Rumiris Dewi, Purwosunu Yuditiya, Wibowo Noroyono, Farina Antonio, Sekizawa Akihiko
Department of Obstetrics and Gynecology, University of Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
Hypertens Pregnancy. 2006;25(3):241-53. doi: 10.1080/10641950600913016.
To investigate maternal and neonatal outcomes after antioxidant supplementation relatively early in pregnancy (8 to 12 weeks) for pregnant women with low antioxidant status.
A randomized, double-blind, placebo-controlled trial of daily antioxidant supplementation was performed on pregnant women screening positive for low antioxidant status at 8 to 12 weeks of gestation. Low antioxidant status was defined as a superoxidedismutase (SOD) level below 1102 U/g Hb or 164 U/mL. The supplementation group received the following antioxidants daily: vitamins A (1000 IU), B6 (2.2 mg), B12 (2.2 microg), C (200 mg), and E (400 IU), folic acid (400 microg), N-acetylcysteine (200 mg), Cu (2 mg), Zn (15 mg), Mn (0.5 mg), Fe (30 mg), calcium (800 mg), and selenium (100 microg). The control group received Fe (30 mg) and folic acid (400 microg). Maternal (preeclampsia, abortion, and hypertension) and perinatal outcomes were assessed.
In the supplementation group (29 subjects), we observed 2 cases of preeclampsia (6.8%, 1 mild and 1 severe), 1 of IUGR (birth weight 2300 g at 38 weeks), and 1 preterm delivery. In the control group (31 subjects), there were 8 abortions, 9 cases of preeclampsia (29%, 6 mild and 3 severe) with perinatal outcome: 3 preterm delivery cases and 1 IUGR (birth weight 2030 g at 39 weeks). Preeclampsia was significantly less frequent in the supplementation group when compared to the control group (2 vs. 9 cases, p = 0.043, OR = 0.18 [95% CI: 0.03, 0.92]). Finally we focused on the prediction of preeclampsia at 8 to 12 weeks. Combined sensitivity of markers of antioxidant status (SOD slutathione peroxidase, [GPx], and total anti-oxidant status [TAS]) was 33% (false-positive rate of 4.5%).
Antioxidant supplementation was associated with better maternal and perinatal outcome in pregnant women with low antioxidant status than control supplementation with iron and folate alone. In a selected population already screened positive for low SOD, preeclampsia can be detected in 33% of asymptomatic cases in the first trimester using SOD, GPx, and TAS. It seems feasible that panels of both biochemical and molecular markers may be clinically useful in the prediction of this disease.
研究在妊娠早期（8至12周）对抗氧化状态较低的孕妇补充抗氧化剂后的母婴结局。
对妊娠8至12周时抗氧化状态筛查呈阳性的孕妇进行了一项每日补充抗氧化剂的随机、双盲、安慰剂对照试验。抗氧化状态低定义为超氧化物歧化酶（SOD）水平低于1102 U/g Hb或164 U/mL。补充组每天接受以下抗氧化剂：维生素A（1000 IU）、B6（2.2 mg）、B12（2.2 μg）、C（200 mg）和E（400 IU）、叶酸（400 μg）、N-乙酰半胱氨酸（200 mg）、铜（2 mg）、锌（15 mg）、锰（0.5 mg）、铁（30 mg）、钙（800 mg）和硒（100 μg）。对照组接受铁（30 mg）和叶酸（400 μg）。评估了母亲（先兆子痫、流产和高血压）和围产期结局。
在补充组（29名受试者）中，我们观察到2例先兆子痫（6.8%，1例轻度和1例重度）、1例胎儿生长受限（38周时出生体重2300 g）和1例早产。在对照组（31名受试者）中，有8例流产、9例先兆子痫（29%，6例轻度和3例重度），围产期结局为：3例早产和1例胎儿生长受限（39周时出生体重2030 g）。与对照组相比，补充组中先兆子痫的发生率显著更低（2例对9例，p = 0.043，OR = 0.18 [95% CI：0.03，0.92]）。最后，我们专注于8至12周时先兆子痫的预测。抗氧化状态标志物（SOD、谷胱甘肽过氧化物酶[GPx]和总抗氧化状态[TAS]）的综合敏感性为33%（假阳性率为4.5%）。
与单独补充铁和叶酸的对照组相比，补充抗氧化剂与抗氧化状态较低的孕妇更好的母婴结局相关。在已筛查出SOD低呈阳性的特定人群中，使用SOD、GPx和TAS可在孕早期33%的无症状病例中检测出先兆子痫。生化和分子标志物组合在预测该疾病方面可能具有临床实用性，这似乎是可行的。
