Vitamins E, A and B₂ as Possible Risk Factors for Preeclampsia – under Consideration of the PROPER Study (“Prevention of Preeclampsia by High-Dose Riboflavin Supplementation”)

Abstract

In the course of the prospective, randomized, double-blind trial the influence of a high-dose riboflavin substitution on the risk for preeclampsia was studied in a high-risk collective [1]. The present contribution evaluates supplementary data from the already published PROPER trial. The patients were from the two study centers Mérida, Venezuela, and Moshi, Tanzania, they were randomized from the 20th week of pregnancy and received either 15 mg riboflavin daily or placebo. Clinical and laboratory checks were carried out at four-week intervals up to childbirth. Concerning the question of whether there is a relationship between the serum levels of antioxidative vitamins and the risk of developing preeclampsia, it was found that no relationship could be detected between the measured laboratory values of vitamins E, A and B₂ and the total risk of developing a hypertensive disease of pregnancy. On comparisons between patients with severe preeclampsia, those with a mild form, and the general healthy population, however, significant differences in the levels of antioxidative vitamins E and A as well as the FAD level were seen. The patients from Tanzania showed on the whole significantly lower vitamin levels than those from Venezuela, possibly due to the better nutritional situation in Venezuela. Considering the results altogether, the role of antioxidative parameters in the pathophysiology of preeclampsia remains unclear. However, the collected data provide valuable hints for future preventative strategies.

Zusammenfassung

Im Rahmen der prospektiven, randomisierten, doppelt-blinden Studie wurde der Einfluss einer hoch dosierten Riboflavinsubstitution auf das Präeklampsierisiko in einem Hochrisikokollektiv untersucht [1]. Die vorliegende Arbeit wertet hierzu ergänzende Daten aus der bereits publizierten PROPER-Studie aus. Die Patientinnen stammten aus den beiden Studienzentren Mérida, Venezuela, und Moshi, Tansania, wurden ab der 20. SSW randomisiert und erhielten entweder 15 mg Riboflavin täglich oder Placebo. Bis zur Entbindung erfolgten klinische und laborchemische Kontrollen in 4-wöchentlichem Abstand. Zur Klärung der Frage, ob ein Zusammenhang zwischen Serumspiegeln antioxidativer Vitamine und dem Risiko, an Präeklampsie zu erkranken, besteht, zeigte sich, dass das Gesamtrisiko, eine hypertensive Schwangerschaftserkrankung zu entwickeln, keinen Zusammenhang mit laborchemisch gemessenen Vitaminspiegeln E, A und B₂ erkennen ließ. Beim Vergleich zwischen Patientinnen, die an schwerer Präeklampsie erkrankten, mit leichten Formen und der gesunden Kontrollpopulation fanden sich allerdings signifikante Unterschiede in der Höhe der antioxidativen Vitamine E und A sowie der FAD-Spiegel. Patientinnen aus Tansania zeigten insgesamt signifikant niedrigere Vitaminspiegel als Schwangere aus Venezuela, möglicherweise bedingt durch eine bessere Ernährungssitutation in Venezuela. In Zusammenschau der Ergebnisse bleibt die Bedeutung antioxidativer Parameter in der Pathophysiologie der Präeklampsie weiterhin unklar. Die erhobenen Daten liefern jedoch wertvolle Informationen für zukünftige Präventionsstrategien.

Key words

Preeclampsia - obstetrics - childbirth

Schlüsselwörter

Präeklampsie - Geburtshilfe - Geburt

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