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Giourga C, Papadopoulou SK, Voulgaridou G, Karastogiannidou C, Giaginis C, Pritsa A. Vitamin D Deficiency as a Risk Factor of Preeclampsia during Pregnancy. Diseases 2023; 11:158. [PMID: 37987269 PMCID: PMC10660864 DOI: 10.3390/diseases11040158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
A balanced diet is achieved not only via the consumption of a variety of food products but also by ensuring that we take in sufficient quantities the micronutrients necessary for the adequate functioning of the human body, such as vitamins, an important one of which is vitamin D. Vitamin D has been closely linked to bone health. Vitamin D deficiency has often been associated with negative effects concerning several pregnancy adverse outcomes, the most important of which are the birth of SGA newborns, premature birth, and, finally, preeclampsia, which are discussed in this work. The aim of this review is to critically summarize and scrutinize whether the concentration of vitamin D in the blood serum of pregnant women in all its forms may be correlated with the risk of preeclampsia during pregnancy and whether vitamin D levels could act both as a protective agent or as a risk factor or even a prognostic measure of the disease. The association of vitamin D levels with the onset of preeclampsia was examined by searching the PubMed and Google Scholar databases. A total of 31 clinical trials were identified and included in this review, with the aim of summarizing the recent data concerning vitamin D levels and the risk of preeclampsia. Among them, 16 were published in the last five years, and 13 were published within the last a decade. Most studies showed a significant association between vitamin D deficiency and preeclampsia risk. It was also found that the higher the dose, the lower the risk of disease. Of the 31 articles, only 7 of them did not show a significant difference between vitamin D levels and preeclampsia regardless of comorbidity. The results of this review suggest that there is indeed an association between the concentration of vitamin D during pregnancy and the risk of preeclampsia; however, further studies are strongly recommended to derive conclusive evidence.
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Affiliation(s)
- Chrysoula Giourga
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (C.G.); (S.K.P.); (G.V.); (C.K.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (C.G.); (S.K.P.); (G.V.); (C.K.)
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (C.G.); (S.K.P.); (G.V.); (C.K.)
| | - Calliope Karastogiannidou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (C.G.); (S.K.P.); (G.V.); (C.K.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece;
| | - Agathi Pritsa
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (C.G.); (S.K.P.); (G.V.); (C.K.)
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Kelly CB, Karanchi H, Yu JY, Leyva MJ, Jenkins AJ, Nankervis AJ, Hanssen KF, Garg SK, Scardo JA, Hammad SM, Aston CE, Beisswenger PJ, Lyons TJ. Plasma AGE and Oxidation Products, Renal Function, and Preeclampsia in Pregnant Women with Type 1 Diabetes: A Prospective Observational Study. J Diabetes Res 2023; 2023:8537693. [PMID: 37601831 PMCID: PMC10435306 DOI: 10.1155/2023/8537693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/22/2023] Open
Abstract
Aims We aimed to determine whether plasma advanced glycation end products or oxidation products (AGE/oxidation-P) predict altered renal function and/or preeclampsia (PE) in pregnant women with type 1 diabetes. Methods Prospectively, using a nested case-control design, we studied 47 pregnant women with type 1 diabetes, of whom 23 developed PE and 24 did not. Nineteen nondiabetic, normotensive pregnant women provided reference values. In plasma obtained at ~12, 22, and 32 weeks' gestation (visits 1, 2, and 3; V1-V3), we measured five AGE products (carboxymethyllysine (CML), carboxyethyl-lysine (CEL), methylglyoxal-hydroimidazolone (MGH1), 3-deoxyglucosone hydroimidazolone (3DGH), and glyoxal-hydroimidazolone (GH1)) and four oxidation products (methionine sulfoxide (MetSO), 2-aminoadipic acid (2-AAA), 3-nitrotyrosine (3NT), and dityrosine (DT)), by liquid chromatography/mass spectroscopy. Clinical outcomes were "estimated glomerular filtration rate" (eGFR) at each visit and onset of PE. Results In diabetic women, associations between AGE/oxidation-P and eGFR were found only in those who developed PE. In this group, CEL, MGH1, and GH1 at V2 and CML, CEL, MGH1, and GH1 at V3 were inversely associated with contemporaneous eGFR, while CEL, MGH1, 3DGH, and GH1 at V2 were inversely associated with eGFR at V3 (all p < 0.05). There were no associations of plasma AGE or oxidation-P with pregnancy-related development of proteinuria or PE. Conclusions Inverse associations of second and early third trimester plasma AGE with eGFR among type 1 diabetic women who developed PE suggest that these patients constitute a subset susceptible to AGE-mediated injury and thus to cardiorenal complications later in life. However, AGE/oxidation-P did not predict PE in type 1 diabetic women.
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Affiliation(s)
- Clare B. Kelly
- Division of Endocrinology, Medical University of South Carolina, Charleston, South Carolina, USA
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Harsha Karanchi
- Division of Endocrinology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeremy Y. Yu
- Division of Endocrinology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Misti J. Leyva
- Division of Endocrinology, Medical University of South Carolina, Charleston, South Carolina, USA
- Diabetes Free South Carolina, BlueCross BlueShield of South Carolina, Columbia, South Carolina, USA
| | | | | | - Kristian F. Hanssen
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Satish K. Garg
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Colorado, USA
| | - James A. Scardo
- Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA
| | - Samar M. Hammad
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher E. Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Timothy J. Lyons
- Division of Endocrinology, Medical University of South Carolina, Charleston, South Carolina, USA
- Diabetes Free South Carolina, BlueCross BlueShield of South Carolina, Columbia, South Carolina, USA
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Zhang Y, Kong J, Jiang X, Wu J, Wu X. Serum fat-soluble vitamins and the menstrual cycle in women of childbearing age. Food Funct 2023; 14:231-239. [PMID: 36484265 DOI: 10.1039/d2fo02765h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Evidence suggests that fat-soluble vitamins are involved in reproduction, but their association with the menstrual cycle, the proxy of female fecundity, remains largely unexplored in women of childbearing age. Serum fat-soluble vitamin levels were measured by HPLC-MS/MS and menstrual cycle data were acquired from 3123 women of reproductive age in Nanjing, China, using standard questionnaires. Irregular and long menstrual cycles occurred in 725 (23.2%) and 604 (19.3%) participants, respectively. Participants with higher levels of vitamins A and K had increased odds of irregular menstrual cycles (vitamin A: OR = 1.39 (95% CI: 1.12, 1.74); vitamin K: OR = 1.41 (95% CI: 1.13, 1.76)) and long menstrual cycles (vitamin A: OR = 1.34 (95% CI: 1.06, 1.69); vitamin K: OR = 1.27 (95% CI: 1.00, 1.61)), and the relationship showed a linear dose-response pattern (P-overall < 0.05, P-nonlinearity > 0.05). Vitamin A was positively associated with the average menstrual cycle length (β: 1.83, 95% CI: 0.28, 3.39). Vitamins A and K were interacted in their associations with irregular menstrual cycles and long cycles. In sensitivity analysis with further exclusion of participants with abnormal thyroid function or a history of polycystic ovary syndrome (PCOS), the association of vitamins A and K with the menstrual cycle remained robust. This study indicates that higher serum vitamin A and K levels in women of childbearing age are significantly associated with higher odds of irregular and long menstrual cycles with a linear dose-response curve. Further investigations are warranted to determine the appropriate fat-soluble vitamin levels for women of childbearing age.
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Affiliation(s)
- Yuqing Zhang
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China.
| | - Jing Kong
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China.
| | - Xiaohong Jiang
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China.
| | - Jiangping Wu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China.
| | - Xiaoli Wu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210004, China.
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Alirezaei T, Khandani A, Saleh Gargari S, Akbarzadeh MA, Naeiji Z. 25-Hydroxy Vitamin D Level and Its Correlation with Mean Platelet Volume in Preeclampsia. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2592-2598. [PMID: 36561257 PMCID: PMC9745395 DOI: 10.18502/ijph.v51i11.11177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022]
Abstract
Background Preeclampsia is one of the challenging complications of pregnancy, of which little is known about its etiology and pathogenesis. Many studies have shown higher mean platelet volume (MPV) in preeclamptic patients. Vitamin D deficiency is in association with larger-size platelets. Thus, we aimed to determine the correlation of vitamin D with MPV in preeclamptic patients. Methods This prospective case-control study was conducted in two tertiary hospitals in Tehran, Iran. Overall, 85 preeclamptic pregnant women and 85 normotensive pregnant women were entered between 2017 and 2018. Serum vitamin D concentration (ng/ml) and MPV (femtoliter) were measured for all patients. Results MPV was significantly higher in the cases compared to controls (10.59±1.08 vs 8.10±0.95, P=0.0001). In addition, serum vitamin D level in the preeclamptic group was significantly lower in compare to the control group (17.79±11.03 vs 30.24±12.49; P=0.0001). In multivariate logistic regression analysis, high age of mother (OR: 1.13; 95% CI: 1.01-1.27; P=0.03), low level of serum vitamin D (OR: 0.93; 95% CI: 0.87-0.99; P=0.02) and high MPV (OR: 8.83; 95% CI: 4.17-18.67; P=0.0001) were independent predictors of preeclampsia. Moreover, a correlation analysis revealed that vitamin D levels correlated negatively with MPV (r= -0.41, P<0.0001). Conclusion Low levels of vitamin D in preeclamptic pregnancy are associated with higher platelet activity and thrombosis. In fact, the increment of MPV level might be a potential pathway for adverse outcomes of pregnancy including preeclampsia in the context of vitamin D deficiency.
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Affiliation(s)
- Toktam Alirezaei
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ayda Khandani
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soraya Saleh Gargari
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Mohammad Ali Akbarzadeh
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Naeiji
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Karpova N, Dmitrenko O, Arshinova E, Nurbekov M. Review: Influence of 25(OH)D Blood Concentration and Supplementation during Pregnancy on Preeclampsia Development and Neonatal Outcomes. Int J Mol Sci 2022; 23:12935. [PMID: 36361738 PMCID: PMC9653937 DOI: 10.3390/ijms232112935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Briefly, 25-hydroxyvitamin D (25(OH)D) plays an essential role in embryogenesis and the course of intra- and postnatal periods and is crucially involved in the functioning of the mother-placenta-fetus system. The low quantity of 25(OH)D during pregnancy can lead to an elevated risk for preeclampsia occurrence. Despite the numerous studies on the association of 25(OH)D deficiency and preeclampsia development, the current research on this theme is contradictory. In this review, we summarize and analyze study data on the effects of 25(OH)D deficiency and supplementation on pregnancy, labor, and fetal and neonatal outcomes.
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Affiliation(s)
- Nataliia Karpova
- Federal State Budgetary Institution “Research Institute of Pathology and Pathophysiology”, Moscow 125315, Russia
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Freimane KZ, Kerrigan L, Eastwood KA, Watson CJ. Pre-Eclampsia Biomarkers for Women With Type 1 Diabetes Mellitus: A Comprehensive Review of Recent Literature. Front Bioeng Biotechnol 2022; 10:809528. [PMID: 35721866 PMCID: PMC9198830 DOI: 10.3389/fbioe.2022.809528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/21/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Pre-eclampsia is a serious consideration for women with type 1 diabetes mellitus (T1DM) planning pregnancy. Risk stratification strategies, such as biomarkers measured in the first trimester of pregnancy, could help identify high-risk women. The literature on T1DM-specific pre-eclampsia biomarkers is expanding. We aimed to provide a narrative review of recently published evidence to identify the most promising biomarker candidates that could be targeted for clinical implementation in existing PE models. Methods: A search using MeSH terms was carried out of Medline, EMBASE, Maternity and Infant Care, Web of Science, and Scopus for relevant papers published since 2015 inclusive and in English. The time limit was applied from the publication of the preceding systematic review in this field. Included studies had pre-eclampsia as a primary outcome, measured one or more serum, plasma or urine biomarkers at any time during pregnancy, and had a distinct group of women with T1DM who developed pre-eclampsia. Studies with pre-eclampsia as a composite outcome were not considered. No restrictions on study types were applied. A narrative synthesis approach was adopted for analysis. Results: A total of 510 records were screened yielding 18 eligible studies relating to 32 different biomarkers. Higher first-trimester levels of HbA1c and urinary albumin were associated with an increased risk of pre-eclampsia development in women with T1DM. Urinary neutrophil gelatinase-associated lipocalin and adipokines were novel biomarkers showing moderate predictive ability before 15 gestational weeks. Two T1DM-specific pre-eclampsia prediction models were proposed, measuring adipokines or urinary neutrophil gelatinase-associated lipocalin together with easily attainable maternal clinical characteristics. Contradicting previous literature, pre-eclampsia risk in women with T1DM was correlated with vitamin D levels and atherogenic lipid profile in the context of haptoglobin phenotype 2-2. Pregnancy-associated plasma protein-A and soluble endoglin did not predict pre-eclampsia in women with T1DM, and soluble Fms-like tyrosine kinase 1 only predicted pre-eclampsia from the third trimester. Conclusion: Maternally derived biomarkers reflecting glycemic control, insulin resistance and renal dysfunction performed better as PE predictors among women with T1DM than those derived from the placenta. These biomarkers could be trialed in current PE prediction algorithms to tailor them for women with T1DM.
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Affiliation(s)
- Katrina Z. Freimane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Lauren Kerrigan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Kelly-Ann Eastwood
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Department of Fetal Medicine, St. Michael’s Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Chris J. Watson
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
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Zhao R, Zhou L, Wang S, Xiong G, Hao L. Association between maternal vitamin D levels and risk of adverse pregnancy outcomes: a systematic review and dose-response meta-analysis. Food Funct 2021; 13:14-37. [PMID: 34859252 DOI: 10.1039/d1fo03033g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Epidemiological studies have investigated the associations between vitamin D and the risk of adverse pregnancy outcomes; however, the results are conflicting and dose-response relationships remain to be confirmed. This study aimed to summarize previous studies on the associations of vitamin D levels with the risk of gestational diabetes mellitus (GDM), pre-eclampsia (PE), gestational hypertension (GH), and caesarean section (C-section), and to clarify the dose-response trends. PubMed, Embase, Scopus, and Web of Science were searched to identify eligible articles. A total of 69 prospective observational studies including cohort studies, case-cohort studies, or nested case-control studies were included in the current systematic review, of which 68 studies were available for meta-analysis. Compared with the lowest level, the highest level of 25(OH)D was significantly associated with a lower risk of GDM (RR: 0.76; 95% CI: 0.66-0.87), PE (RR: 0.74; 95% CI: 0.60-0.90;), and GH (RR: 0.87; 95% CI: 0.79-0.97); however, no significant relationship was found for C-section (RR: 1.00; 95% CI: 0.90-1.12). There was significant between-study heterogeneity for GDM (I2 = 69.2%; Pheterogeneity < 0.001), PE (I2 = 52.0%; Pheterogeneity = 0.001), and C-section (I2 = 59.1%; Pheterogeneity < 0.001), while no heterogeneity was found for GH (I2 = 0.0%; Pheterogeneity = 0.676). For each 25 nmol L-1 increase in 25(OH)D, the pooled RR was 0.92 (95% CI: 0.86-0.97) for GDM and 0.89 (95% CI: 0.84-0.94) for PE, respectively. Notably, the dose-response analysis showed a non-linear relationship between maternal 25(OH)D levels and the risk of PE (Pnon-linearity = 0.009). Our meta-analysis provides further scientific evidence of the inverse association between 25(OH)D levels and the risk of GDM, PE, and GH, which may be useful for the prevention of pregnancy complications. However, more evidence from prospective studies is needed regarding the dietary intake of vitamin D during pregnancy.
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Affiliation(s)
- Rui Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Leilei Zhou
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Shanshan Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | | | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Bilodeau JF, Gagné A, Greffard K, Audibert F, Fraser WD, Julien P. The plasma antioxidant vitamin status of the INTAPP cohort examined: The unsuspected importance of β-carotene and γ-tocopherol in preeclampsia. Pregnancy Hypertens 2021; 25:213-218. [PMID: 34265569 DOI: 10.1016/j.preghy.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Examine the levels of plasma antioxidant vitamins before and during a treatment with placebo or vitamin E + C supplement to prevent preeclampsia (PE). STUDY DESIGN Per-protocol analysis of a subset group of pregnant women (n = 295) from the International Trial of Antioxidants for the Prevention of PE (INTAPP) randomized case-control study. Normotensive receiving placebo or vitamins (n = 115 and 87 respectively) were compared to gestational hypertension (GH) without proteinuria (n = 30 and 27) and PE (n = 21 and 15). Vitamin quantification was performed at 12-18, 24-26 and 32-34 weeks of gestation. MAIN OUTCOME MEASURES Coenzyme (Co) Q10, β-carotene and vitamins E (α and γ forms) plasma levels. RESULTS Vitamin E + C supplementation was found to increase the α-tocopherol levels by 40% but was associated with a 57% decrease in the γ-tocopherol isoform for all study groups (p < 0.001). The β -carotene was lower in the PE than in the normotensive and GH groups (p < 0.001) while the level of CoQ10 remained unaffected. CONCLUSIONS A more personalized approach that target the suboptimal levels of specific antioxidants without disturbing the α/γ-tocopherol ratio could be a more successful approach to counteract oxidative stress in PE.
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Affiliation(s)
- Jean-François Bilodeau
- Department of Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada; Endocrinology and Nephrology Research Axis, CHU of Quebec-Laval University, Quebec, Quebec, Canada.
| | - Amélie Gagné
- Endocrinology and Nephrology Research Axis, CHU of Quebec-Laval University, Quebec, Quebec, Canada
| | - Karine Greffard
- Endocrinology and Nephrology Research Axis, CHU of Quebec-Laval University, Quebec, Quebec, Canada
| | - François Audibert
- Department of Obstetrics and Gynaecology, CHU of Sainte-Justine Research Center and Montreal University, Montreal, Quebec, Canada
| | - William D Fraser
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, CHU of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pierre Julien
- Department of Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada; Endocrinology and Nephrology Research Axis, CHU of Quebec-Laval University, Quebec, Quebec, Canada
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Gannon BM, Jones C, Mehta S. Vitamin A Requirements in Pregnancy and Lactation. Curr Dev Nutr 2020; 4:nzaa142. [PMID: 32999954 PMCID: PMC7513584 DOI: 10.1093/cdn/nzaa142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/06/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.
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Affiliation(s)
- Bryan M Gannon
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Camille Jones
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, and Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
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10
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Vitamin D Metabolites and Binding Protein Predict Preeclampsia in Women with Type 1 Diabetes. Nutrients 2020; 12:nu12072048. [PMID: 32664257 PMCID: PMC7400952 DOI: 10.3390/nu12072048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022] Open
Abstract
The risk for preeclampsia (PE) is enhanced ~4-fold by the presence of maternal type 1 diabetes (T1DM). Vitamin D is essential for healthy pregnancy. We assessed the total, bioavailable, and free concentrations of plasma 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), and vitamin D binding protein (VDBP) at ~12, ~22, and ~32 weeks’ gestation (“Visits” (V) 1, 2, and 3, respectively) in 23 T1DM women who developed PE, 24 who remained normotensive, and 19 non-diabetic, normotensive women (reference controls). 25(OH)D deficiency was more frequent in diabetic than non-diabetic women (69% vs. 22%, p < 0.05), but no measure of 25(OH)D predicted PE. By contrast, higher 1,25(OH)2D concentrations at V2 (total, bioavailable, and free: p < 0.01) and V3 (bioavailable: p < 0.05; free: p < 0.01), lower concentrations of VDBP at V3 (p < 0.05), and elevated ratios of 1,25(OH)2D/VDBP (V2, V3: p < 0.01) and 1,25(OH)2D/25(OH)D (V3, p < 0.05) were all associated with PE, and significance persisted in multivariate analyses. In summary, in women with T1DM, concentrations of 1,25(OH)2D were higher, and VDBP lower, in the second and third trimesters in women who later developed PE than in those who did not. 1,25(OH)2D may serve as a new marker for PE risk and could be implicated in pathogenesis.
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11
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Haram K, Mortensen JH, Myking O, Magann EF, Morrison JC. The Role of Oxidative Stress, Adhesion Molecules and Antioxidants in Preeclampsia. Curr Hypertens Rev 2020; 15:105-112. [PMID: 30663572 DOI: 10.2174/1573402115666190119163942] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/19/2018] [Accepted: 01/11/2019] [Indexed: 12/30/2022]
Abstract
Oxidative stress is a consequence of reduction in the antioxidant capacity and excessive production of reactive oxygen and nitrogen species (ROS). Oxidative agents, which are overproduced due to ischemic-reperfusion injury in the placenta, may overwhelm the normal antioxidant activity. This imbalance is a key feature in the pathogenesis of preeclampsia. A decrease in glutathione peroxidase (GPX) activity is associated with the synthesis of vasoconstrictive eicosanoids such as F2-isoprostanes and thromboxane, which are known to be upregulated in preeclampsia. Biochemical markers of lipid peroxidation, such as malondialdehyde and F2-isoprostane in the placenta, are also increased. Adhesion molecules participate in the pathophysiology of preeclampsia by contributing to a reduced invasion by the trophoblast and increased vascular endothelial damage. Superoxide dismutase (SOD), catalase (CAT) and GPX play important roles counteracting oxidative stress. Other antioxidant factors participate in the etiology of preeclampsia. Levels of antioxidants such as Lycopene, Coenzyme 10, as well as some vitamins, are reduced in preeclamptic gestations.
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Affiliation(s)
- Kjell Haram
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Jan Helge Mortensen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Ole Myking
- Department of Internal Medicine, Section of Endocrinology, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - John C Morrison
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, MS, United States
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Hajizadeh S, Rankin Shary J, Gayle Reed S, Lynn Wagner C. The prevalence of hypovitaminosis D and its risk factors in pregnant women and their newborns in the Middle East: A systematic review. Int J Reprod Biomed 2019; 17:685-708. [PMID: 31807718 PMCID: PMC6844283 DOI: 10.18502/ijrm.v17i10.5284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 10/31/2018] [Accepted: 12/15/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pregnant women and newborns are at risk for vitamin D deficiency (VDD). Also, poor health outcomes for pregnant women with VDD are reported in the published literature. OBJECTIVE The aim of this systematic review was to estimate the prevalence of hypovitaminosis D and the associated risk factors for hypovitaminosis D in Middle Eastern pregnant women and their newborns. RESULTS The prevalence of circulating 25-hydroxyvitamin D (25(OH)D) < 50 nmol/L as a marker of vitamin D status in pregnant women and their newborns was between 24.5-98% and 22-100%, respectively. The prevalence of 25(OH) D < 25 nmol/L in pregnant women and their newborns was over a wide range between 16.7-80% and 22-82%, respectively. Predictors for low maternal and neonatal 25(OH)D concentrations included decreased vitamin D synthesis due to reduced exposure to sunlight and decreased nutritional intake of vitamin D. A predictor of low neonatal 25(OH)D concentrations included maternal vitamin D status and the correlation between vitamin D concentrations in maternal and cord blood. CONCLUSION The high prevalence of VDD in the pregnant women of the Middle East underscores the necessity of implementing national prevention and intervention strategies. A clear policy for clinicians and healthcare workers is needed for screening and maintaining sufficient vitamin D status during pregnancy.
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Affiliation(s)
- Shayesteh Hajizadeh
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Judy Rankin Shary
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Susan Gayle Reed
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Carol Lynn Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
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Yusuf H, Subih HS, Obeidat BS, Sharkas G. Associations of macro and micronutrients and antioxidants intakes with preeclampsia: A case-control study in Jordanian pregnant women. Nutr Metab Cardiovasc Dis 2019; 29:458-466. [PMID: 30952573 DOI: 10.1016/j.numecd.2019.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES A study was conducted to evaluate whether preeclampsia in pregnant women is associated with dietary factors and antioxidant intake (vitamin C, vitamin E, vitamin A, and selenium). METHODS AND RESULTS In this case-control study, a group of 79 pregnant Jordanian women (36 preeclamptic pregnant women and 43 healthy pregnant women aged 18-45 years with a gestational age ≥20th week of pregnancy) were recruited from the obstetrics and gynecology clinics at Royal Medical Services, King Hussein Medical Center, Amman, Jordan. Information about socio-demographics, anthropometric measurements, biochemical measurements, nutritional intake, and dietary habits was collected through a structured interview. Three 24-hour dietary records were also made. Data were analyzed using Statistical Package for the Social Sciences (SPSS), and dietary intake was analyzed using ESHA software. Prepregnancy BMI, age, multiple pregnancies, energy intake, beta-carotene, vitamin C, and sodium showed significant difference between preeclamptic pregnant women and healthy pregnant women. The odds ratio (OR) and the corresponding 95% confidence interval (CI) show that a strong association with preeclampsia exists for the intake of fat (OR = 6.40, 95% CI: 1.85-22.17) and saturated fat (OR = 3.35, 95% CI: 1.0-11.54). Inverse associations with preeclampsia were found for fruit intake (OR = 0.16, 95% CI: 0.47-0.55) and olive oil intake (OR = 0.20, 95% CI: 0.05-0.78). CONCLUSION In this case-control study in Jordanian pregnant women, preeclampsia was associated with a high intake of fat, saturated fat, and sodium and a low intake of fruits, fiber, vitamin C, B-carotene, and olive oil.
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Affiliation(s)
- H Yusuf
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - H S Subih
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan.
| | - B S Obeidat
- Department of Animal Production, Faculty of Agriculture, Jordan University of Science and Technology, Jordan
| | - G Sharkas
- Field Epidemiology Training Program, Non-communicable Diseases, Ministry of Health, Amman, Jordan
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Jenkins A, Lengyel I, Rutter GA, Lowe N, Shai I, Tirosh A, Petro T, Khamaisi M, Andrews S, Zmora N, Gross A, Maret W, Lewis EC, Moran A. Obesity, diabetes and zinc: A workshop promoting knowledge and collaboration between the UK and Israel, november 28-30, 2016 - Israel. J Trace Elem Med Biol 2018; 49:79-85. [PMID: 29895375 DOI: 10.1016/j.jtemb.2018.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Alicia Jenkins
- Centre for Experimental Medicine, Queens University, Belfast, UK; NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Imre Lengyel
- Centre for Experimental Medicine, Queens University, Belfast, UK.
| | - Guy A Rutter
- Faculty of Medicine, Department of Medicine, Imperial College, London, UK
| | - Nicola Lowe
- School of Sport and Wellbeing, University of Central Lancashire Preston, UK
| | - Iris Shai
- Department of Public Health School of Pharmacy, Ben Gurion University, Beer Sheva, Israel
| | - Amir Tirosh
- The Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Tunde Petro
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, UK
| | - Mogher Khamaisi
- Internal Medicine D and the Institute of Endocrinology, Diabetes and Metabolism, Rambam Medical Center and RB Rappaport Faculty of Medicine-Technion, Haifa, Israel
| | - Simon Andrews
- School of Biological Sciences, University of Reading, Reading, UK
| | - Niv Zmora
- Department of Immunology Weizmann Institute of Science Rehovot, Israel
| | - Atan Gross
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Wolfgang Maret
- Department of Biochemistry & Diabetes and Nutritional Sciences Division King's College London, UK
| | - Eli C Lewis
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Arie Moran
- Dept. of Physiology and Cell Biology, Ben Gurion University of the Negev, Beer Sheva, Israel
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Serrano-Díaz NC, Gamboa-Delgado EM, Domínguez-Urrego CL, Vesga-Varela AL, Serrano-Gómez SE, Quintero-Lesmes DC. Vitamin D and risk of preeclampsia: A systematic review and meta-analysis. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2018; 38 Suppl 1:43-53. [PMID: 29874709 DOI: 10.7705/biomedica.v38i0.3683] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 05/02/2017] [Accepted: 05/23/2017] [Indexed: 01/23/2023]
Abstract
Introduction Human vitamin D levels have been increasingly related to a wide range of clinical outcomes. There is a large amount of reports on its associations, especially with obstetric complications, including preeclampsia and gestational diabetes. These results are scarcely consistent and there is still a lack of quality intervention studies to confirm the role of vitamin D in those outcomes. Objective: To review the available scientific evidence on the role of maternal vitamin D in the development of preeclampsia. Materials and methods The methodology used followed the recommendations of the Cochrane guide for the preparation of systematic reviews, and for metaanalysis, the Guide of the Metaanalysis of Observational Studies in Epidemiology group (MOOSE). The search included both observational studies and controlled clinical trials. Results Low vitamin D levels, measured by the 25-hydroxyvitamin D test, are common in pregnancy. The results of this systematic review and metaanalysis suggest an inverse ratio between vitamin D levels and the development of preeclampsia. There was heterogeneity among the studies with regard to the design, population, geographic location, definitions of exposure, and the outcome. We excluded randomized controlled trials from this meta-analysis. Conclusion The inverse association we found suggests that the higher the levels of vitamin D the lesser the probability of developing preeclampsia, in spite of the heterogeneity of the global measurement in this type of analysis.
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Affiliation(s)
- Norma Cecilia Serrano-Díaz
- Grupo de Investigación Biomédica Traslacional, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia.
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Health Effects of Carotenoids during Pregnancy and Lactation. Nutrients 2017; 9:nu9080838. [PMID: 28777356 PMCID: PMC5579631 DOI: 10.3390/nu9080838] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
Adequate nutrition is particularly important during pregnancy since it is needed not only for maintaining the health of the mother, but also determines the course of pregnancy and its outcome, fetus development as well as the child’s health after birth and during the later period of life. Data coming from epidemiological and interventions studies support the observation that carotenoids intake provide positive health effects in adults and the elderly population. These health effects are the result of their antioxidant and anti-inflammatory properties. Recent studies have also demonstrated the significant role of carotenoids during pregnancy and infancy. Some studies indicate a correlation between carotenoid status and lower risk of pregnancy pathologies induced by intensified oxidative stress, but results of these investigations are equivocal. Carotenoids have been well studied in relation to their beneficial role in the prevention of preeclampsia. It is currently hypothesized that carotenoids can play an important role in the prevention of preterm birth and intrauterine growth restriction. Carotenoid status in the newborn depends on the nutritional status of the mother, but little is known about the transfer of carotenoids from the mother to the fetus. Carotenoids are among the few nutrients found in breast milk, in which the levels are determined by the mother’s diet. Nutritional status of the newborn directly depends on its diet. Both mix feeding and artificial feeding may cause depletion of carotenoids since infant formulas contain only trace amounts of these compounds. Carotenoids, particularly lutein and zeaxanthin play a significant role in the development of vision and nervous system (among others, they are important for the development of retina as well as energy metabolism and brain electrical activity). Furthermore, more scientific evidence is emerging on the role of carotenoids in the prevention of disorders affecting preterm infants, who are susceptible to oxidative stress, particularly retinopathy of prematurity.
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Vestgaard M, Secher AL, Ringholm L, Jensen JEB, Damm P, Mathiesen ER. Vitamin D insufficiency, preterm delivery and preeclampsia in women with type 1 diabetes - an observational study. Acta Obstet Gynecol Scand 2017; 96:1197-1204. [DOI: 10.1111/aogs.13180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 05/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marianne Vestgaard
- Center for Pregnant Women with Diabetes; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Department of Endocrinology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Institute of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Anna L. Secher
- Center for Pregnant Women with Diabetes; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Department of Endocrinology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Steno Diabetes Center Copenhagen; Gentofte Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Institute of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Department of Obstetrics; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Elisabeth R. Mathiesen
- Center for Pregnant Women with Diabetes; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Department of Endocrinology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- Institute of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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Bohn T, Desmarchelier C, Dragsted LO, Nielsen CS, Stahl W, Rühl R, Keijer J, Borel P. Host-related factors explaining interindividual variability of carotenoid bioavailability and tissue concentrations in humans. Mol Nutr Food Res 2017; 61:1600685. [PMID: 28101967 PMCID: PMC5516247 DOI: 10.1002/mnfr.201600685] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/19/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
Carotenoid dietary intake and their endogenous levels have been associated with a decreased risk of several chronic diseases. There are indications that carotenoid bioavailability depends, in addition to the food matrix, on host factors. These include diseases (e.g. colitis), life-style habits (e.g. smoking), gender and age, as well as genetic variations including single nucleotide polymorphisms that govern carotenoid metabolism. These are expected to explain interindividual differences that contribute to carotenoid uptake, distribution, metabolism and excretion, and therefore possibly also their association with disease risk. For instance, digestion enzymes fostering micellization (PNLIP, CES), expression of uptake/efflux transporters (SR-BI, CD36, NPC1L1), cleavage enzymes (BCO1/2), intracellular transporters (FABP2), secretion into chylomicrons (APOB, MTTP), carotenoid metabolism in the blood and liver (LPL, APO C/E, LDLR), and distribution to target tissues such as adipose tissue or macula (GSTP1, StARD3) depend on the activity of these proteins. In addition, human microbiota, e.g. via altering bile-acid concentrations, may play a role in carotenoid bioavailability. In order to comprehend individual, variable responses to these compounds, an improved knowledge on intra-/interindividual factors determining carotenoid bioavailability, including tissue distribution, is required. Here, we highlight the current knowledge on factors that may explain such intra-/interindividual differences.
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Affiliation(s)
- Torsten Bohn
- Luxembourg Institute of HealthStrassenLuxembourg
| | | | - Lars O. Dragsted
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenFrederiksberg CDenmark
| | - Charlotte S. Nielsen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenFrederiksberg CDenmark
| | - Wilhelm Stahl
- Institute of Biochemistry and Molecular Biology IHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Ralph Rühl
- Paprika Bioanalytics BTDebrecenHungary
- MTA‐DE Public Health Research Group of the Hungarian Academy of SciencesFaculty of Public HealthUniversity of DebrecenDebrecenHungary
| | - Jaap Keijer
- Human and Animal PhysiologyWageningen UniversityWageningenThe Netherlands
| | - Patrick Borel
- NORT, Aix‐Marseille Université, INRAINSERMMarseilleFrance
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Rubin LP, Ross AC, Stephensen CB, Bohn T, Tanumihardjo SA. Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models. Adv Nutr 2017; 8:197-212. [PMID: 28298266 PMCID: PMC5347109 DOI: 10.3945/an.116.014167] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The association between inflammation and vitamin A (VA) metabolism and status assessment has been documented in multiple studies with animals and humans. The relation between inflammation and carotenoid status is less clear. Nonetheless, it is well known that carotenoids are associated with certain health benefits. Understanding these relations is key to improving health outcomes and mortality risk in infants and young children. Hyporetinolemia, i.e., low serum retinol concentrations, occurs during inflammation, and this can lead to the misdiagnosis of VA deficiency. On the other hand, inflammation causes impaired VA absorption and urinary losses that can precipitate VA deficiency in at-risk groups of children. Many epidemiologic studies have suggested that high dietary carotenoid intake and elevated plasma concentrations are correlated with a decreased risk of several chronic diseases; however, large-scale carotenoid supplementation trials have been unable to confirm the health benefits and in some cases resulted in controversial results. However, it has been documented that dietary carotenoids and retinoids play important roles in innate and acquired immunity and in the body's response to inflammation. Although animal models have been useful in investigating retinoid effects on developmental immunity, it is more challenging to tease out the effects of carotenoids because of differences in the absorption, kinetics, and metabolism between humans and animal models. The current understanding of the relations between inflammation and retinoid and carotenoid metabolism and status are the topics of this review.
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Affiliation(s)
- Lewis P Rubin
- Texas Tech Health Sciences Center El Paso, El Paso, TX
| | | | | | - Torsten Bohn
- Luxembourg Institute of Health, Population Health Department, Strassen, Luxembourg; and
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Baca KM, Simhan HN, Platt RW, Bodnar LM. Low maternal 25-hydroxyvitamin D concentration increases the risk of severe and mild preeclampsia. Ann Epidemiol 2016; 26:853-857.e1. [PMID: 27818017 DOI: 10.1016/j.annepidem.2016.09.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/06/2016] [Accepted: 09/26/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE The objective of this case-cohort study was to evaluate the relationship between maternal 25-hydroxyvitamin D (25(OH)D) concentration and preeclampsia overall and by severity. METHODS From an eligible cohort of 12,861 women who had serum banked from aneuploidy screening in Pittsburgh, Pennsylvania from 1999 to 2010, we randomly sampled a subcohort of 2327 pregnancies and all remaining preeclampsia cases (n = 650 cases). Preeclampsia (defined as new-onset hypertension and proteinuria) and its mild and severe forms were identified using ICD-9 codes. Maternal serum collected at 20 weeks or less gestation was measured for 25(OH)D. We used log-binomial regression with restricted cubic splines to estimate the association between 25(OH)D and preeclampsia after adjusting for confounders. RESULTS Approximately 21% of the randomly selected sample had 25(OH)D less than 50 nmol per L. We found that the adjusted risk of preeclampsia declined as serum 25(OH)D increased to 50 nmol per L and then plateaued (test of nonlinearity P < .05). The adjusted preeclampsia risk ratios (95% confidence intervals) for 25(OH)D less than 25 nmol per L, 25 to 49.9 nmol per L, and 50 to 74.9 nmol per L were 2.4 (1.2-4.8), 1.1 (0.69-1.7), and 1.3 (0.89-1.8), respectively, compared with those with 25(OH)D 75 nmol per L and over. Similar associations were observed with severe and mild preeclampsia. CONCLUSIONS Vitamin D deficiency increases risks of severe and mild forms of preeclampsia.
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Affiliation(s)
- Katharyn M Baca
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
| | - Robert W Platt
- Department of Pediatrics, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Lisa M Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA.
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Kamudoni P, Poole C, Davies SJ. An estimate of the economic burden of vitamin D deficiency in pregnant women in the United Kingdom. Gynecol Endocrinol 2016; 32:592-597. [PMID: 27023277 DOI: 10.3109/09513590.2016.1160374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pregnancy is associated with an increased risk of vitamin D deficiency beyond that of the general population. The aim of the current analysis was to synthesize the current evidence on the dose-outcome relationship of vitamin D/serum 25 hydroxyvitamin D (25-OHD) and complications during pregnancy. An additional aim was to estimate the economic burden attributable to inadequate levels of serum 25-OHD. Published literature on the effects of vitamin D supplementation/serum 25-OHD on pregnancy complications, including randomized control trials and non-interventional studies, was searched in bibliographic databases including Pubmed, Google Scholar, Scopus and EMBASE. A positive and significant treatment effect was obtained for pre-eclampsia (OR = 0.75 95% CI 0.662-0.843), but not for preterm birth (OR = 0.783, 95% CI 0.49-1.251) or small for gestational age (OR = 0.76 95% CI 0.38-1.28). Inadequate vitamin D accounted for 14.04% of risk for pre-eclampsia. It is estimated that addressing vitamin D inadequacy in pregnant women in England and Wales would reduce the number of cases of pre-eclampsia by 4126; and would result in a net saving of £18.6 million for the NHS in England and Wales. The current results suggest that based on current evidence a public health policy preventing vitamin D inadequacy in pregnant women is likely to have a positive impact on the NHS budget in England and Wales. This is contingent upon further evidence regarding the vitamin D dose-pregnancy outcome relationship becoming available.
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Affiliation(s)
- Paul Kamudoni
- a Research Fellow, Centre for Socioeconomic Research, School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK
| | - Chris Poole
- b Senior Lecturer, Department of Primary Care and Public Health, School of Medicine, Cardiff University , Cardiff , UK , and
| | - Stephen J Davies
- c Consultant Endocrinologist, University Hospital of Wales , Cardiff , UK
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Wotherspoon AC, Young IS, McCance DR, Holmes VA. Evaluation of biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes mellitus: A systematic review. J Diabetes Complications 2016; 30:958-66. [PMID: 26900097 DOI: 10.1016/j.jdiacomp.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/19/2016] [Accepted: 02/01/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. Women with type 1 diabetes are considered a high-risk group for developing pre-eclampsia. Much research has focused on biomarkers as a means of screening for pre-eclampsia in the general maternal population; however, there is a lack of evidence for women with type 1 diabetes. OBJECTIVES To undertake a systematic review to identify potential biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes. SEARCH STRATEGY We searched Medline, EMBASE, Maternity and Infant Care, Scopus, Web of Science and CINAHL SELECTION CRITERIA: Studies were included if they measured biomarkers in blood or urine of women who developed pre-eclampsia and had pre-gestational type 1 diabetes mellitus Data collection and analysis A narrative synthesis was adopted as a meta-analysis could not be performed, due to high study heterogeneity. MAIN RESULTS A total of 72 records were screened, with 21 eligible studies being included in the review. A wide range of biomarkers was investigated and study size varied from 34 to 1258 participants. No single biomarker appeared to be effective in predicting pre-eclampsia; however, glycaemic control was associated with an increased risk while a combination of angiogenic and anti-angiogenic factors seemed to be potentially useful. CONCLUSIONS Limited evidence suggests that combinations of biomarkers may be more effective in predicting pre-eclampsia than single biomarkers. Further research is needed to verify the predictive potential of biomarkers that have been measured in the general maternal population, as many studies exclude women with diabetes preceding pregnancy.
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Affiliation(s)
- Amy C Wotherspoon
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ian S Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, UK
| | - Valerie A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
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Cohen JM, Kramer MS, Platt RW, Basso O, Evans RW, Kahn SR. The association between maternal antioxidant levels in midpregnancy and preeclampsia. Am J Obstet Gynecol 2015. [PMID: 26215330 DOI: 10.1016/j.ajog.2015.07.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We sought to determine whether midpregnancy antioxidant levels are associated with preeclampsia, overall and by timing of onset. STUDY DESIGN We carried out a case-control study, nested within a cohort of 5337 pregnant women in Montreal, Quebec, Canada. Blood samples obtained at 24-26 weeks were assayed for nonenzymatic antioxidant levels among cases of preeclampsia (n = 111) and unaffected controls (n = 441). We excluded women diagnosed with gestational hypertension only. We used logistic regression with the z-score of each antioxidant level as the main predictor variable for preeclampsia risk. We further stratified early-onset (<34 weeks) and late-onset preeclampsia and carried out multinomial logistic regression. Finally, we assessed associations between antioxidant biomarkers and timing of onset (in weeks) by Cox regression, with appropriate selection weights. We summed levels of correlated biomarkers (r(2) > 0.3) and log-transformed positively skewed distributions. We adjusted for body mass index, nulliparity, preexisting diabetes, hypertension, smoking, and proxies for ethnicity and socioeconomic status. RESULTS The odds ratios for α-tocopherol, α-tocopherol:cholesterol, lycopene, lutein, and carotenoids (sum of α-carotene, β-carotene, anhydrolutein, α-cryptoxanthin, and β-cryptoxanthin) suggested an inverse association between antioxidant levels and overall preeclampsia risk; however, only lutein was significantly associated with overall preeclampsia in adjusted models (odds ratio, 0.60; 95% confidence interval, 0.46-0.77) per SD. In multinomial logistic models, the relative risk ratio (RRR) estimates for the early-onset subgroup were farther from the null than those for the late-onset subgroup. The ratio of α-tocopherol to cholesterol and retinol were significantly associated with early- but not late-onset preeclampsia: RRRs (95% confidence intervals) for early-onset preeclampsia 0.67 (0.46-0.99) and 1.61 (1.12-2.33), respectively. Lutein was significantly associated with both early- and late-onset subtypes in adjusted models; RRRs 0.53 (0.35-0.80) and 0.62 (0.47-0.82), respectively. Survival analyses confirmed these trends. CONCLUSION Most antioxidants were more strongly associated with early-onset preeclampsia, suggesting that oxidative stress may play a greater role in the pathophysiology of early-onset preeclampsia. Alternatively, reverse causality may explain this pattern. Lutein was associated with both early- and late-onset preeclampsia and may be a promising nutrient to consider in preeclampsia prevention trials, if this finding is corroborated.
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Affiliation(s)
- Jacqueline M Cohen
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rhobert W Evans
- Department of Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan R Kahn
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Sadin B, Pourghassem Gargari B, Pourteymour Fard Tabrizi F. Vitamin D Status in Preeclamptic and Non-preeclamptic Pregnant Women: A Case-Control Study in the North West of Iran. Health Promot Perspect 2015; 5:183-90. [PMID: 26634196 PMCID: PMC4667260 DOI: 10.15171/hpp.2015.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 08/04/2015] [Indexed: 02/05/2023] Open
Abstract
Background: There are few studies on the
vitamin D status in preeclamptic women. The objective of this case-control
study was to determine vitamin D status, in preeclamptic women and compare it
with that of healthy pregnant controls.
Methods: Forty
preeclamptic women, aged 18 to 45yr and forty age- and pregnancy
weight-matched healthy controls participated in the study. Serum 25-hydroxy
vitamin D (25(OH)D) levels were measured and its levels of <10,
10-30, 30-90 and >90 nanogram per milliliter (ng/ml) were considered
as vitamin D deficiency, insufficiency, sufficiency, and toxicity,
respectively. Results: Sixty and forty percent of preeclamptic
women were vitamin D deficient and insufficient, while in the control group they
were 10% and 90%, respectively. No significant difference was found in the
median intake of vitamin D between preeclamptic and non preeclamptic women
(1.45 and 1.20µg/day respectively), but serum 25(OH)D concentration was
significantly lower in preeclamptic cases compared to controls (10.09 ± 6.66
and 15.73 ± 5.85ng /ml respectively, P= 0.002) .
Conclusion: Vitamin D deficiency is
common among preeclamptic and non-preeclamptic pregnant women in the north-west of Iran.
Preeclampsia can cause decreasing of serum level of 25(OH)D.
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Affiliation(s)
- Bita Sadin
- Aras International Branch, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahram Pourghassem Gargari
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Tabriz University of Medical Sciences, Tabriz, Iran
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Weinert LS, Silveiro SP. Maternal-fetal impact of vitamin D deficiency: a critical review. Matern Child Health J 2015; 19:94-101. [PMID: 24748216 DOI: 10.1007/s10995-014-1499-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Research into the extra-skeletal functions of vitamin D has been expanding in recent years. During pregnancy, maternal vitamin D status may be of concern because of the key role of this vitamin in fetal skeletal development and due to the association between hypovitaminosis D and adverse maternal-fetal outcomes. Therefore, the objective of this manuscript was to review the maternal-fetal impact of gestational vitamin D deficiency and the benefits of vitamin D supplementation during pregnancy. A literature search was performed in PubMed and Embase employing the following keywords: vitamin D deficiency, pregnancy, 25-hydroxyvitamin D, and hypovitaminosis D. All relevant articles in English language published since 1980 were analysed by the two authors. Neonatal complications derived from vitamin D deficiency include low birth weight, growth restriction, and respiratory tract infection. In the mother, vitamin D deficiency has been associated with altered glucose homeostasis and increased incidence of gestational diabetes mellitus, pre-eclampsia, and bacterial vaginosis. However, the current state of the evidence is controversial for some other endpoints and the actual benefit of vitamin D supplementation in pregnancy remains unclear. Additional longitudinal studies may clarify the actual impact of vitamin D deficiency during pregnancy, and randomised trials are required to define the benefits of vitamin D supplementation in reducing the incidence of adverse outcomes in the mother and infant.
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Affiliation(s)
- Letícia Schwerz Weinert
- Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,
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27
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Cohen JM, Beddaoui M, Kramer MS, Platt RW, Basso O, Kahn SR. Maternal Antioxidant Levels in Pregnancy and Risk of Preeclampsia and Small for Gestational Age Birth: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0135192. [PMID: 26247870 PMCID: PMC4527773 DOI: 10.1371/journal.pone.0135192] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/19/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Oxidative stress in preeclampsia and small for gestational age (SGA) birth suggests antioxidant supplementation could prevent these conditions. However, it remains unclear whether maternal antioxidant levels are systematically lower in these pregnancies. OBJECTIVE To conduct a systematic review of the association between maternal antioxidant levels during pregnancy and preeclampsia or SGA. METHODS We searched PubMed, Embase, and several other databases from 1970-2013 for observational studies that measured maternal blood levels of non-enzymatic antioxidants (vitamins A, C, E, and carotenoids) during pregnancy or within 72 hours of delivery. The entire review process was done in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale and additional questions. We pooled the standardized mean difference (SMD) across studies, stratified by outcome and pregnancy trimester, and investigated heterogeneity using meta-regression. RESULTS We reviewed 1,882 unique citations and 64 studies were included. Most studies were small with important risk of bias. Among studies that addressed preeclampsia (n = 58) and SGA (n = 9), 16% and 66%, respectively, measured levels prior to diagnosis. The SMDs for vitamins A, C, and E were significantly negative for overall preeclampsia, but not for mild or severe preeclampsia subtypes. Significant heterogeneity was observed in all meta-analyses and most could not be explained. Evidence for lower carotenoid antioxidants in preeclampsia and SGA was limited and inconclusive. Publication bias appears likely. CONCLUSIONS Small, low-quality studies limit conclusions that can be drawn from the available literature. Observational studies inconsistently show that vitamins C and E or other antioxidants are lower in women who develop preeclampsia or SGA. Reverse causality remains a possible explanation for associations observed. New clinical trials are not warranted in light of this evidence; however, additional rigorous observational studies measuring antioxidant levels before clinical detection of preeclampsia and SGA may clarify whether levels are altered at a causally-relevant time of pregnancy.
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Affiliation(s)
- Jacqueline M. Cohen
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Margaret Beddaoui
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael S. Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Susan R. Kahn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Moon RJ, Harvey NC, Cooper C. ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the fetal skeleton. Eur J Endocrinol 2015; 173:R69-83. [PMID: 25862787 PMCID: PMC4968635 DOI: 10.1530/eje-14-0826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/10/2015] [Indexed: 12/28/2022]
Abstract
Vitamin D status has been increasingly associated with wide-ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including pre-eclampsia, gestational diabetes and the mode and timing of delivery. The findings are inconsistent, and currently there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation. Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for offspring birthweight, calcium concentrations and bone mass as well as for reduced maternal pre-eclampsia. However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish the potential efficacy and safety of vitamin D supplementation to improve particular outcomes.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
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Smith TA, Kirkpatrick DR, Kovilam O, Agrawal DK. Immunomodulatory role of vitamin D in the pathogenesis of preeclampsia. Expert Rev Clin Immunol 2015; 11:1055-63. [PMID: 26098965 DOI: 10.1586/1744666x.2015.1056780] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Worldwide, preeclampsia is a significant health risk to both pregnant women and their unborn children. Despite scientific advances, the exact pathogenesis of preeclampsia is not yet fully understood. Meanwhile, the incidence of preeclampsia is expected to increase. A series of potential etiologies for preeclampsia has been identified, including endothelial dysfunction, immunological dysregulation and trophoblastic invasion. In this literature review, we have critically reviewed existing literature regarding the research findings that link the role of vitamin D to the pathogenesis and immunoregulation of preeclampsia. The relationship of vitamin D with the suspected etiologies of preeclampsia underscores its clinical potential in the diagnosis and treatment of preeclampsia.
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Affiliation(s)
- Tyler A Smith
- Center for Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA
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30
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Flood-Nichols SK, Tinnemore D, Huang RR, Napolitano PG, Ippolito DL. Vitamin D deficiency in early pregnancy. PLoS One 2015; 10:e0123763. [PMID: 25898021 PMCID: PMC4405493 DOI: 10.1371/journal.pone.0123763] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/23/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Vitamin D deficiency is a common problem in reproductive-aged women in the United States. The effect of vitamin D deficiency in pregnancy is unknown, but has been associated with adverse pregnancy outcomes. The objective of this study was to analyze the relationship between vitamin D deficiency in the first trimester and subsequent clinical outcomes. Study Design This is a retrospective cohort study. Plasma was collected in the first trimester from 310 nulliparous women with singleton gestations without significant medical problems. Competitive enzymatic vitamin D assays were performed on banked plasma specimens and pregnancy outcomes were collected after delivery. Logistic regression was performed on patients stratified by plasma vitamin D concentration and the following combined clinical outcomes: preeclampsia, preterm delivery, intrauterine growth restriction, gestational diabetes, and spontaneous abortion. Results Vitamin D concentrations were obtained from 235 patients (mean age 24.3 years, range 18-40 years). Seventy percent of our study population was vitamin D insufficient with a serum concentration less than 30 ng/mL (mean serum concentration 27.6 ng/mL, range 13-71.6 ng/mL). Logistic regression was performed adjusting for age, race, body mass index, tobacco use, and time of year. Adverse pregnancy outcomes included preeclampsia, growth restriction, preterm delivery, gestational diabetes, and spontaneous abortion. There was no association between vitamin D deficiency and composite adverse pregnancy outcomes with an adjusted odds ratio of 1.01 (p value 0.738, 95% confidence intervals 0.961-1.057). Conclusion Vitamin D deficiency did not associate with adverse pregnancy outcomes in this study population. However, the high percentage of affected individuals highlights the prevalence of vitamin D deficiency in young, reproductive-aged women.
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Affiliation(s)
- Shannon K. Flood-Nichols
- Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
- * E-mail:
| | - Deborah Tinnemore
- Department of Clinical Investigation, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
| | - Raywin R. Huang
- Department of Clinical Investigation, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
| | - Peter G. Napolitano
- Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
| | - Danielle L. Ippolito
- Department of Clinical Investigation, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
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Trace elements as predictors of preeclampsia in type 1 diabetic pregnancy. Nutr Res 2015; 35:421-30. [PMID: 25912764 DOI: 10.1016/j.nutres.2015.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 12/16/2022]
Abstract
Preeclampsia (PE) affects approximately 5% of all pregnancies, but is increased several-fold in women with pre-gestational type 1 diabetes mellitus (T1DM). Increased oxidative stress and altered maternal plasma trace elements that modulate the antioxidant system have been implicated in PE. In non-diabetic women, increased plasma copper and iron and decreased manganese, selenium, and zinc have been associated with PE in cross-sectional studies. In a longitudinal study, we hypothesized that plasma levels of trace elements differ between T1DM women with vs. without subsequent PE. Samples were collected during the first (gestation 12.2 ± 1.9 weeks, [mean ± SD]), second (21.6 ± 1.5 weeks), and third (31.5 ± 1.7 weeks) trimesters of pregnancy, all before the onset of PE. We compared 23 T1DM women who subsequently developed PE with 24 T1DM women who remained normotensive; and we included 19 non-diabetic (non-DM) normotensive pregnant women as reference controls. Trace elements were measured using inductively coupled plasma mass spectroscopy. In T1DM women with subsequent PE vs normotensive, only plasma zinc was significantly higher at the first trimester, while copper:zinc and copper:high-density lipoprotein cholesterol ratios were higher throughout gestation (all P < .05). These findings persisted after adjustment for covariates. Higher copper:zinc ratios may contribute to oxidative stress in T1DM women who develop PE. Ratios of pro- to anti-oxidant factors may predict risk for PE in diabetic pregnancies more effectively than individual trace element levels.
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32
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Singh A, Ahmad S, Ahmad A. Green extraction methods and environmental applications of carotenoids-a review. RSC Adv 2015. [DOI: 10.1039/c5ra10243j] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This review covers and discusses various aspects of carotenoids including their chemistry, classification, biosynthesis, extraction methods (conventional and non-conventional), analytical techniques and biological roles in living beings.
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Affiliation(s)
- Aarti Singh
- Department of Chemistry
- Aligarh Muslim University
- Aligarh
- India
| | - Sayeed Ahmad
- Department of Pharmacognosy and Phytochemistry
- Jamia Hamdard
- New Delhi
- India
| | - Anees Ahmad
- Department of Chemistry
- Aligarh Muslim University
- Aligarh
- India
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Hekmat K, Bagheri R, Abedi P, Tabesh H. The relationship of fat soluble antioxidants with gestational diabetes in Iran: a case-control study. J Matern Fetal Neonatal Med 2014; 27:1676-9. [PMID: 24512283 DOI: 10.3109/14767058.2014.892921] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The primary aim of this study was to evaluate the relationship of fat soluble antioxidants (retinol and α-tocopherol) with gestational diabetes (GDM). METHODS This was a case-control study in which 41 pregnant women with GDM and 41 healthy women were recruited. The inclusion criteria were gestational age ≥32 weeks, singleton foetus, nulliparous or parous women up to four pregnancies and normal fasting blood sugar in the early pregnancy. Two groups were matched regarding age, gestational age and body mass index. A 5 ml venous blood sample were drawn and analysed with the chromatograph for measuring retinol and α-tocopherol. Data were analysed through Chi-square and t test. RESULTS The mean serum retinol of the GDM group was 0.46 µg/dl and in the control group it was 0.59 mg/dl (p = 0.01).The mean α-tocopherol in the women with GDM was 6.21 mg/dl and in the control group it was 6.92 mg/dl (p > 0.05). CONCLUSION The level of retinol in the diabetic pregnant women was significantly lower than that in the control group. This reduction may be due to the reduced antioxidant defences in women with GDM.
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Affiliation(s)
- Khadijeh Hekmat
- Midwifery Department, Reproductive Health Improvement Research Centre, Jundishapur University of Medical Sciences , Ahvaz , Iran and
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35
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Ulmannova T, Bartaskova D, Spalova I, Zoban P, Vesely Z, Stechova K. Maternal BMI and HDL as predictors of pregnancy outcome in women with type 1 diabetes. J Matern Fetal Neonatal Med 2014; 27:1580-3. [DOI: 10.3109/14767058.2013.871252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Bennett SE, McPeake J, McCance DR, Manderson JG, Johnston P, McGalliard R, McGinty A. Maternal vitamin D status in type 1 diabetic pregnancy: impact on neonatal vitamin D status and association with maternal glycaemic control. PLoS One 2013; 8:e74068. [PMID: 24019947 PMCID: PMC3760821 DOI: 10.1371/journal.pone.0074068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/29/2013] [Indexed: 02/06/2023] Open
Abstract
Objective The first aim of this study was to assess 25-hydroxy vitamin D (25OHD) concentrations in women with type 1 diabetes (T1DM) during pregnancy, post-delivery and also foetal (cord blood) 25OHD concentrations and to examine relationships between these. The second aim of the study was to investigate potential interactions between maternal body mass index (BMI) and foetal vitamin D status. A further study aim was to examine potential relationships between maternal 25OHD and glycosylated haemoglobin (HbA1c) throughout pregnancy. Research Design and Methods This was an observational study of 52 pregnant controls without diabetes and 65 pregnant women with T1DM in a university teaching hospital. Maternal serum 25OHD was measured serially throughout the pregnancy and post-delivery. Cord blood 25OHD was measured at delivery. 25OHD was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS). Results Vitamin D deficiency (25OHD <25 nmol/L) was apparent in both the T1DM subjects and controls at all 3 pregnancy trimesters. Vitamin D levels in all cord blood were <50 nmol/L. Maternal 25OHD correlated positively with cord 25OHD at all 3 trimesters in the T1DM group (p = 0.02; p<0.001; p<0.001). 25OHD levels within cord blood were significantly lower for women with diabetes classified as obese vs. normal weight at booking [normal weight BMI <25 kg/m2 vs. obese BMI >30 kg/m2 (nmol/L±SD); 19.93±11.15 vs. 13.73±4.74, p = 0.026]. In the T1DM group, HbA1c at booking was significantly negatively correlated with maternal 25OHD at all 3 trimesters (p = 0.004; p = 0.001; p = 0.05). Conclusion In T1DM pregnancy, low vitamin D levels persist throughout gestation and post-delivery. Cord blood vitamin D levels correlate with those of the mother, and are significantly lower in obese women than in their normal weight counterparts. Maternal vitamin D levels exhibit a significant negative relationship with HbA1c levels, supporting a potential role for this vitamin in maintaining glycaemic control.
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Affiliation(s)
- Sarah E. Bennett
- Nutrition and Metabolism Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Jennifer McPeake
- Nutrition and Metabolism Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - David R. McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, United Kingdom
| | - John G. Manderson
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, United Kingdom
| | - Philip Johnston
- Nutrition and Metabolism Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, United Kingdom
| | - Rachel McGalliard
- Nutrition and Metabolism Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Ann McGinty
- Nutrition and Metabolism Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- * E-mail:
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Du M, Basu A, Fu D, Wu M, Centola M, Jenkins AJ, Hanssen KF, Garg SK, Hammad SM, Scardo JA, Aston CE, Lyons TJ. Serum inflammatory markers and preeclampsia in type 1 diabetes: a prospective study. Diabetes Care 2013; 36:2054-61. [PMID: 23393212 PMCID: PMC3687330 DOI: 10.2337/dc12-1934] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Inflammation and endothelial dysfunction have been associated with the immunobiology of preeclampsia (PE), a significant cause of adverse pregnancy outcomes. The prevalence of PE is elevated several fold in the presence of maternal type 1 diabetes mellitus (T1DM). Although cross-sectional studies of pregnancies among women without diabetes have shown altered inflammatory markers in the presence of PE, longitudinal studies of diabetic women are lacking. In maternal serum samples, we examined the temporal associations of markers of inflammation with the subsequent development of PE in women with T1DM. RESEARCH DESIGN AND METHODS We conducted longitudinal analyses of serum C-reactive protein (CRP), adhesion molecules, and cytokines during the first (mean ± SD, 12.2 ± 1.9 weeks), second (21.6 ± 1.5 weeks), and third (31.5 ± 1.7 weeks) trimesters of pregnancy (visits 1-3, respectively). All study visits took place before the onset of PE. Covariates were BMI, HbA1c, age of onset, duration of diabetes, and mean arterial pressure. RESULTS In women with T1DM who developed PE versus those who remained normotensive, CRP tended to be higher at visits 1 (P = 0.07) and 2 (P = 0.06) and was significantly higher at visit 3 (P < 0.05); soluble E-selectin and interferon-γ-inducible protein-10 (IP-10) were significantly higher at visit 3; interleukin-1 receptor antagonist (IL-1ra) and eotaxin were higher and lower, respectively, at visit 2 (all P < 0.05). These conclusions persisted following adjustment for covariates. CONCLUSIONS In pregnant women with T1DM, elevated CRP, soluble E-selectin, IL-1ra, and IP-10 and lower eotaxin were associated with subsequent PE. The role of inflammatory factors as markers and potential mechanisms of the high prevalence of PE in T1DM merits further investigation.
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Affiliation(s)
- Mei Du
- Harold Hamm Diabetes Center and Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Basu A, Betts NM, Mulugeta A, Tong C, Newman E, Lyons TJ. Green tea supplementation increases glutathione and plasma antioxidant capacity in adults with the metabolic syndrome. Nutr Res 2013; 33:180-7. [PMID: 23507223 PMCID: PMC3603270 DOI: 10.1016/j.nutres.2012.12.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/09/2012] [Accepted: 12/31/2012] [Indexed: 12/11/2022]
Abstract
Green tea, a popular polyphenol-containing beverage, has been shown to alleviate clinical features of the metabolic syndrome. However, its effects in endogenous antioxidant biomarkers are not clearly understood. Thus, we tested the hypothesis that green tea supplementation will upregulate antioxidant parameters (enzymatic and nonenzymatic) in adults with the metabolic syndrome. Thirty-five obese participants with the metabolic syndrome were randomly assigned to receive one of the following for 8 weeks: green tea (4 cups per day), control (4 cups water per day), or green tea extract (2 capsules and 4 cups water per day). Blood samples and dietary information were collected at baseline (0 week) and 8 weeks of the study. Circulating carotenoids (α-carotene, β-carotene, lycopene) and tocopherols (α-tocopherol, γ-tocopherol) and trace elements were measured using high-performance liquid chromatography and inductively coupled plasma mass spectroscopy, respectively. Serum antioxidant enzymes (glutathione peroxidase, glutathione, catalase) and plasma antioxidant capacity were measured spectrophotometrically. Green tea beverage and green tea extract significantly increased plasma antioxidant capacity (1.5 to 2.3 μmol/L and 1.2 to 2.5 μmol/L, respectively; P < .05) and whole blood glutathione (1783 to 2395 μg/g hemoglobin and 1905 to 2751 μg/g hemoglobin, respectively; P < .05) vs controls at 8 weeks. No effects were noted in serum levels of carotenoids and tocopherols and glutathione peroxidase and catalase activities. Green tea extract significantly reduced plasma iron vs baseline (128 to 92 μg/dL, P < .02), whereas copper, zinc, and selenium were not affected. These results support the hypothesis that green tea may provide antioxidant protection in the metabolic syndrome.
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Affiliation(s)
- Arpita Basu
- Nutritional Sciences, 301 Human Sciences, Oklahoma State University, Stillwater, OK 74078-6141, USA.
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Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS. The impact of vitamin D on pregnancy: a systematic review. Acta Obstet Gynecol Scand 2012; 91:1357-67. [PMID: 22974137 DOI: 10.1111/aogs.12000] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hypovitaminosis D is common in pregnancy. To systematically review the evidence on vitamin D-dependent pregnancy outcomes, PubMed and Embase were searched for randomized control trials, cohort and case-control studies. In randomized control trials (n = 7), larger doses of vitamin D resulted in higher 25-hydroxylated vitamin D (25OHD) levels (n = 6), increased maternal weight gain (n = 1), and fewer classical vitamin D deficiency symptoms (n = 1). In observational studies (n = 32), lower vitamin D intake, or low 25OHD-levels, were associated with adverse fertility parameters (n = 2), preeclampsia (n = 5), gestational diabetes or higher blood glucose (n = 6), bacterial vaginosis (n = 4), primary cesarean section (n = 1), none (n = 3) or a few days' (n = 2) shorter gestation, and postpartum depression (n = 1). Studies with few participants having low 25OHD did not identify an association to preeclampsia (n = 5) or gestational diabetes (n = 2). Increased odds of pregnancy-associated breast cancer with 25OHD >25.8 nmol/L were observed (n = 1). In conclusion, an effect of vitamin D on several pregnancy outcomes is suggested.
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Affiliation(s)
- Henrik T Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
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Yu Y, Hanssen KF, Kalyanaraman V, Chirindel A, Jenkins AJ, Nankervis AJ, Torjesen PA, Scholz H, Henriksen T, Lorentzen B, Garg SK, Menard MK, Hammad SM, Scardo JA, Stanley JR, Wu M, Basu A, Aston CE, Lyons TJ. Reduced soluble receptor for advanced glycation end-products (sRAGE) scavenger capacity precedes pre-eclampsia in Type 1 diabetes. BJOG 2012; 119:1512-20. [PMID: 22900949 DOI: 10.1111/j.1471-0528.2012.03463.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Increased advanced glycation end-products (AGEs) and their soluble receptors (sRAGE) have been implicated in the pathogenesis of pre-eclampsia (PE). However, this association has not been elucidated in pregnancies complicated by diabetes. We aimed to investigate the serum levels of these factors in pregnant women with Type 1 diabetes mellitus (T1DM), a condition associated with a four-fold increase in PE. DESIGN Prospective study in women with T1DM at 12.2 ± 1.9, 21.6 ± 1.5 and 31.5 ± 1.7 weeks of gestation [mean ± standard deviation (SD); no overlap] before PE onset. SETTING Antenatal clinics. POPULATION Pregnant women with T1DM (n = 118; 26 developed PE) and healthy nondiabetic pregnant controls (n = 21). METHODS Maternal serum levels of sRAGE (total circulating pool), N(ε)-(carboxymethyl)lysine (CML), hydroimidazolone (methylglyoxal-modified proteins) and total AGEs were measured by immunoassays. MAIN OUTCOME MEASURES Serum sRAGE and AGEs in pregnant women with T1DM who subsequently developed PE (DM PE+) versus those who remained normotensive (DM PE-). RESULTS In DM PE+ versus DM PE-, sRAGE was significantly lower in the first and second trimesters, prior to the clinical manifestation of PE (P < 0.05). Further, reflecting the net sRAGE scavenger capacity, sRAGE:hydroimidazolone was significantly lower in the second trimester (P < 0.05) and sRAGE:AGE and sRAGE:CML tended to be lower in the first trimester (P < 0.1) in women with T1DM who subsequently developed PE versus those who did not. These conclusions persisted after adjusting for prandial status, glycated haemoglobin (HbA1c), duration of diabetes, parity and mean arterial pressure as covariates. CONCLUSIONS In the early stages of pregnancy, lower circulating sRAGE levels, and the ratio of sRAGE to AGEs, may be associated with the subsequent development of PE in women with T1DM.
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Affiliation(s)
- Y Yu
- Harold Hamm Diabetes Center and Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK 73104, USA
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Basu A, Alaupovic P, Wu M, Jenkins AJ, Yu Y, Nankervis AJ, Hanssen KF, Scholz H, Henriksen T, Lorentzen B, Clausen T, Garg SK, Menard MK, Hammad SM, Scardo JA, Stanley JR, Dashti A, Aston CE, Lyons TJ. Plasma lipoproteins and preeclampsia in women with type 1 diabetes: a prospective study. J Clin Endocrinol Metab 2012; 97:1752-62. [PMID: 22438226 PMCID: PMC3339882 DOI: 10.1210/jc.2011-3255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In nondiabetic pregnancy, cross-sectional studies have shown associations between maternal dyslipidemia and preeclampsia (PE). In type 1 diabetes mellitus (T1DM), the prevalence of PE is increased 4-fold, but prospective associations with plasma lipoproteins are unknown. OBJECTIVES The aim of this study was to define lipoprotein-related markers and potential mechanisms for PE in T1DM. DESIGN AND SETTINGS We conducted a multicenter prospective study in T1DM pregnancy. PATIENTS We studied 118 T1DM women (26 developed PE, 92 remained normotensive). Subjects were studied at three visits before PE onset [12.2 ± 1.9, 21.6 ± 1.5, and 31.5 ± 1.7 wk gestation (means ± SD)] and at term (37.6 ± 2.0 wk). Nondiabetic normotensive pregnant women (n = 21) were included for reference. MAIN OUTCOME MEASURES Conventional lipid profiles, lipoprotein subclasses [defined by size (nuclear magnetic resonance) and by apolipoprotein content], serum apolipoproteins (ApoAI, ApoB, and ApoCIII), and lipolysis (ApoCIII ratio) were measured in T1DM women with and without subsequent PE. RESULTS In women with vs. without subsequent PE, at the first and/or second study visits: low-density lipoprotein (LDL)-cholesterol, particle concentrations of total LDL and large (but not small) LDL, serum ApoB, and ApoB:ApoAI ratio were all increased (P < 0.05); peripheral lipoprotein lipolysis was decreased (P < 0.01). These early differences remained significant in covariate analysis (glycated hemoglobin, actual prandial status, gravidity, body mass index, and diabetes duration) but were not present at the third study visit. High-density lipoprotein and very low-density lipoprotein subclasses did not differ between groups before PE onset. CONCLUSIONS Early in pregnancy, increased cholesterol-rich lipoproteins and an index suggesting decreased peripheral lipolysis were associated with subsequent PE in T1DM women. Background maternal lipoprotein characteristics, perhaps masked by effects of late pregnancy, may influence PE risk.
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Affiliation(s)
- Arpita Basu
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma 74078, USA
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Cabrera-Vique C, Marfil R, Giménez R, Martínez-Augustin O. Bioactive compounds and nutritional significance of virgin argan oil - an edible oil with potential as a functional food. Nutr Rev 2012; 70:266-79. [DOI: 10.1111/j.1753-4887.2012.00478.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Wei SQ, Audibert F, Hidiroglou N, Sarafin K, Julien P, Wu Y, Luo ZC, Fraser WD. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia. BJOG 2012; 119:832-9. [PMID: 22462640 DOI: 10.1111/j.1471-0528.2012.03307.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Whether vitamin D deficiency in pregnancy is a cause of pre-eclampsia remains controversial. Most previous studies to date have assessed exposure at only one time-point in pregnancy. We assessed longitudinal vitamin D status during pregnancy and the risk of pre-eclampsia. DESIGN Prospective cohort study. SETTING Seventeen urban obstetric hospitals, Canada. POPULATION Pregnant women who were participants in a trial of vitamin C and E supplementation for the prevention of pre-eclampsia. Canadian participants who consented to participate in a biobank with plasma specimens available at the baseline visit were included (n = 697). METHODS Maternal plasma 25-hydroxyvitamin D (25(OH)D) concentrations were measured at 12-18 and 24-26 weeks of gestation using chemiluminescence immunoassay. MAIN OUTCOME MEASURES Pre-eclampsia. RESULTS Of the women, 39% were vitamin D deficient (25(OH)D <50 nmol/l). A strong positive correlation was observed in maternal 25(OH)D concentrations between the two gestational age windows (r = 0.69, P < 0.0001). Mean maternal 25(OH)D concentrations at 24-26 weeks of gestation were significantly lower in women who subsequently developed pre-eclampsia compared with those who did not (mean ± SD: 48.9 ± 16.8 versus 57.0 ± 19.1 nmol/l, P = 0.03). Women with 25(OH)D < 50 nmol/l at 24-26 weeks gestation experienced an increased risk of pre-eclampsia (adjusted odds ratio 3.24, 95% confidence interval 1.37-7.69), whereas the association was not statistically significant for maternal 25(OH)D level at 12-18 weeks of gestation. CONCLUSIONS Lower maternal 25(OH)D levels at late mid-trimester were associated with an increased risk of pre-eclampsia.
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Affiliation(s)
- S Q Wei
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, QC, Canada.
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Abstract
PURPOSE OF REVIEW Vitamin D is part of a complex steroid hormone system long known to be involved in bone metabolism. Recently, vitamin D has been implicated in physiologic processes as diverse as vascular health, immune function, metabolism and placental function. This review summarizes the current evidence for the role of vitamin D in pregnancy and perinatal outcomes A systematic review of articles published in PubMed between May 2010 and October 2011 was undertaken using key words for vitamin D and pregnancy. Seventy-eight studies were reviewed. RECENT FINDINGS The biologic evidence regarding a role for vitamin D in reproductive outcomes is strong, and rates of vitamin D deficiency may be high among pregnant women. However, no consensus exists regarding optimum vitamin D levels in pregnancy or standard measurement of vitamin D deficiency. Clinical studies establishing an association between vitamin D levels and adverse pregnancy outcomes such as preeclampsia, gestational diabetes, low birthweight, preterm labor, cesarean delivery and infectious diseases have conflicting results. This is likely due to a paucity of randomized trials, heterogeneity of populations studied and low sample size with poor adjustment for confounding among observational studies. SUMMARY Further research should focus on defining optimum 25-hydroxy vitamin D levels in pregnancy as well as among various subgroups of the population. Randomized trials are needed to determine whether vitamin D supplementation can improve pregnancy outcomes. Currently, the American College of Obstetrics and Gynecology and the Institute of Medicine recommend 600 IU of daily vitamin D supplementation during pregnancy to support maternal and fetal bone metabolism.
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Affiliation(s)
- Rachel P Urrutia
- Division of Women's Primary Care, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA.
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Abstract
PURPOSE OF REVIEW To consider evidence from recent studies linking maternal vitamin D status during pregnancy with maternal, fetal, and postnatal outcomes. RECENT FINDINGS Several studies have demonstrated an association between poor maternal vitamin D status and severe preeclampsia, though results are inconsistent and cannot be generalized to nonsevere preeclampsia. Pregnant women with gestational diabetes, intrahepatic cholestasis of pregnancy, and periodontal disease had lower vitamin D status at mid-gestation or delivery compared with controls. Maternal vitamin D status early in pregnancy was associated with risk of low birth weight and small-for-gestational age infants in one study, whereas another study found this relation only among white women. Polymorphisms in the vitamin D receptor gene may contribute to vitamin D-related disparities in fetal growth. Evidence from recent studies suggests an early prenatal influence of maternal vitamin D status on fetal skeletal development, with lasting postnatal effects. Cord blood vitamin D status was associated with tolerogenic immune regulation and fewer respiratory infections in the newborn. SUMMARY Recent evidence supports a role of maternal vitamin D status, particularly early in pregnancy, in modulating the risk of pregnancy complications and in sustaining fetal growth, bone development, and immune maturation.
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