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The effect of omega-3 supplementation on pregnancy outcomes by smoking status.
Am J Obstet Gynecol. 2017 10; 217(4):476.e1-476.e6.AJ

Abstract

BACKGROUND

Smoking during pregnancy is associated with adverse maternal and neonatal outcomes such as preterm delivery, intrauterine growth restriction, stillbirth, and low birth weight. Because smoking causes oxidative stress, some have suggested using antioxidants to counteract the effects of oxidative stress. Smokers have lower serum levels of omega-3 fatty acids, an important antioxidant, and thus, investigating whether omega-3 supplementation in smokers reduces adverse maternal and neonatal outcomes represents an important area of research.

OBJECTIVE

To investigate whether the antioxidant effect of omega-3 fatty acid supplementation on the incidence of adverse pregnancy outcomes differs between smokers and nonsmokers.

STUDY DESIGN

Secondary analysis of a multicenter randomized controlled trial of omega-3 supplementation for preterm delivery prevention in women with a singleton pregnancy and a history of a previous singleton spontaneous preterm delivery. Subjects were randomized to begin omega-3 or placebo before 22 weeks, which was continued until delivery. All women received 17 alpha-hydroxyprogesterone caproate intramuscularly weekly beginning between 16 and 20 weeks of gestation and continued until 36 weeks of gestation or delivery, whichever occurred first. The primary outcome was spontaneous preterm delivery. Secondary outcomes were indicated preterm delivery, any preterm delivery (spontaneous and indicated), pregnancy-associated hypertension (gestational hypertension and preeclampsia), a neonatal composite (retinopathy of prematurity, intraventricular hemorrhage grade III or IV, patent ductus arteriosus, necrotizing enterocolitis, sepsis, respiratory morbidity, or perinatal death), low birth weight (<2500 g), small for gestational age (less than the 10th percentile), and neonatal intensive care unit or intermediate nursery admission. The study population was stratified into smokers and nonsmokers, and the incidence of each outcome was compared by omega-3 supplementation versus placebo in each subgroup. Zelen tests were performed to test for homogeneity of effect in smokers and nonsmokers.

RESULTS

Of 851 subjects included in the analysis, 136 (16%) smoked. Baseline characteristics between omega-3 and placebo groups did not differ in smokers or nonsmokers. Omega-3 supplementation was associated with a lower risk of spontaneous preterm delivery in smokers (relative risk, 0.56, 95% confidence interval, 0.36-0.87) but not in nonsmokers (relative risk 1.04, 95% confidence interval 0.84-1.29); P value for interaction = 0.013. Low birth weight was also less frequent in smokers receiving omega-3 supplementation (relative risk 0.57, 95% confidence interval 0.36-0.90) compared with nonsmokers (relative risk 0.93, 95% confidence interval 0.71-1.24); P value for interaction = 0.047. The effect on other secondary outcomes did not differ significantly between smokers and nonsmokers.

CONCLUSION

Omega-3 supplementation in smokers may have a protective effect against recurrent spontaneous preterm delivery and low birth weight.

Authors+Show Affiliations

University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, AL. Electronic address: sgkuper@uabmc.edu.University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, AL.University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, AL.University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, AL.University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, AL.University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, AL.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

28549983

Citation

Kuper, Spencer G., et al. "The Effect of Omega-3 Supplementation On Pregnancy Outcomes By Smoking Status." American Journal of Obstetrics and Gynecology, vol. 217, no. 4, 2017, pp. 476.e1-476.e6.
Kuper SG, Abramovici AR, Jauk VC, et al. The effect of omega-3 supplementation on pregnancy outcomes by smoking status. Am J Obstet Gynecol. 2017;217(4):476.e1-476.e6.
Kuper, S. G., Abramovici, A. R., Jauk, V. C., Harper, L. M., Biggio, J. R., & Tita, A. T. (2017). The effect of omega-3 supplementation on pregnancy outcomes by smoking status. American Journal of Obstetrics and Gynecology, 217(4), e1-e6. https://doi.org/10.1016/j.ajog.2017.05.033
Kuper SG, et al. The Effect of Omega-3 Supplementation On Pregnancy Outcomes By Smoking Status. Am J Obstet Gynecol. 2017;217(4):476.e1-476.e6. PubMed PMID: 28549983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of omega-3 supplementation on pregnancy outcomes by smoking status. AU - Kuper,Spencer G, AU - Abramovici,Adi R, AU - Jauk,Victoria C, AU - Harper,Lorie M, AU - Biggio,Joseph R, AU - Tita,Alan T, Y1 - 2017/05/23/ PY - 2017/02/22/received PY - 2017/04/27/revised PY - 2017/05/15/accepted PY - 2017/5/28/pubmed PY - 2017/10/3/medline PY - 2017/5/28/entrez KW - low birth weight KW - omega-3 supplementation KW - preterm birth KW - preterm delivery KW - smoking KW - spontaneous preterm delivery KW - tobacco abuse SP - 476.e1 EP - 476.e6 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 217 IS - 4 N2 - BACKGROUND: Smoking during pregnancy is associated with adverse maternal and neonatal outcomes such as preterm delivery, intrauterine growth restriction, stillbirth, and low birth weight. Because smoking causes oxidative stress, some have suggested using antioxidants to counteract the effects of oxidative stress. Smokers have lower serum levels of omega-3 fatty acids, an important antioxidant, and thus, investigating whether omega-3 supplementation in smokers reduces adverse maternal and neonatal outcomes represents an important area of research. OBJECTIVE: To investigate whether the antioxidant effect of omega-3 fatty acid supplementation on the incidence of adverse pregnancy outcomes differs between smokers and nonsmokers. STUDY DESIGN: Secondary analysis of a multicenter randomized controlled trial of omega-3 supplementation for preterm delivery prevention in women with a singleton pregnancy and a history of a previous singleton spontaneous preterm delivery. Subjects were randomized to begin omega-3 or placebo before 22 weeks, which was continued until delivery. All women received 17 alpha-hydroxyprogesterone caproate intramuscularly weekly beginning between 16 and 20 weeks of gestation and continued until 36 weeks of gestation or delivery, whichever occurred first. The primary outcome was spontaneous preterm delivery. Secondary outcomes were indicated preterm delivery, any preterm delivery (spontaneous and indicated), pregnancy-associated hypertension (gestational hypertension and preeclampsia), a neonatal composite (retinopathy of prematurity, intraventricular hemorrhage grade III or IV, patent ductus arteriosus, necrotizing enterocolitis, sepsis, respiratory morbidity, or perinatal death), low birth weight (<2500 g), small for gestational age (less than the 10th percentile), and neonatal intensive care unit or intermediate nursery admission. The study population was stratified into smokers and nonsmokers, and the incidence of each outcome was compared by omega-3 supplementation versus placebo in each subgroup. Zelen tests were performed to test for homogeneity of effect in smokers and nonsmokers. RESULTS: Of 851 subjects included in the analysis, 136 (16%) smoked. Baseline characteristics between omega-3 and placebo groups did not differ in smokers or nonsmokers. Omega-3 supplementation was associated with a lower risk of spontaneous preterm delivery in smokers (relative risk, 0.56, 95% confidence interval, 0.36-0.87) but not in nonsmokers (relative risk 1.04, 95% confidence interval 0.84-1.29); P value for interaction = 0.013. Low birth weight was also less frequent in smokers receiving omega-3 supplementation (relative risk 0.57, 95% confidence interval 0.36-0.90) compared with nonsmokers (relative risk 0.93, 95% confidence interval 0.71-1.24); P value for interaction = 0.047. The effect on other secondary outcomes did not differ significantly between smokers and nonsmokers. CONCLUSION: Omega-3 supplementation in smokers may have a protective effect against recurrent spontaneous preterm delivery and low birth weight. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/28549983/The_effect_of_omega_3_supplementation_on_pregnancy_outcomes_by_smoking_status_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(17)30644-0 DB - PRIME DP - Unbound Medicine ER -