Advertisement

The Role of Vitamin E in Pregnancy

  • Ann L. Anderson BerryEmail author
  • Corrine K. Hanson
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

Oxidative stress has been associated with low birth weight, preterm delivery, and preeclampsia, all important negative maternal or neonatal outcomes of pregnancy. Vitamin E, specifically RRR-α-tocopherol, has potent antioxidant effects that may help mitigate these risks if intake is optimal during pregnancy. Many complications of pregnancy and the neonatal period are augmented by inflammation making the task of defining optimal vitamin E status and antioxidant capacity during pregnancy a worthwhile endeavor. Clinical supplementation trials of vitamin E during pregnancy as reviewed by a 2015 Cochrane review are inconclusive or draw contradictory conclusions and have designs that do not lead to robust data for analysis. Additional information regarding placental regulation of α- and γ-tocopherols, fetal tissue incorporation, and fetal serum concentrations of tocopherol metabolites are other areas for continued research. A more complete understanding of vitamin E status of the pregnant woman and its impact on the developing fetus as well as associations with pregnancy outcomes such as length of gestation, mode of delivery, and associations with preeclampsia, pregnancy-induced hypertension, and gestational diabetes is critical to improving pregnancy outcomes. Considerable scientific work remains necessary to fully understand the role of vitamin E in fertility and pregnancy and its ability to optimize maternal and neonatal outcomes.

Keywords

Pregnancy Vitamin E α-Tocopherol γ-Tocopherol Preeclampsia Pregnancy outcomes Oxidative stress Fertility Prematurity Intrauterine growth restriction Preterm delivery 

Notes

Acknowledgments

We would like to gratefully acknowledge the help of Ammar Kamil and Matthew VanOrmer for their help in the preparation of this chapter.

References

  1. 1.
    Acuff RV, Dunworth RG, Webb LW, Lane JR. Transport of deuterium-labeled tocopherols during pregnancy. Am J Clin Nutr. 1998;67:459–64.CrossRefGoogle Scholar
  2. 2.
    Adewoyin M, Ibrahim M, Roszaman R, Isa MLM, Alewi NAM, Rafa AAA, et al. Male infertility: the effect of natural antioxidants and phytocompounds on seminal oxidative stress. Diseases. 2017;5:9.  https://doi.org/10.3390/diseases5010009.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Amazan D, Cordero G, Lopez-Bote CJ, Lauridsen C, Rey AI. Effects of oral micellized natural vitamin E (D-alpha-tocopherol) v. synthetic vitamin E (DL-alpha-tocopherol) in feed on alpha-tocopherol levels, stereoisomer distribution, oxidative stress and the immune response in piglets. Animal. 2014;8(419):410.  https://doi.org/10.1017/S1751731113002401.CrossRefPubMedGoogle Scholar
  4. 4.
    American College of Obstetricians and Gynecologists. Preeclampsia and hypertension in pregnancy: resource overview. https://www.acog.org/Womens-Health/Preeclampsia-and-Hypertension-in-Pregnancy. Accessed 26 Oct 2017.
  5. 5.
    Azzi A, Gysin R, Kempna P, Munteanu A, Negis Y, Villacorta L, et al. Vitamin E mediates cell signaling and regulation of gene expression. Ann N Y Acad Sci. 2004;1031:86–95.CrossRefGoogle Scholar
  6. 6.
    Bendich A, Machlin L. The safety of oral intake of vitamin E: data from clinical studies from 1986–1991. In: Packer L, Fuchs J, editors. Vitamin E in health and disease. New York: Marcel-Dekker; 1993. p. 411–6.Google Scholar
  7. 7.
    Capper JL, Wilkinson RG, Kasapidou E, Pattinson SE, Mackenzie AM, Sinclair LA. The effect of dietary vitamin E and fatty acid supplementation of pregnant and lactating ewes on placental and mammary transfer of vitamin E to the lamb. Br J Nutr. 2005;93:549–57.  https://doi.org/10.1079/BJN20051376.CrossRefPubMedGoogle Scholar
  8. 8.
    Chappell LC, Seed PT, Briley AL, Kelly FJ, Lee R, Hunt BJ, et al. Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial. Lancet. 1999;354:810–6.  https://doi.org/10.1016/S0140-6736(99)80010-5.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen K, Zhang X, Wei X, Qu P, Liu Y, Li T. Antioxidant vitamin status during pregnancy in relation to cognitive development in the first two years of life. Early Hum Dev. 2009;85:421–7.  https://doi.org/10.1016/j.earlhumdev.2009.02.001.CrossRefPubMedGoogle Scholar
  10. 10.
    Debier C. Vitamin E during pre- and postnatal periods. Vitam Horm. 2007;76:357–73. https://doi.org/10.1016/S0083-6729(07)76013-2.CrossRefPubMedGoogle Scholar
  11. 11.
    Devereux G, Barker RN, Seaton A. Antenatal determinants of neonatal immune responses to allergens. Clin Exp Allergy. 2002;32:43–50. https://doi.org/10.1046/j.0022-0477.2001.01267.x.
  12. 12.
    Devereux G. Early life events in asthma—diet. Pediatr Pulmonol. 2007;42:663–73.  https://doi.org/10.1002/ppul.20640.CrossRefPubMedGoogle Scholar
  13. 13.
    Didenco S, Gillingham MB, Go MD, Leonard SW, Traber MG, McEvoy CT. Increased vitamin E intake is associated with higher alpha-tocopherol concentration in the maternal circulation but higher alpha-carboxyethyl hydroxychroman concentration in the fetal circulation. Am J Clin Nutr. 2011;93:368–73.  https://doi.org/10.3945/ajcn.110.008367.CrossRefPubMedGoogle Scholar
  14. 14.
    Dimenstein R, Medeiros AC, Cunha LR, Araujo KF, Dantas JC, Macedo TM, et al. Vitamin E in human serum and colostrum under fasting and postprandial conditions. J Pediatr. 2010;86:345–8.  https://doi.org/10.2223/JPED.1971.CrossRefGoogle Scholar
  15. 15.
    Evans H, Emerson G, Emerson O. The isolation from wheat germ oil of an alcohol, [alpha]-tocopherol, having the properties of vitamin E. J Biol Chem. 1936;113:319–32.Google Scholar
  16. 16.
    Evans H, Bishop K. On the existence of a hitherto unrecognized dietary factor essential for reproduction. Science. 1922;56:650–1.CrossRefGoogle Scholar
  17. 17.
    Evans H. The Pioneer history of vitamin E. Vitam Horm. 1962;20:379–87.  https://doi.org/10.1016/S0083-6729(08)60725-6.CrossRefGoogle Scholar
  18. 18.
    Fayol L, Gulian JM, Dalmasso C, Calaf R, Simeoni U, Millet V. Antioxidant status of neonates exposed in utero to tobacco smoke. Biol Neonate. 2005;87:121–6.  https://doi.org/10.1159/000082128.CrossRefPubMedGoogle Scholar
  19. 19.
    Freeman BA, Crapo JD. Biology of disease: free radicals and tissue injury. Lab Investig. 1982;47:412–26.PubMedGoogle Scholar
  20. 20.
    Gao X, Wilde PE, Lichtenstein AH, Bermudez OI, Tucker KL. The maximal amount of dietary alpha-tocopherol intake in U.S. adults (NHANES 2001–2002). J Nutr. 2006;136:1021–6.CrossRefGoogle Scholar
  21. 21.
    Gaur S, Kuchan MJ, Lai CS, Jensen SK, Sherry CL. Supplementation with RRR- or all-rac-alpha-tocopherol differentially affects the alpha-tocopherol stereoisomer profile in the milk and plasma of lactating women. J Nutr. 2017;147:1301–7.  https://doi.org/10.3945/jn.116.245134.CrossRefPubMedGoogle Scholar
  22. 22.
    Gilboa SM, Lee KA, Cogswell ME, Traven FK, Botto LD, Riehle-Colarusso T, et al. Maternal intake of vitamin E and birth defects, national birth defects prevention study, 1997 to 2005. Birth Defects Res A Clin Mol Teratol. 2014;100:647–57.  https://doi.org/10.1002/bdra.23247.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Hanson C, Lyden E, Furtado J, Van Ormer M, Johnson R, McGinn E, Cave C, Rilett K, Weishaar K, Maddipati S, Appeah H, Anderson-Berry A. Vitamin E status and associations in maternal-infant dyads in the Midwestern United States. Clin Nutr. 2018;  https://doi.org/10.1016/j.clnu.2018.02.003.
  24. 24.
    Heaney RP, Davies KM, Recker RR, Packard PT. Long-term consistency of nutrient intakes in humans. J Nutr. 1990;120:869–75. https://doi.org/10.1093/jn/120.8.869.
  25. 25.
    Hubel CA, Kagan VE, Kisin ER, McLaughlin MK, Roberts JM. Increased ascorbate radical formation and ascorbate depletion in plasma from women with preeclampsia: implications for oxidative stress. Free Radic Biol Med. 1997;23:597–609.  https://doi.org/10.1016/S0891-5849(97)00010-5.CrossRefPubMedGoogle Scholar
  26. 26.
    Hubel CA. Oxidative stress in the pathogenesis of preeclampsia. Proc Soc Exp Biol Med. 1999;222:222–35.  https://doi.org/10.1046/j.1525-1373.1999.d01-139.x.CrossRefPubMedGoogle Scholar
  27. 27.
    Hubel CA, Roberts JM, Taylor RN, Musci TJ, Rogers GM, McLaughlin MK. Lipid peroxidation in pregnancy: New perspectives on preeclampsia. Am J Obstet Gynecol. 1989;161:1025–34.  https://doi.org/10.1016/0002-9378(89)90778-3.CrossRefPubMedGoogle Scholar
  28. 28.
    Institute of Medicine. Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. Washington, DC: National Academies Press; 2000. https://www.nap.edu/login.php?record_id=9810. Accessed 16 Oct 2017.Google Scholar
  29. 29.
    Jauniaux E, Cindrova-Davies T, Johns J, Dunster C, Hempstock J, Kelly FJ, et al. Distribution and transfer pathways of antioxidant molecules inside the first trimester human gestational sac. J Clin Endocrinol Metab. 2004;89:1452–8.  https://doi.org/10.1210/jc.2003-031332.CrossRefPubMedGoogle Scholar
  30. 30.
    Jeyabalan A. Epidemiology of preeclampsia: impact of obesity. Nutr Rev. 2013;71(Suppl 1):S18–25.  https://doi.org/10.1111/nure.12055.CrossRefPubMedGoogle Scholar
  31. 31.
    Jishage K, Arita M, Igarashi K, Iwata T, Watanabe M, Ogawa M, et al. Alpha-tocopherol transfer protein is important for the normal development of placental labyrinthine trophoblasts in mice. J Biol Chem. 2001;276:1669–72.  https://doi.org/10.1074/jbc.C000676200.CrossRefPubMedGoogle Scholar
  32. 32.
    Kaempf-Rotzoll DE, Horiguchi M, Hashiguchi K, Aoki J, Tamai H, Linderkamp O, et al. Human placental trophoblast cells express alpha-tocopherol transfer protein. Placenta. 2003; 24:439–444. https://doi.org/10.1053/plac.2002.0966.
  33. 33.
    Kaempf-Rotzoll DE, Igarashi K, Aoki J, Jishage K, Suzuki H, Tamai H, et al. Alpha-tocopherol transfer protein is specifically localized at the implantation site of pregnant mouse uterus. Biol Reprod. 2002;67:599–604.CrossRefGoogle Scholar
  34. 34.
    Kodama H, Yamaguchi R, Fukuda J, Kasai H, Tanaka T. Increased oxidative deoxyribonucleic acid damage in the spermatozoa of infertile male patients. Fertil Steril. 1997;68:519–24.  https://doi.org/10.1016/S0015-0282(97)00236-7.CrossRefPubMedGoogle Scholar
  35. 35.
    Lee BE, Hong YC, Lee KH, Kim YJ, Kim WK, Chang NS, et al. Influence of maternal serum levels of vitamins C and E during the second trimester on birth weight and length. Eur J Clin Nutr. 2004;58:1365–71.  https://doi.org/10.1038/sj.ejcn.1601976.CrossRefPubMedGoogle Scholar
  36. 36.
    Llurba E, Gratacos E, Martin-Gallan P, Cabero L, Dominguez C. A comprehensive study of oxidative stress and antioxidant status in preeclampsia and normal pregnancy. Free Radic Biol Med. 2004;37:557–70.  https://doi.org/10.1016/j.freeradbiomed.2004.04.035.CrossRefPubMedGoogle Scholar
  37. 37.
    Malmberg KJ, Lenkei R, Petersson M, Ohlum T, Ichihara F, Glimelius B, et al. A short-term dietary supplementation of high doses of vitamin E increases T helper 1 cytokine production in patients with advanced colorectal cancer. Clin Cancer Res. 2002;8:1772–8.PubMedGoogle Scholar
  38. 38.
    Maras JE, Bermudez OI, Qiao N, Bakun PJ, Boody-Alter EL, Tucker KL. Intake of alpha-tocopherol is limited among US adults. J Am Diet Assoc. 2004;104:567–75.  https://doi.org/10.1016/j.jada.2004.01.004.CrossRefPubMedGoogle Scholar
  39. 39.
    McEvoy GK, editor. AHFS drug information 2000. Bethesda: American Society of Health System Pharmacists; 2000.Google Scholar
  40. 40.
    Medeiros JF, da Silva Ribeiro Rodrigues KD, Lima MS, da Silva AL, de Queiroz JL, Dimenstein R. Alpha-tocopherol concentration in colostrum and serum of women with premature labor. J Pediatr Gastroenterol Nutr. 2016;62:348–52.  https://doi.org/10.1097/MPG.0000000000000969.CrossRefPubMedGoogle Scholar
  41. 41.
    Micronutrient Information Center. Vitamin E. Corvallis: Linus Pauling Institute; 2015. http://lpi.oregonstate.edu/mic/vitamins/vitamin-E. Accessed 26 Oct 2017.Google Scholar
  42. 42.
    Mikhail MS, Anyaegbunam A, Garfinkel D, Palan PR, Basu J, Romney SL. Preeclampsia and antioxidant nutrients: decreased plasma levels of reduced ascorbic acid, alpha-tocopherol, and beta-carotene in women with preeclampsia. Am J Obstet Gynecol. 1994;171:150–7.  https://doi.org/10.1016/0002-9378(94)90462-6.CrossRefPubMedGoogle Scholar
  43. 43.
    Miller GW, Labut EM, Lebold KM, Floeter A, Tanguay RL, Traber MG. Zebrafish (Danio Rerio) Fed Vitamin E Deficient Diets Produce Embryos with Increased Morphologic Abnormalities and Mortality. J Nutr Biochem. 2012a;23:478–86.  https://doi.org/10.1016/j.jnutbio.2011.02.002.CrossRefPubMedGoogle Scholar
  44. 44.
    Miller GW, Ulatowski L, Labut EM, Lebold KM, Manor D, Atkinson J, et al. The alpha-tocopherol transfer protein is essential for vertebrate embryogenesis. PLoS One. 2012b;7:–e47402.  https://doi.org/10.1371/journal.pone.0047402.
  45. 45.
    Morris JM, Gopaul NK, Endresen MJ, Knight M, Linton EA, Dhir S, et al. Circulating markers of oxidative stress are raised in normal pregnancy and pre-eclampsia. Br J Obstet Gynaecol. 1998;105:1195–9.CrossRefGoogle Scholar
  46. 46.
    Olcott H, Mattill H. The unsaponifiable lipids of lettuce. 2. Fractionation. J Biol Chem. 1931;93:59–64.Google Scholar
  47. 47.
    Panburana P, Phuapradit W, Puchaiwatananon O. Antioxidant nutrients and lipid peroxide levels in Thai preeclamptic pregnant women. J Obstet Gynaecol Res. 2000;26:377–81.  https://doi.org/10.1111/j.1447-0756.2000.tb01343.x.CrossRefPubMedGoogle Scholar
  48. 48.
    Pressman EK, Cavanaugh JL, Mingione M, Norkus EP, Woods JR. Effects of maternal antioxidant supplementation on maternal and fetal antioxidant levels: a randomized, double-blind study. Am J Obstet Gynecol. 2003;189:1720–5. https://doi.org/10.1016/S0002-9378(03)00858-5.
  49. 49.
    Qian J, Wilson K, Nava P, Morley S, Atkinson J, Manor D. Intracellular localization of alpha-tocopherol transfer protein and alpha-tocopherol. Ann N Y Acad Sci. 2004;1031:330–1.CrossRefGoogle Scholar
  50. 50.
    Roberts JM. Is oxidative stress the link in the two-stage model of pre-eclampsia? Lancet. 1999;354:788–9.CrossRefGoogle Scholar
  51. 51.
    Roberts K. Vitamin E. In: Truswell A, Dreosti I, English R, Palmer N, Rutihauser I, editors. Recommended nutrient intakes: Australian papers. Sydney: Australian Professional Publications; 1990. p. 158–73.Google Scholar
  52. 52.
    Ross C, Morriss A, Khairy M, Khalaf Y, Braude P, Coomarasamy A, et al. A systematic review of the effect of oral antioxidants on male infertility. Reprod Biomed Online. 2010;20:711–23.  https://doi.org/10.1016/j.rbmo.2010.03.008.CrossRefPubMedGoogle Scholar
  53. 53.
    Rumbold A, Ota E, Nagata C, Shahrook S, Crowther CA. Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev. 2015;9  https://doi.org/10.1002/14651858.CD004072.pub3.
  54. 54.
    Sagol S, Ozkinay E, Ozsener S. Impaired antioxidant activity in women with pre-eclampsia. Int J Gynaecol Obstet. 1999;64:121–7. https://doi.org/10.1016/S0020-7292(98)00217-3.Google Scholar
  55. 55.
    Schenker S, Yang Y, Perez A, Acuff RV, Papas AM, Henderson G, et al. Antioxidant transport by the human placenta. Clin Nutr. 1998;17:159–67.CrossRefGoogle Scholar
  56. 56.
    Scholl TO, Chen X, Sims M, Stein TP. Vitamin E: maternal concentrations are associated with fetal growth. Am J Clin Nutr. 2006;84:1442–8.CrossRefGoogle Scholar
  57. 57.
    Scholl TO, Leskiw M, Chen X, Sims M, Stein TP. Oxidative stress, diet, and the etiology of preeclampsia. Am J Clin Nutr. 2005;81:1390–6.CrossRefGoogle Scholar
  58. 58.
    Scholl TO, Stein TP. Oxidant damage to DNA and pregnancy outcome. J Matern Fetal Med. 2001;10:182–5.CrossRefGoogle Scholar
  59. 59.
    Shah RS, Rajalakshmi R, Bhatt RV, Hazra MN, Patel BC, Swamy NB, et al. Vitamin E status of the newborn in relation to gestational age, birth weight and maternal vitamin E status. Br J Nutr. 1987;58:191–8.CrossRefGoogle Scholar
  60. 60.
    Simsek M, Naziroglu M, Simsek H, Cay M, Aksakal M, Kumru S. Blood plasma levels of lipoperoxides, glutathione peroxidase, beta carotene, vitamin A and E in women with habitual abortion. Cell Biochem Funct. 1998;16:227–31.  https://doi.org/10.1002/(SICI)1099-0844(1998120)16:43.0.CO;2-M.CrossRefPubMedGoogle Scholar
  61. 61.
    Smedts HP, de Vries JH, Rakhshandehroo M, Wildhagen MF, Verkleij-Hagoort AC, Steegers EA, et al. High maternal vitamin E intake by diet or supplements is associated with congenital heart defects in the offspring. BJOG. 2009;116:416–23.  https://doi.org/10.1111/j.1471-0528.2008.01957.x.CrossRefPubMedGoogle Scholar
  62. 62.
    Traber MG, Rader D, Acuff RV, Brewer HB, Kayden HJ. Discrimination between RRR- and all-racemic-α-tocopherols labeled with deuterium by patients with abetalipoproteinemia. Atherosclerosis. 1994;108:27–37.  https://doi.org/10.1016/0021-9150(94)90035-3.CrossRefPubMedGoogle Scholar
  63. 63.
    Turner S, Prabhu N, Danielan P, McNeill G, Craig L, Allan K, et al. First- and second-trimester fetal size and asthma outcomes at age 10 years. Am J Respir Crit Care Med. 2011;184:407–13.  https://doi.org/10.1164/rccm.201012-2075OC.CrossRefPubMedGoogle Scholar
  64. 64.
    von Mandach U, Huch R, Huch A. Maternal and cord serum vitamin E levels in normal and abnormal pregnancy. Int J Vitam Nutr Res. 1994;64:26–32.Google Scholar
  65. 65.
    Wang Y, Boguski M, Riggs M, Rodgers L, Wigler M. Sar1, a gene from Schizosaccharomyces pombe encoding a protein that regulates ras1. Cell Regul. 1991;2:453–65.CrossRefGoogle Scholar
  66. 66.
    Williams MA, Woelk GB, King IB, Jenkins L, Mahomed K. Plasma carotenoids, retinol, tocopherols, and lipoproteins in preeclamptic and normotensive pregnant Zimbabwean women. Am J Hypertens. 2003;16:665–72. doi: S0895706103008975.CrossRefGoogle Scholar
  67. 67.
    Zhang C, Williams MA, Sanchez SE, King IB, Ware-Jauregui S, Larrabure G, et al. Plasma concentrations of carotenoids, retinol, and tocopherols in preeclamptic and normotensive pregnant women. Am J Epidemiol. 2001;153:572–80.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Nebraska Medical CenterOmahaUSA
  2. 2.Nebraska Perinatal Quality Improvement Collaborative (NPQIC)OmahaUSA
  3. 3.NICU and Newborn Nursery/Nebraska Medicine, University of Nebraska Medical CenterOmahaUSA
  4. 4.Medical Nutrition EducationUniversity of Nebraska Medical Center, College of Allied Health ProfessionsOmahaUSA

Personalised recommendations