Spinnato Joseph A
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio 40267-0526, USA.
Curr Opin Obstet Gynecol. 2006 Dec;18(6):601-4. doi: 10.1097/01.gco.0000247393.86968.e6.
The review summarizes the results of recent randomized clinical trials whose primary purpose was to prevent preeclampsia and explores safety concerns that have been raised by these trials. Preeclampsia remains one the most common causes of perinatal and maternal mortality, particularly in resource-poor developing countries where its impact on morbidity and mortality is 20 to 100-fold greater than that in developed countries. The potential benefit of antioxidant vitamins and calcium continue to be explored, and are the subject of this review.
Two large, prospective, randomized trials involving more than 4000 low and high-risk subjects, respectively, compared vitamin C/E to placebo. There were no differences noted in the frequency of preeclampsia between groups. Additionally, potential adverse influences of supplementation on low birthweight, late stillbirth, and severity and timing of preeclampsia and neonatal acidosis were noted. A large, multicenter calcium vs. placebo trial sponsored by the World Health Organization in locations known to have dietary calcium deficiency failed to reduce preeclampsia or low birthweight rates.
These negative trials have reduced the likelihood that antioxidant or calcium supplementation will significantly impact the incidence of this disease. The safety concerns regarding antioxidants must be carefully explored.
本综述总结了近期主要目的为预防子痫前期的随机临床试验结果，并探讨了这些试验引发的安全问题。子痫前期仍然是围产期和孕产妇死亡的最常见原因之一，特别是在资源匮乏的发展中国家，其对发病率和死亡率的影响比发达国家高20至100倍。抗氧化维生素和钙的潜在益处仍在探索中，也是本综述的主题。
两项大型前瞻性随机试验分别涉及4000多名低风险和高风险受试者，将维生素C/E与安慰剂进行了比较。两组之间子痫前期的发生率没有差异。此外，还注意到补充剂对低出生体重、晚期死产、子痫前期的严重程度和发生时间以及新生儿酸中毒的潜在不利影响。世界卫生组织在已知膳食钙缺乏的地区发起的一项大型多中心钙与安慰剂试验未能降低子痫前期或低出生体重率。
这些阴性试验降低了抗氧化剂或钙补充剂会显著影响该疾病发病率的可能性。必须仔细探讨与抗氧化剂有关的安全问题。
