Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis
A Abramovici, R E Gandley, R G Clifton, K J Leveno, L Myatt, R J Wapner, J M Thorp Jr, B M Mercer, A M Peaceman, P Samuels, A Sciscione, M Harper, G Saade, Y Sorokin, Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, J Hauth, D J Rouse, A Northen, P Files, J Grant, M Wallace, K Bailey, J Roberts, S Caritis, T Kamon, M Cotroneo, D Fischer, M Varner, P Reed, S Quinn, V Morby, F Porter, R Silver, J Miller, K Hill, S Bousleiman, R Alcon, K Saravia, F Loffredo, A Bayless, C Perez, M Lake, M Talucci, K Boggess, K Dorman, J Mitchell, K Clark, S Timlin, J Bailit, C Milluzzi, W Dalton, C Brezine, D Bazzo, J Sheffield, L Moseley, M Santillan, K Buentipo, J Price, L S Hermann, C Melton, Y Gloria-McCutchen, B Espino, M Dinsmoor, T Matson-Manning, G Mallett, S Ramin, S Blackwell, K Cannon, S Lege-Humbert, Z Spears, M Carpenter, J Tillinghast, M Seebeck, J Iams, F Johnson, S Fyffe, C Latimer, S Frantz, S Wylie, M Talucci, M Hoffman, J Benson, Z Reid, C Tocci, P Meis, M Swain, J Tolosa, W Smith, L Davis, E Lairson, S Butcher, S Maxwell, D Fisher, J Moss, B Stratton, G Hankins, J Brandon, C Nelson-Becker, G Olson, L Pacheco, G Norman, S Blackwell, P Lockhart, D Driscoll, M Dombrowski, E Thom, T Boekhoudt, G Pearson, V Pemberton, J Cutler, W Barouch, C Spong, S Tolivaisa, G D Anderson, A Abramovici, R E Gandley, R G Clifton, K J Leveno, L Myatt, R J Wapner, J M Thorp Jr, B M Mercer, A M Peaceman, P Samuels, A Sciscione, M Harper, G Saade, Y Sorokin, Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, J Hauth, D J Rouse, A Northen, P Files, J Grant, M Wallace, K Bailey, J Roberts, S Caritis, T Kamon, M Cotroneo, D Fischer, M Varner, P Reed, S Quinn, V Morby, F Porter, R Silver, J Miller, K Hill, S Bousleiman, R Alcon, K Saravia, F Loffredo, A Bayless, C Perez, M Lake, M Talucci, K Boggess, K Dorman, J Mitchell, K Clark, S Timlin, J Bailit, C Milluzzi, W Dalton, C Brezine, D Bazzo, J Sheffield, L Moseley, M Santillan, K Buentipo, J Price, L S Hermann, C Melton, Y Gloria-McCutchen, B Espino, M Dinsmoor, T Matson-Manning, G Mallett, S Ramin, S Blackwell, K Cannon, S Lege-Humbert, Z Spears, M Carpenter, J Tillinghast, M Seebeck, J Iams, F Johnson, S Fyffe, C Latimer, S Frantz, S Wylie, M Talucci, M Hoffman, J Benson, Z Reid, C Tocci, P Meis, M Swain, J Tolosa, W Smith, L Davis, E Lairson, S Butcher, S Maxwell, D Fisher, J Moss, B Stratton, G Hankins, J Brandon, C Nelson-Becker, G Olson, L Pacheco, G Norman, S Blackwell, P Lockhart, D Driscoll, M Dombrowski, E Thom, T Boekhoudt, G Pearson, V Pemberton, J Cutler, W Barouch, C Spong, S Tolivaisa, G D Anderson
Abstract
Objective: Smoking and pre-eclampsia (PE) are associated with increases in preterm birth, placental abruption and low birthweight. We evaluated the relationship between prenatal vitamin C and E (C/E) supplementation and perinatal outcomes by maternal self-reported smoking status focusing on outcomes known to be impacted by maternal smoking.
Design/setting/population: A secondary analysis of a multi-centre trial of vitamin C/E supplementation starting at 9-16 weeks in low-risk nulliparous women with singleton gestations.
Methods: We examined the effect of vitamin C/E by smoking status at randomisation using the Breslow-Day test for interaction.
Main outcome measures: The trial's primary outcomes were PE and a composite outcome of pregnancy-associated hypertension (PAH) with serious adverse outcomes. Perinatal outcomes included preterm birth and abruption.
Results: There were no differences in baseline characteristics within subgroups (smokers versus nonsmokers) by vitamin supplementation status. The effect of prenatal vitamin C/E on the risk of PE (P = 0.66) or PAH composite outcome (P = 0.86) did not differ by smoking status. Vitamin C/E was protective for placental abruption in smokers (relative risk [RR] 0.09; 95% CI 0.00-0.87], but not in nonsmokers (RR 0.92; 95% CI 0.52-1.62) (P = 0.01), and for preterm birth in smokers (RR 0.76; 95% CI 0.58-0.99) but not in nonsmokers (RR 1.03; 95% CI 0.90-1.17) (P = 0.046).
Conclusion: In this cohort of women, smoking was not associated with a reduction in PE or the composite outcome of PAH. Vitamin C/E supplementation appears to be associated with a reduction in placental abruption and preterm birth among smokers.
Keywords: Placental abruption; preterm birth; smoking.
Conflict of interest statement
Disclosure of interests: The authors have no relevant conflict of interests to disclose
© 2014 Royal College of Obstetricians and Gynaecologists.
Source: PubMed