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, B. M. Mercer, A. M. Peaceman, P. Samuels, A. Sciscione, M. Harper, G. Saade, Y. Sorokin

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1740-1747
Number of pages8
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume122
Issue number13
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Abruptio Placentae
Premature Birth
Vitamin E
Ascorbic Acid
Smoking
Pre-Eclampsia
Pregnancy Outcome
Hypertension
Mothers
Pregnancy
Random Allocation
Vitamins
Outcome Assessment (Health Care)
Population

Keywords

  • Placental abruption
  • preterm birth
  • smoking

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Prenatal Vitamin C and e supplementation in smokers is associated with reduced placental abruption and preterm birth : A secondary analysis. / Abramovici, A.; Gandley, R. E.; Clifton, R. G.; Leveno, K. J.; Myatt, L.; Wapner, R. J.; Thorp, J. M.; Mercer, B. M.; Peaceman, A. M.; Samuels, P.; Sciscione, A.; Harper, M.; Saade, G.; Sorokin, Y.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 122, No. 13, 01.12.2015, p. 1740-1747.

Research output: Contribution to journalArticle

Abramovici, A, Gandley, RE, Clifton, RG, Leveno, KJ, Myatt, L, Wapner, RJ, Thorp, JM, Mercer, BM, Peaceman, AM, Samuels, P, Sciscione, A, Harper, M, Saade, G & Sorokin, Y 2015, 'Prenatal Vitamin C and e supplementation in smokers is associated with reduced placental abruption and preterm birth: A secondary analysis', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 122, no. 13, pp. 1740-1747. https://doi.org/10.1111/1471-0528.13201
Abramovici, A. ; Gandley, R. E. ; Clifton, R. G. ; Leveno, K. J. ; Myatt, L. ; Wapner, R. J. ; Thorp, J. M. ; Mercer, B. M. ; Peaceman, A. M. ; Samuels, P. ; Sciscione, A. ; Harper, M. ; Saade, G. ; Sorokin, Y. / Prenatal Vitamin C and e supplementation in smokers is associated with reduced placental abruption and preterm birth : A secondary analysis. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2015 ; Vol. 122, No. 13. pp. 1740-1747.
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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.",
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TY - JOUR

T1 - Prenatal Vitamin C and e supplementation in smokers is associated with reduced placental abruption and preterm birth

T2 - A secondary analysis

AU - Abramovici, A.

AU - Gandley, R. E.

AU - Clifton, R. G.

AU - Leveno, K. J.

AU - Myatt, L.

AU - Wapner, R. J.

AU - Thorp, J. M.

AU - Mercer, B. M.

AU - Peaceman, A. M.

AU - Samuels, P.

AU - Sciscione, A.

AU - Harper, M.

AU - Saade, G.

AU - Sorokin, Y.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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.

AB - 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.

KW - Placental abruption

KW - preterm birth

KW - smoking

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DO - 10.1111/1471-0528.13201

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