Preeclampsia prevention: a case-control study nested in a cohort
Preeclampsia is the main complication of pregnancy in developing countries. Calcium starting at 14 weeks of pregnancy is indicated to prevent the disease. Recent advances in prevention of preeclampsia endorse the addition of conjugated linoleic acid.Objective:
To estimate the protective effect from calcium alone, compared to calcium plus conjugated linoleic acid in nulliparous women at risk of preeclampsia.Methods:
A case-control design nested in the cohort of nulliparous women attending antenatal care from 2010 to 2014. The clinical histories of 387 cases of preeclampsia were compared with 1,054 normotensive controls. The exposure was prescriptions for calcium alone, the first period, or calcium plus conjugated linoleic acid, the second period, from 12 to 16 weeks of gestational age to labor. Confounding variables were controlled, allowing only nulliparous women into the study and stratifying by age, education and ethnic group.Results:
The average age was 26.4 yrs old (range= 13-45), 85% from mixed ethnic backgrounds and with high school education. There were no differences between women who received calcium carbonate and those who did not (OR= 0.96; 95% CI= 0.73-1.27). The group of adolescents (13 to 18 years old) in the calcium plus conjugated linoleic acid was protected for preeclampsia (OR= 0.00; 95% CI= 0.00-0.44) independent of the confounder variables.Conclusions:
1. Calcium supplementation during pregnancy did not have preventive effects on preeclampsia. 2. Calcium plus Conjugated Linoleic acid provided to adolescents was observed to have preventive effect on Preeclampsia.
- conjugated linoleic acid
Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010;8:CD001059–CD001059.
Belizan JM, Villar J, González L, Campodonico L, Bergel E. Calcium supplementation to prevent hypertensive disorders of pregnancy. N Engl J Med. 1991;325(20):1399–1405.
Levine RJ, Hauth JC, Curret LB, Sibai M, Catalano PM, Morris CD, et al. Trial of calcium to prevent preeclampsia. N Engl J Med. 1997;337(2):69–76.
Villar J, Abdel-Aleem H, Merialdi M, Mathai M, Ali MM, Zavaleta N, et al. World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. Am J Obstet Gynecol. 2006;194(3):639–649.
Herrera-Suarez CC, Vásquez-Garibay EM, Romero-Valverde E, Romo-Huerta HP, García De Alba Garcia JE, Troyo-Sanromán R. Food habits and culture factors in pregnant adolescents. Arch Latinoam Nutr. 2008;58(1):19–26.
Nieto A, Herrera JA, Villar J, Matorral R, de la Manzanara C CL, Arribas I, et al. Association between calcium intake, parathormone levels and blood pressure during pregnancy. Colomb Med. 2009;40(2):185–193.
Herrera JA, Arevalo-Herrera M, Shahabuddin AKM, Ersheng G, Herrera S, Garcia RG, et al. Calcium and conjugated linoleic acid reduces pregnancy-induced hypertension and decreases intracellular calcium in lymphocytes. Am J Hypertens. 2006;19:381–387.
Herrera JA, Arévalo-Herrera M, Herrera S. Prevention of preeclampsia by linoleic acid and calcium supplementation: A randomized controlled trial. Obstet Gynecol. 1998;91:585–590.
Herrera JA, Shahabuddin AK, Ersheng G, Wei Y, García RG, López- Jaramillo P. Calcium plus linoleic acid therapy for pregnancy-induced hypertension. Int J Gynaecol Obstet. 2005;91:221–227.
Herrera JA, Chaudhuri G, López-Jaramillo P. Is infection a major risk to preeclampsia. Med Hypotheses. 2001;57(3):393–397.
Paré E, Parry S, McErath TF, Pucci D, Newton A, Lim KH. Clinical risk factors for preeclampsia in the 21st century. Obstet Gynecol. 2014;124(4):763–770.
López-Jaramillo P, Casas JP, Serrano N. Preeclampsia: from epidemiological observations to molecular mechanisms. Braz J Med Bio Res. 2001;34(10):1227–1235.
Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies and the hierarchy of research designs. N Engl J Med. 2000;342:1887–1892.
Dreyer NA, Schneeweiss S, McNeil BJ, Berger ML, Walker AM, Ollendorf DA, et al. GRACE PrinciplesRecognizing High-Quality Observational Studies of Comparative Effectiveness. Am J Manag Care. 2010;16(6):467–471.
Berger ML, Mamdani M, Atkins D, Johnson ML. Good research practices for comparative effectiveness research: defining, reporting and interpreting nonrandomized studies of treatment effects using secondary data sourcesthe ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report--Part I. Value Health. 2009;12(8):1044–1052.
Cox E, Martin B, van Staa T, Edeltraut G, Johnson M. Good research practices for comparative effectiveness research: approaches to mitigate bias and confounding in the design of non-randomized studies of treatment effects using secondary data sourcesthe International Society for Pharmacoeconomics and Outcomes Research Good Research Practices for Retrospective Database Analysis Task Force Report--Part II. Value Health. 2009;12(8):1053–1061.
Johnson ML, Crown W, Martin BC, Dormuth CR, Siebert U. Good research practices for comparative effectiveness research: analytic methods to improve causal inference from non-randomized studies of treatment effects using secondary data sourcesthe ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report--Part III. Value Health. 2009;12(8):1062–1073.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the reporting of observational studies in epidemiology (STROBE) statementGuidelines for reporting observational studies. BMJ. 2007;335(7624):806–808.
Hofmeyr GJ, Belizan JM, von Dadelszen P, Calcium and Pre-eclampsia (CAP) Study Group Low-dose calcium supplementation for preventing pre-eclampsia: a systematic review and commentary. BJOG. 2014;121(8):951–957.
Retzke U, Graf H. Incidence of hypertension in pregnancy in relation to the definition of hypertension. Zentralbl Gynakol. 1994;116(2):73–75.
Kaaja R, Kinnunen T, Luoto R. Regional differences in the prevalence of pre-eclampsia in relation to risk factors for coronary artery disease in women in Finland. Eur Hearth J. 2005;26(1):44–50.
Roberts CL, Algert CS, Morris JM, Ford JB, Henderson-Smart DJ. Hypertensive disorders in pregnancy: a population-based study. Med J Aust. 2005;182(7):332–335.
Gnadig S, Rickert R, Sébedio JL, Steinhart H. Conjugated linoleic acid (CLA): physiological effects and production. Eur J Lipid Sci Technol. 2001;103:56–61.
Sanhueza CJ, Nieto KS, Valenzuela BA. Acido linoleico conjugadoun acido graso con isomería trans potencialmente beneficioso. Rev Chil Nutr. 2002;29(2):98–105.
Zuo R, Ai Q, Mai K, Xu W. Effects of conjugated linoleic acid on growth, non-specific immunity, antioxidant capacity, lipid deposition and related gene expression in juvenile large yellow croaker (Larmichthyscrocea) fed soya bean oil-based diets. Br J Nutr. 2013;110(7):1220–1232.
Mac Donald HB. Conjugated linoleic acid and disease prevention: a review of current knowledge. J Am Coll Nutr. 2000;19(2 Suppl):111S–118S.
Reynolds CM, Roche HM. Conjugated linoleic acid and inflammatory cell signaling. Prostaglandins Leukot Essent Fatty Acids. 2010;82(4-6):199–204.
Campos Mondragon MG, Oliart Ros RM, Martínez Martinez A, Mendez Machado GF, Angulo guerrero JO. Metabolic syndrome reversion by polyinsaturated fatty acids ingestion. Med Clin (Barc) 2013;141(12):513–518.
Herrera JA, Arévalo-Herrera M, Villegas A, Herrera S, Villalba M, Bromet A. Suplementación oral de calcio en adolescentes embarazadas. Colomb Med. 2006;37(2) suppl 1:15–20.
Herrera JA. Nutritional factors and lateral rest reduce pregnancy-induced hypertension in positive roll-over test primigravidae. Int J Gynaecol Obstet. 1993;41:31–35.
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