title: First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh.
abstract: BACKGROUND
  Tocopherols were discovered for their role in animal reproduction, but little is known about the contribution of deficiencies of vitamin E to human pregnancy loss.
  
  
  OBJECTIVE
  We sought to determine whether higher first-trimester concentrations of α-tocopherol and γ-tocopherol were associated with reduced odds of miscarriage (pregnancy losses <24 wk of gestation) in women in rural Bangladesh.
  
  
  METHODS
  A case-cohort study in 1605 pregnant Bangladeshi women [median (IQR) gestational age: 10 wk (8-13 wk)] who participated in a placebo-controlled vitamin A- or β-carotene-supplementation trial was done to assess ORs of miscarriage in women with low α-tocopherol (<12.0 μmol/L) and γ-tocopherol (<0.81 μmol/L; upper tertile cutoff of the γ-tocopherol distribution in women who did not miscarry).
  
  
  RESULTS
  In all women, plasma α- and γ-tocopherol concentrations were low [median (IQR): 10.04 μmol/L (8.07-12.35 μmol/L) and 0.66 μmol/L (0.50-0.95 μmol/L), respectively]. In a logistic regression analysis that was adjusted for cholesterol and the other tocopherol, low α-tocopherol was associated with an OR of 1.83 (95% CI: 1.04, 3.20), whereas a low γ-tocopherol concentration was associated with an OR of 0.62 (95% CI: 0.41, 0.93) for miscarriage. Subgroup analyses revealed that opposing ORs were evident only in women with BMI (in kg/m(2)) ≥18.5 and serum ferritin concentration ≤150 μg/L, although low BMI and elevated ferritin conferred stronger risk of miscarriage.
  
  
  CONCLUSIONS
  In pregnant women in rural Bangladesh, low plasma α-tocopherol was associated with increased risk of miscarriage, and low γ-tocopherol was associated with decreased risk of miscarriage. Maternal vitamin E status in the first trimester may influence risk of early pregnancy loss. The JiVitA-1 study, from which data for this report were derived, was registered at clinicaltrials.gov as NCT00198822.
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Abu Ahmed
authors: AA
authors: Shamim
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Kerry
authors: K
authors: Schulze
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Rebecca D
authors: RD
authors: Merrill
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Alamgir
authors: A
authors: Kabir
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Parul
authors: P
authors: Christian
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Saijuddin
authors: S
authors: Shaikh
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Lee
authors: L
authors: Wu
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Hasmot
authors: H
authors: Ali
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Alain B
authors: AB
authors: Labrique
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Sucheta
authors: S
authors: Mehra
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Rolf D W
authors: RD
authors: Klemm
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Mahbubur
authors: M
authors: Rashid
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Pongtorn
authors: P
authors: Sungpuag
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Emorn
authors: E
authors: Udomkesmalee
authors: From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU).
authors: Keith P
authors: KP
authors: West
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood* / Q000453:epidemiology* / Q000517:prevention & control; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D016000:Cluster Analysis; D015331:Cohort Studies; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D009752:Nutritional Status; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D024505:Tocopherols / Q000008:administration & dosage / Q000097:blood*; D014810:Vitamin E / Q000008:administration & dosage / Q000097:blood; D055815:Young Adult; D024502:alpha-Tocopherol / Q000008:administration & dosage / Q000097:blood; D024504:gamma-Tocopherol / Q000008:administration & dosage / Q000097:blood
chemical_list: D014810:Vitamin E; D024504:gamma-Tocopherol; D005293:Ferritins; D002784:Cholesterol; D024502:alpha-Tocopherol; D024505:Tocopherols
keywords: alpha-tocopherol; gamma-tocopherol; miscarriage; pregnancy; vitamin E