Multivitamin supplementation of HIV-positive women during pregnancy reduces hypertension.

Hypertension during pregnancy increases fetal growth retardation, preterm deliveries, and perinatal deaths, and yet its causes remain unclear. In HIV-infected women, preterm birth additionally increases the risk of HIV transmission to the infant. Oxidative stress and endothelial cell dysfunction of the placenta have been implicated in the development of hypertension during pregnancy. Vitamin intake can reduce oxidative stress and improve endothelial function. We therefore evaluated the effect of multivitamin (20 mg thiamine, 20 mg riboflavin, 25 mg B-6, 50 microg B-12, 500 mg C, 30 mg E, and 0.8 mg folic acid) and vitamin A supplements (30 mg beta-carotene plus 5000 IU preformed vitamin A) in relation to hypertension during pregnancy (systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg at any time during pregnancy). In a double-blind, placebo-controlled, randomized, clinical trial, conducted among 1078 HIV-positive pregnant Tanzanian women, those who received multivitamins were 38% less likely to develop hypertension during pregnancy than those who did not [relative risk (RR) = 0.62, 95% CI 0.40-0.94, P = 0.03]. There was no overall effect of vitamin A on hypertension during pregnancy (RR = 1.00, 95% CI 0.66-1.51, P = 0.98). Hypertension during pregnancy was more likely in women with high baseline systolic blood pressure (>120 vs. < or = 120 mm Hg) (RR = 6.02, 95%CI 2.59-13.97, P < 0.001), and those with higher mid-upper arm circumference (RR = 1.12, 95% CI 1.04-1.19, P = 0.002). Taking multivitamins containing vitamins B, C, and E during pregnancy may be an inexpensive and effective strategy to improve the health of the mother and baby.

[1]  D. Nyholt,et al.  during pregnancy , 2022 .

[2]  G. Piaggio,et al.  WHO systematic review of maternal mortality and morbidity: methodological issues and challenges , 2004, BMC medical research methodology.

[3]  W. Fawzi,et al.  A randomized trial of multivitamin supplements and HIV disease progression and mortality. , 2004, The New England journal of medicine.

[4]  C. Mantzoros,et al.  Exercise and vitamin E intake are independently associated with metabolic abnormalities in human immunodeficiency virus-positive subjects: a cross-sectional study. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  E. Seely,et al.  Insulin resistance and its potential role in pregnancy-induced hypertension. , 2003, The Journal of clinical endocrinology and metabolism.

[6]  H. Honest,et al.  Aspirin for Prevention of Preeclampsia in Women With Historical Risk Factors: A Systematic Review , 2003, Obstetrics and gynecology.

[7]  M. Merialdi,et al.  Nutritional interventions during pregnancy for the prevention or treatment of maternal morbidity and preterm delivery: an overview of randomized controlled trials. , 2003, The Journal of nutrition.

[8]  W. März,et al.  Triglyceride-rich lipoproteins are associated with hypertension in preeclampsia. , 2003, The Journal of clinical endocrinology and metabolism.

[9]  Gail D Pearson,et al.  Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy , 2003, Hypertension in pregnancy.

[10]  S. Vollset,et al.  Plasma total cysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study. , 2000, The American journal of clinical nutrition.

[11]  E. Sarandöl,et al.  Lipid and protein oxidation and antioxidant function in women with mild and severe preeclampsia , 2003, Archives of Gynecology and Obstetrics.

[12]  A. Hughes,et al.  Pre-eclampsia, antiretroviral therapy, and immune reconstitution , 2002, The Lancet.

[13]  L. Poston,et al.  Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indices of oxidative stress and placental function. , 2002, American journal of obstetrics and gynecology.

[14]  L. Poston,et al.  A longitudinal study of biochemical variables in women at risk of preeclampsia. , 2002, American journal of obstetrics and gynecology.

[15]  K. Joseph,et al.  Trends in preterm birth and neonatal mortality among blacks and whites in the United States from 1989 to 1997. , 2001, American journal of epidemiology.

[16]  F. Hu,et al.  Dietary modulation of endothelial function: implications for cardiovascular disease. , 2001, The American journal of clinical nutrition.

[17]  Jean-Marie Moutquin,et al.  The Classification and Diagnosis of the Hypertensive Disorders of Pregnancy: Statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP) , 2001, Hypertension in pregnancy.

[18]  J. Kooner,et al.  Improved Vascular Endothelial Function After Oral B Vitamins: An Effect Mediated Through Reduced Concentrations of Free Plasma Homocysteine , 2000, Circulation.

[19]  A. Carr,et al.  Potential Antiatherogenic Mechanisms of Ascorbate (Vitamin C) and α-Tocopherol (Vitamin E) , 2000 .

[20]  W. Fawzi,et al.  Randomized Trial of Vitamin Supplements in Relation to Vertical Transmission of HIV‐1 in Tanzania , 2000, Journal of acquired immune deficiency syndromes.

[21]  A. Carr,et al.  Potential antiatherogenic mechanisms of ascorbate (vitamin C) and alpha-tocopherol (vitamin E). , 2000, Circulation research.

[22]  C. Hubel.  Oxidative Stress in the Pathogenesis of Preeclampsia (44447) , 1999 .

[23]  L. Poston,et al.  Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial , 1999, The Lancet.

[24]  A. Sommer,et al.  Double blind, cluster randomised trial of low dose supplementation with vitamin A or β carotene on mortality related to pregnancy in Nepal , 1999, BMJ.

[25]  A. Sommer,et al.  Double blind, cluster randomised trial of low dose supplementation with vitamin A or βcarotene on mortality related to pregnancy in Nepal , 1999 .

[26]  J. D. Vries,et al.  Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. , 1998, American journal of obstetrics and gynecology.

[27]  S Cnattingius,et al.  Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. , 1998, American journal of epidemiology.

[28]  Donna Spiegelman,et al.  Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania , 1998, The Lancet.

[29]  David A. Cooper,et al.  A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors , 1998, AIDS.

[30]  H. Blom,et al.  Lowering blood homocysteine with folic acid based supplements: meta-analysis of randomised trials , 1998, BMJ.

[31]  M. Fowler.  Update: Transmission of HIV-1 from mother to child , 1997 .

[32]  L. Kouam,et al.  [Rate of prematurity and perinatal mortality in the Yaoundé (Cameroon) University Gynecologic Clinic 1982-1992> An analysis of 680 cases]. , 1995, Zeitschrift fur Geburtshilfe und Neonatologie.

[33]  E. Hudes,et al.  Classification of HIV Infection and Disease in Women from Rwanda: Evaluation of the World Health Organization HIV Staging System and Recommended Modifications , 1995, Annals of Internal Medicine.

[34]  H. Berendes,et al.  Risk factors for intrauterine growth retardation: results of a community-based study from Karachi. , 1994, JPMA. The Journal of the Pakistan Medical Association.

[35]  T. Musci,et al.  Lipid peroxidation in pregnancy: New perspectives on preeclampsia , 1989, American journal of obstetrics and gynecology.