NIH Funds Study of Serious Pregnancy Complication

Strong Team Examines Role of Poor Nutrition in Premature Rupture of Fetal Membranes and Low Birth Weight Babies

March 22, 2001

A team of researchers will begin the nation's first controlled study to determine why pregnant women experience premature rupture of the fetal membranes (PROM), a severe obstetric complication that leads to the early delivery of unhealthy babies. The University of Rochester Medical Center doctors and scientists are looking for evidence that improved nutrition and vitamins, used as therapy, may help prevent the complication.

The National Institutes of Health awarded a $1.38 million, four-year grant this week to support the UR project, entitled "Role of Oxidant Stress in Premature Rupture of Membranes." The team, led by James R. Woods, M.D., director of Maternal-Fetal Medicine at Strong Memorial Hospital, has already conducted basic science research, the results of which were published in the October 2000 edition of the American Journal of Obstetrics and Gynecology.

The Journal report, authored by Mark A. Plessinger, Ph.D., Woods, and Richard K. Miller, Ph.D., director of Obstetric Research at the UR Medical Center, demonstrated that tissue-damaging molecules called reactive oxygen species (commonly referred to as "free radicals,") which are generated in the body, can damage fetal membranes - but that vitamins C and E can protect the membranes, at least in the laboratory.

The research has great significance: premature rupture of the membranes (your "water breaks" before the onset of labor) is associated with up to 50 percent of newborns delivered prior to 37 weeks gestation. Quite often, these newborns need intensive medical care.

During the last 50 years, unfortunately, the incidence of low birth weight babies has not declined. Any improvements in newborn survival have come as a result of new technology in neonatology - not new approaches in obstetrics. Finding ways to use nutrition as therapy may result in better outcomes for mothers at risk for PROM - patients who smoke, use drugs, contract infections during pregnancy or experience bleeding - as well as save health care dollars. (Estimated cost of care at the NICU at Strong Memorial for critically ill babies is more than $20,000 for one month of treatment.)

Woods' initial research, which was used to support the request for the NIH grant, exposed fetal membranes obtained at delivery to hypochlorous acid. This acid, the active ingredient in household bleach, is one of the molecules generated naturally by immune cells in our body in response to infection, and by normal cells in the body during cellular respiration. But hypochlorous acid also damages other tissues in the body, such as the fetal membrane.

Woods' team found that when fetal membranes in the laboratory were treated with vitamins C and E, and then exposed to hypochlorous acid, they were protected from the tissue-damaging effects of the acid.

It is generally recognized that vitamins C and E are important antioxidants in our diet. During pregnancy, both vitamins also may play important roles in the biology of fetal membranes. Vitamin C, or ascorbic acid, increases the body's production of collagen, the tissue that provides strength to the fetal membranes. Levels of vitamin C are lowest in women at risk for PROM. Vitamin E, located in the lipid within the cell membranes, protects the cells from damage by reactive oxygen species. It also appears that C and E work together to maintain a high level of vitamin E in the lipid membranes.

Diet alone may not provide a proper defense against PROM. Typical prenatal vitamin preparations have concentrations of vitamins C and E that may be too low to offer effective antioxidant protection against PROM, especially for cigarette smokers.

"Our feeling is that improved nutrition is under-appreciated as a treatment to prevent obstetric complications such as PROM, and possibly preterm labor and preeclampsia," said Woods, describing this research project as the most exciting in his career.

Woods, however, advises caution. There is a delicate balance in the body between reactive oxygen species and the antioxidants that keep them under control. Carefully monitored clinical trials are needed before women begin indiscriminately taking higher concentrations of vitamins during pregnancy, Woods said. His research trials will begin in June.

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