular risk was positively associated with TBARS (P = 0.003). Oxidative stress profiles do not differ between hypertensive states but appear to distinguish between recently-pregnant and non-pregnant states. This suggests that pregnancy may alter vascular integrity with changes remaining 6 weeks postpartum. LDL-cholesterol is a known determinant of oxidative stress in cardiovascular disease and we have shown this association to be present in hypertensive pregnancy further emphasizing that such a pregnancy may be revealing a pre-existing cardiovascular risk.

You are what you eat, and so are your children: the impact of micronutrients on the epigenetic programming of offspring

The research field of fetal programming has developed tremendously over the years and increasing knowledge suggests that both maternal and paternal unbalanced diet can have long-lasting effects on the health of offspring. Studies implicate that macronutrients play an important role in fetal programming, although the importance of micronutrients is also becoming increasingly apparent. Folic acid and vitamins B2, B6 and B12 are essential for one-carbon metabolism and are involved in DNA methylation. They can therefore influence the programming of the offspring's epigenome. Also, other micronutrients such as vitamins A and C, iron, chromium, zinc and flavonoids play a role in fetal programming. Since it is estimated that approximately 78 % of pregnant women in the US take vitamin supplements during pregnancy, more attention should be given to the long-term effects of these supplements on offspring. In this review we address several different studies which illustrate that an unbalanced diet prior and during pregnancy, regarding the intake of micronutrients of both mother and father, can have long-lasting effects on the health of adult offspring.

Pre-pregnancy iron reserves, iron supplementation during pregnancy, and birth weight

BACKGROUND

Early iron supplementation in women with sufficient reserves could provoke iron excess resulting in haemoconcentration and low infant birth weight (IBW).

AIM

To clarify the influence of early iron supplementation on maternal iron status and the IBW, taking into account pre-pregnancy iron deposits.

STUDY DESIGN

Longitudinal, prospective study.

SUBJECTS

Healthy women volunteers (n=82) intending to become pregnant.

OUTCOME MEASURES

Women were grouped as a function of their pre-pregnancy (low or present) iron stores (serum ferritin (SF)<or≥20μg/L) and time of commencement of iron supplementation during pregnancy; "early" (<20weeks) or "late" (≥20weeks). Obstetric and clinical history, smoking habit, dietary intake and iron biochemical parameters were obtained at pre-pregnancy as well as at 1st, 2nd and 3rd trimesters. Haemoglobin, MCV, SF and transferrin saturation (TS) were measured.

RESULTS

Overall, 36% of the women had low iron stores at pre-pregnancy. The mean early supplementation with iron was 140.7mg/d and the mean of late supplementation was 99.01mg/d. Early supplementation improves the biochemical status of the mother and does not provoke a significant increase in haemoconcentration relative to late supplementation independently of the pre-pregnancy iron levels. Supplemental iron had a positive effect on birth weight among women with pre-pregnancy low iron stores (β=4.37; SE=1.8; p=0.038) and did not affect birth weight among women with present iron stores (β=-0.008; SE=3.03; p=0.998).

CONCLUSION

Early iron supplementation with doses ~100mg/d improves the biochemical status of the mother independently of her pre-pregnancy iron status. Supplementation with iron improves newborn birth weight in those women who start pregnancy with iron deficiency, and makes no significant difference to those women who are not iron deficient.