Antioxidants in the treatment of severe pre-eclampsia: an explanatory randomised controlled trial.
OBJECTIVE
To determine whether antioxidant therapy alters the disease process in severe early onset pre-eclampsia, in support of the hypothesis that increased lipid peroxides and reactive oxygen species production-play an important role in the pathogenesis of the disease.


METHODS
Randomised, double-blind, placebo controlled trial.


METHODS
Two tertiary care, referral hospitals in Johannesburg, South Africa.


METHODS
Women with severe pre-eclampsia diagnosed between 24 and 32 weeks of gestation.


METHODS
Combined antioxidant treatment with vitamin E (800 IU/day), vitamin C (1000 mg/day), and allopurinol (200 mg/day).


METHODS



METHODS
1. prolongation of pregnancy and 2, biochemical assessment of lipid peroxides and antioxidants.


RESULTS
data on maternal complications, side effects of treatment, infant outcomes and regular assessment of haematologic and renal parameters.


RESULTS
The proportion of women delivered within 14 days in the antioxidant group was 52% (14/27) compared with 76% (22/29) in the placebo group (relative risk 0.68, 95% confidence interval 0.45-1.04). One woman in each group had eclampsia. Eleven women (42%) in the antioxidant and 16 (59%) in the placebo group required two antihypertensives for blood pressure control. Trial medications were well tolerated with few side effects. Lipid peroxide levels were not significantly altered in the antioxidant and placebo groups. Serum uric acid levels decreased and vitamin E levels increased significantly.


CONCLUSIONS
The results of this explanatory randomised trial do not encourage the routine use of antioxidants against pre-eclampsia. However, further research with modified strategies such as earlier initiation of therapy or different combinations seem worthwhile.
Gülmezoğlu
A M
AM
Department of Obstetrics and Gynaecology, Coronation/JG Strijdom Hospitals, Johannesburg, South Africa.
Hofmeyr
G J
GJ
Oosthuisen
M M
MM
D000293:Adolescent; D000328:Adult; D000493:Allopurinol / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D004311:Double-Blind Method; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008054:Lipid Peroxides / Q000097:blood; D011225:Pre-Eclampsia / Q000188:drug therapy* / Q000378:metabolism; D011247:Pregnancy; D011256:Pregnancy Outcome; D014527:Uric Acid / Q000097:blood; D014810:Vitamin E / Q000627:therapeutic use*
D000975:Antioxidants; D008054:Lipid Peroxides; D014810:Vitamin E; D014527:Uric Acid; D000493:Allopurinol; D001205:Ascorbic Acid