Influence of caesarean delivery and maternal factors on fat-soluble vitamins in blood from cord and neonates

Scientific opinion on the tolerable upper intake level for vitamin E

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the revision of the tolerable upper intake level (UL) for vitamin E. As α-tocopherol is recognised as the only essential form of vitamin E, the Panel restricted its evaluation to α-tocopherol. Systematic reviews of the literature were conducted to assess evidence on priority adverse health effects of excess intake of vitamin E, namely risk of impaired coagulation and bleeding, cardiovascular disease and prostate cancer. The effect on blood clotting and associated increased risk of bleeding is considered as the critical effect to establish an UL for vitamin E. No new evidence has been published that could improve the characterisation of a dose-response. The ULs for vitamin E from all dietary sources, which were previously established by the Scientific Committee on Food, are retained for all population groups, i.e. 300 mg/day for adults, including pregnant and lactating women, 100 mg/day for children aged 1-3 years, 120 mg/day for 4-6 years, 160 mg/day for 7-10 years, 220 mg/day for 11-14 years and 260 mg/day for 15-17 years. A UL of 50 mg/day is established for infants aged 4-6 months and a UL of 60 mg/day for infants aged 7-11 months. ULs apply to all stereoisomeric forms of α-tocopherol. ULs do not apply to individuals receiving anticoagulant or antiplatelet medications (e.g. aspirin), to patients on secondary prevention for CVD or to patients with vitamin K malabsorption syndromes. It is unlikely that the ULs for vitamin E are exceeded in European populations, except for regular users of food supplements containing high doses of vitamin E.

Vitamin E Levels in Preterm and Full-Term Infants: A Systematic Review

Vitamin E deficiency (VED) is associated with clinical repercussions in preterm newborns (PTN), but low levels are also found in full-term newborns (TN). As this inadequacy can compromise neurogenesis in childhood, studies are needed to assess whether there is a difference in vitamin E status among newborns according to gestational age to provide support for neonatal monitoring protocols. This systematic review presents a synthesis of the available information on the vitamin E status among PTN and TN. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies that evaluated alpha-tocopherol levels were searched in the databases reported in the protocol registered in PROSPERO (CRD42021165152). The Newcastle–Ottawa Scale was used to assess the methodological quality. Overall, 1809 articles were retrieved; 10 were included in the systematic review. In the PTN, the alpha-tocopherol levels ranged from 3.9 to 8.5 mmol/L, while in TN, they were 4.9 to 14.9 mmol/L, and VED ranged from 19% to 100% in newborns. Despite substantial heterogeneity in research methodology and VED classification, the results suggest that the alpha-tocopherol levels among preterm and full-term newborns is below the recommended levels. Our findings demonstrate that further investigations are needed to standardize this classification and to monitor vitamin E status in birth and postnatal with adequate bias control.

Geographic and socio-demographic determinants of plasma retinol concentrations in Chinese pregnant and lactating women

PURPOSE

To examine plasma retinol status and its determinants in Chinese pregnant or lactating women.

METHODS

A cross-sectional study involving 1211 healthy women in mid-pregnancy, late pregnancy, or lactation was conducted in northern, central, and southern China. Plasma retinol concentration was determined by high-performance liquid chromatography. Multivariate quantile regression or modified Poisson regression was used to estimate adjusted medians, or to examine the associations of suboptimal retinol concentration (< 1.05 µmol/L) with various factors.

RESULTS

The overall median (interquartile range) retinol concentration was 1.25 (1.06-1.46) µmol/L. The adjusted concentration was higher in women at lactation (1.39 [1.20-1.63] µmol/L) and mid-pregnancy (1.26 [1.10-1.44] µmol/L) than late pregnancy (1.07 [0.92-1.28] µmol/L), and higher in women in the central area (1.34 [1.18-1.49] µmol/L) and the north (1.26 [1.10-1.43] µmol/L) than the south (1.19 [1.07-1.31] µmol/L). The retinol concentration was more likely to be low in women with lower pre-pregnancy BMI, younger age, less education, and in lactating women who had a caesarean birth or were breastfeeding exclusively. A total of 290 (24.0%) women had a suboptimal retinol concentration, and the prevalence was higher in women at late pregnancy, residing in the south, with younger age, and having underweight pre-pregnancy.

CONCLUSION

About one-fourth of pregnant or lactating women in China had suboptimal retinol concentrations that varied with phases of pregnancy and lactation, region of residence, and socio-demographic characteristics, indicating a need for population-specific public health strategies to optimize vitamin A status.

The relationship between umbilical cord blood vitamin A levels and late preterm infant morbidities: a prospective cohort study

The aim of this study is to explore the association between umbilical cord blood (UCB) vitamin A levels and late preterm infants morbidities. We conducted a prospective cohort study of 208 late-preterm infants(from 34 ⁰/₇ to 36 ⁶/₇ weeks gestational age) between January 1, 2014 and June 30, 2015. UCB specimens were collected shortly after birth, and vitamin A levels were determined by enzyme-linked immunosorbent assay. Prevalence of low UCB vitamin A level < 0.7 μmol/L was 37.5% in late preterm infants. In comparison to vaginal delivery, cesarean section was associated with UCB vitamin A level < 0.7 μmol/L (P < 0.001). Nevertheless, UCB vitamin A levels did not correlate with gestational age, birth weight, and gender. UCB vitamin A level < 0.7 μmol/L was not an independent risk factor for hospitalization, oxygen supplementation, hyperbilirubinemia, sepsis, and respiratory distress syndrome.Conclusions: Low umbilical cord blood vitamin A levels are common among late-preterm infants. Cesarean section delivery is associated with low umbilical cord blood vitamin A level. Low umbilical cord blood vitamin A levels at birth do not increase morbidity of late-preterm infants, including hyperbilirubinemia, sepsis, and respiratory distress syndrome. What is Known: • Late preterm infants have a higher morbidity and mortality rates when compared to term infants. • Low plasma vitamin A levels increase the risk of preterm infants' morbidity. What is New: • Late preterm infants commonly have low level of umbilical cord blood vitamin A. • Low umbilical cord blood vitamin A level at birth appears to be not associated with the morbidity of late-preterm infants. • Cesarean section is associated with low umbilical cord blood vitamin A level < 0.7 μmol/L compared with vaginal delivery.

Analysis of circulating lipid-phase micronutrients in humans by HPLC: review and overview of new developments

Retinol, tocopherols, coenzyme Q10, carotenoids, and vitamin D are lipophilic compounds shown to function as important health-protective agents by mitigating the damaging effects of oxidative and other injury. Scientific interest in evaluating these compounds has resurfaced in recent years, particularly in the nutritional, clinical and epidemiologic fields, and has precipitated the development of a multitude of new analytical techniques. This review considers recent developments in HPLC-based assays since 2007 for the simultaneous determination of these lipid-phase compounds utilizing exclusively serum or plasma as these matrices are mostly used in clinical and epidemiological investigations. We also provide an overview of blood measurements for selected carotenoids, tocopherols, coenzyme Q10 and retinol from the last 15years of healthy umbilical cord blood, children, and adults.

Sociodemographic and lifestyle characteristics are associated with antioxidant intake and the consumption of their dietary sources during pregnancy

Objective

To analyse the associations of selected sociodemographic and lifestyle factors with the intake of antioxidant nutrients and consumption of their main dietary sources among pregnant women.

Design

A population-based cohort study. Dietary intake during pregnancy was assessed by a self-administered FFQ one to three months after the delivery.

Setting

Type 1 Diabetes Prediction and Prevention (DIPP) Project.

Subjects

Subjects comprised 3730 women (70·1 % of those invited) who entered the DIPP Nutrition Study after delivering a child at increased genetic risk for type 1 diabetes at the university hospitals in Oulu and Tampere, Finland, 1997–2002.

Results

All sociodemographic and lifestyle factors studied showed significant associations with antioxidant intake in multiple regression models adjusting for all other factors. Older and more educated women tended to have higher intake of most antioxidants. Parity was positively associated with retinol intake and inversely with vitamin C intake. Smokers had lower intakes of most antioxidants. Only the partner’s education was positively associated with high intake of fruits, whereas own education was positively associated with berry consumption. Vegetable consumption was positively associated with partner’s education except for women with academic education, who tended to have high vegetable consumption irrespective of partner’s education.

Conclusions

Young women, smokers and those with a low education are at risk for low antioxidant intake and non-optimal food choices during pregnancy.

Intake of antioxidant vitamins and trace elements during pregnancy and risk of advanced beta cell autoimmunity in the child

BACKGROUND

Type 1 diabetes may have its origins in the fetal period of life. Free radicals were implicated in the cause of type 1 diabetes. It was hypothesized that antioxidant nutrients could protect against type 1 diabetes.

OBJECTIVE

We assessed whether high maternal intake of selected dietary antioxidants during pregnancy is associated with a reduced risk of advanced beta cell autoimmunity in the child, defined as repeated positivity for islet cell antibodies plus >/=1 other antibody, overt type 1 diabetes, or both.

DESIGN

The study was carried out as part of the population-based birth cohort of the Type 1 Diabetes Prediction and Prevention Project. The data comprised 4297 children with increased genetic susceptibility to type 1 diabetes, born at the University Hospital of Oulu or Tampere, Finland, between October 1997 and December 2002. The children were monitored for diabetes-associated autoantibodies from samples obtained at 3-12-mo intervals. Maternal antioxidant intake during pregnancy was assessed postnatally with a self-administered food-frequency questionnaire, which contained a question about consumption of dietary supplements.

RESULTS

Maternal intake of none of the studied antioxidant nutrients showed association with the risk of advanced beta cell autoimmunity in the child. The hazard ratios, indicating the change in risk per a 2-fold increase in the intake of each antioxidant, were nonsignificant and close to 1.

CONCLUSION

High maternal intake of retinol, beta-carotene, vitamin C, vitamin E, selenium, zinc, or manganese does not protect the child from development of advanced beta cell autoimmunity in early childhood.

Vitamin E During Pre‐ and Postnatal Periods

Vitamin E is a fat-soluble nutrient that is extremely important during the early stages of life, from the time of conception to the postnatal development of the infant. The mechanisms involved in its placental and mammary uptake appear to be allowed by the presence of lipoprotein receptors (LDL-receptor, VLDL-receptor, scavenger receptor class B type I) together with lipoprotein lipase at the placental and mammary barriers. In addition, alpha-tocopherol transfer protein has been described as playing an essential role in the selective transfer of RRR-alpha-tocopherol across the placenta. Lower alpha-tocopherol concentrations are found in cord blood as compared to maternal circulation. The ingestion of colostrum which contains very high levels of vitamin E is therefore of utmost importance to supply the newborn with an essential defense against oxygen toxicity. Pregnancy is sometimes associated with complications that may lead to a premature delivery of the baby. Preterm infants are usually facing an oxidative stress that is among others related to a deficiency in alpha-tocopherol, as it accumulates mainly during the third trimester of pregnancy. Despite vitamin E supplementation, preterm infants usually require significantly longer to replenish their serum alpha-tocopherol levels than full-term infants. The use of vitamin E as a therapeutic agent in preeclampsia, which induces high maternal and fetal morbidity and mortality, has been discussed in numerous papers. This disorder is indeed associated with an important oxidative stress in the placenta and maternal circulation. However, the most recent studies did not show a beneficial effect of vitamin E administration in this pathology.

Maternal intake of antioxidant vitamins in pregnancy in relation to maternal and fetal plasma levels at delivery

The aim of the present study was to test the hypothesis that maternal intake of antioxidant vitamins is associated with maternal and cord plasma levels at delivery. Women were recruited in early pregnancy in Aberdeen Maternity Hospital and habitual diet during pregnancy was assessed by a food-frequency questionnaire mailed at 34 weeks gestation. Blood samples were taken at recruitment (n 1149) and maternal (n 1149) and cord blood samples (n 747) taken at delivery for analyses of vitamins A, C, E and beta-carotene. Maternal plasma levels of vitamin E and beta-carotene at delivery were significantly higher than levels in early pregnancy while levels of vitamins A and C were significantly lower. Positive correlations were observed for maternal levels of all the vitamins between early pregnancy and delivery. At delivery, maternal plasma concentrations of vitamins A, E and beta-carotene were significantly higher than cord levels, while maternal levels of vitamin C were significantly lower. There were significant correlations between maternal and cord plasma concentrations for beta-carotene and vitamin C but not for vitamins A or E. Maternal dietary intakes were positively correlated with maternal plasma levels of vitamins C, E and beta-carotene in early pregnancy, with maternal plasma levels of beta-carotene and vitamin C at delivery and with cord plasma levels of beta-carotene and vitamin C. The results from the present study show that, in this population, maternal diet influences cord plasma levels of beta-carotene and vitamin C, but not vitamins A and E.