Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
Department of Clinical Pharmacology, University Clinical Center Kragujevac, Kragujevac, Serbia
Balkan Med J. 2024 Jul 5;41(4):248-260. doi: 10.4274/balkanmedj.galenos.2024.2024-2-79. Epub 2024 May 22.
Premature rupture of membranes (PROM) is defined as the leakage of amniotic fluid before the onset of labor and delivery contractions. Some studies found that women who experienced PROM had significantly lower vitamin C blood levels than those who did not, while others found no significant differences. Previous systematic reviews and meta-analyses on the efficacy of vitamin C in the prevention of PROM had conflicting results.
Conduct a systematic review and meta-analysis to determine if there was a significant difference in vitamin C blood levels in women who had PROM versus the control group who did not and to determine if vitamin C supplements could help prevent it.
Systematic review and meta-analysis.
We registered our protocol with PROSPERO (CRD42022371644). We searched PubMed/MEDLINE, Web of Science, and Scopus through February 15, 2024. Additionally, backward and forward citation searches were conducted. Studies were selected based on predetermined inclusion and exclusion criteria. Meta-Essentials: Workbooks for Meta-Analysis (version 1.5) was used for analysis.
Twenty-five studies (26 reports) met all eligibility criteria, with 18 studies (18 reports) assessing vitamin C levels and seven studies (eight reports) evaluating efficacy. Women with PROM, whether preterm or term, had significantly lower vitamin C levels [Hedges’ g, -1.48; 95% confidence interval (CI): -2.82, -0.14; = 0.020; = 94.08%) and specifically preterm PROM after removing the outlying study [Hedges’ g, -1.29; 95% CI: -1.85, -0.73; < 0.001; = 87.35%). Vitamin C supplementation significantly reduced the risk of preterm or term PROM [risk ratio (RR), 0.57; 95% CI: 0.39, 0.81; < 0.001; = 12.17%), particularly for preterm PROM (RR, 0.67; 95% CI: 0.45, 0.99; = 0.001; = 0.00%). There were no significant differences in vitamin C levels between women with term PROM and controls, and there were no differences in the risk of developing term PROM between women taking vitamin C supplements and controls. Results were not robust in all sensitivity analyses.
Women with PROM, particularly those who developed it preterm, appear to have significantly lower vitamin C levels, and vitamin C supplementation appears to be effective in reducing the risk of PROM, particularly preterm PROM. More high-quality studies with low risk of bias, more homogenous, and larger samples are needed to confirm these findings.
胎膜早破（PROM）定义为分娩和分娩收缩前羊水的泄漏。一些研究发现，经历胎膜早破的女性的维生素 C 血液水平明显低于未经历胎膜早破的女性，而其他研究则未发现明显差异。之前关于维生素 C 在预防胎膜早破中的功效的系统评价和荟萃分析结果存在冲突。
进行系统评价和荟萃分析，以确定胎膜早破女性的维生素 C 血液水平与未发生胎膜早破的对照组之间是否存在显著差异，并确定维生素 C 补充剂是否有助于预防胎膜早破。
系统评价和荟萃分析。
我们在 PROSPERO（CRD42022371644）上注册了我们的方案。我们通过 2024 年 2 月 15 日的 PubMed/MEDLINE、Web of Science 和 Scopus 进行了搜索。此外，还进行了回溯和前向引文搜索。研究根据预先确定的纳入和排除标准进行选择。Meta-Essentials：元分析工作簿（版本 1.5）用于分析。
有 25 项研究（26 项报告）符合所有纳入标准，其中 18 项研究（18 项报告）评估了维生素 C 水平，7 项研究（8 项报告）评估了疗效。无论是早产还是足月胎膜早破的女性，维生素 C 水平明显降低[Hedges'g，-1.48；95%置信区间（CI）：-2.82，-0.14；=0.020；=94.08%]，特别是在去除离群研究后，早产胎膜早破[Hedges'g，-1.29；95% CI：-1.85，-0.73；<0.001；=87.35%]。维生素 C 补充剂显著降低了早产或足月胎膜早破的风险[风险比（RR），0.57；95% CI：0.39，0.81；<0.001；=12.17%]，特别是早产胎膜早破（RR，0.67；95% CI：0.45，0.99；=0.001；=0.00%）。足月胎膜早破的女性与对照组之间的维生素 C 水平没有显著差异，服用维生素 C 补充剂的女性与对照组之间的早产胎膜早破风险也没有差异。所有灵敏度分析的结果均不稳健。
胎膜早破的女性，尤其是那些早产的女性，维生素 C 水平似乎明显降低，维生素 C 补充剂似乎可以有效降低胎膜早破的风险，尤其是早产胎膜早破的风险。需要更多高质量、低偏倚、更同质和更大样本的研究来证实这些发现。
