Vitamin C Supplementation and Risk for Preterm Premature Rupture of Membranes and Preterm Birth: A Meta-Analysis [23O]

Abstract

INTRODUCTION: Strong evidence has linked perturbations of vitamin C levels and collagen integrity with risk for preterm premature rupture of membranes (PPROM). We sought to evaluate the literature and perform a meta-analysis using available data from randomized clinical trials (RCT) which evaluated the use of vitamin C supplementation to prevent PPROM and preterm birth (PTB). METHODS: A systematic literature review was conducted using PUBMED and MEDLINE 1966-2017 using relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCT were abstracted and meta-analysis performed using Mantel-Haenszel fixed effects model with test of heterogeneity (Comprehensive Meta-Analysis - Version 2.2.064). RESULTS: Ten randomized placebo controlled trials, conducted 2004-2013, assessing Vitamin C supplementation and relationship to PPROM or PTB were identified. These studies included at total cohort of 14291 women who received vitamin C supplementation and 14307 women who received placebo. PPROM and/or PTB were the primary outcome in 4 of the 10 studies. The remainder of studies evaluated PPROM and/or PTB as a secondary outcome. Eight studies included data for PPROM<37 weeks and/or PTB<37 weeks. Five studies included data for PTB<34 weeks. Vitamin C was not associated with reduction in risk of PPROM<37 weeks (OR 1.05, CI 0.91-1.21, p=0.55), PTB<37 weeks (OR 1.02, CI 0.95-1.10, p=0.62) or PTB<34 weeks (OR 1.15, CI 0.97-1.36, p= 0.10). CONCLUSION: Vitamin C supplementation during pregnancy is not associated with prevention of PPROM or PTB.

Can Vitamin C Supplements Prevent Premature Rupture of Membranes and Preterm Birth?

“…Vitamin C (ascorbic acid) is an essential water-soluble micronutrient involved in the antioxidant defense mechanisms and synthesis of collagen [1]. It has been suggested that vitamin C could be effective in preventing premature rupture of membranes (PROM) and preterm birth, but previous systematic reviews and meta-analyses had inconsistent results [1][2][3][4]. Some found that women supplemented with vitamin C had reduced risk of preterm PROM (PPROM) [1] and term PROM (TPROM) [1], while other found that vitamin C supplementation was not effective in reducing risk of PPROM [3,4] or preterm birth [1,3] or, conversely, that it was associated with an increased risk of preterm birth [2].…”

“…It has been suggested that vitamin C could be effective in preventing premature rupture of membranes (PROM) and preterm birth, but previous systematic reviews and meta-analyses had inconsistent results [1][2][3][4]. Some found that women supplemented with vitamin C had reduced risk of preterm PROM (PPROM) [1] and term PROM (TPROM) [1], while other found that vitamin C supplementation was not effective in reducing risk of PPROM [3,4] or preterm birth [1,3] or, conversely, that it was associated with an increased risk of preterm birth [2]. Considering previous inconsistencies, we aimed to conduct a systematic review and meta-analysis to determine if vitamin C supplements could be effective in preventing PROM or preterm birth.…”