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. 2015 Dec 30;46(4):156-61.

Preeclampsia prevention: a case-control study nested in a cohort

Alberto Alzate  1 , Rodolfo Herrera-Medina  1 , Lucia M Pineda  2
Affiliations

Preeclampsia prevention: a case-control study nested in a cohort

Alberto Alzate et al. Colomb Med (Cali). .

Abstract
in English, Spanish

Background: Preeclampsia is the main complication of pregnancy in developing countries. Calcium starting at 14 weeks of pregnancy is indicated to prevent the disease. Recent advances in prevention of preeclampsia endorse the addition of conjugated linoleic acid.

Objective: To estimate the protective effect from calcium alone, compared to calcium plus conjugated linoleic acid in nulliparous women at risk of preeclampsia.

Methods: A case-control design nested in the cohort of nulliparous women attending antenatal care from 2010 to 2014. The clinical histories of 387 cases of preeclampsia were compared with 1,054 normotensive controls. The exposure was prescriptions for calcium alone, the first period, or calcium plus conjugated linoleic acid, the second period, from 12 to 16 weeks of gestational age to labor. Confounding variables were controlled, allowing only nulliparous women into the study and stratifying by age, education and ethnic group.

Results: The average age was 26.4 yrs old (range= 13-45), 85% from mixed ethnic backgrounds and with high school education. There were no differences between women who received calcium carbonate and those who did not (OR= 0.96; 95% CI= 0.73-1.27). The group of adolescents (13 to 18 years old) in the calcium plus conjugated linoleic acid was protected for preeclampsia (OR= 0.00; 95% CI= 0.00-0.44) independent of the confounder variables.

Conclusions: 1. Calcium supplementation during pregnancy did not have preventive effects on preeclampsia. 2. Calcium plus Conjugated Linoleic acid provided to adolescents was observed to have preventive effect on Preeclampsia.

Introducción: La preeclampsia es la principal causa de mortalidad materna y bajo peso al nacer en países en vías de desarrollo. Empezar la suplementación de calcio en la semana 14 de gestación es indicada para prevenir la enfermedad. Recientes avances en prevención de preeclampsia han sugerido la suplementación de calcio y la combinación de calcio con ácido linoleico conjugado.

Objetivo: Estimar el efecto protector de la suplementación de calcio (CC), comparado con la suplementación de calcio más ácido linoleico conjugado (CC+ALC) en mujeres embarazadas primigravidas con relación al desarrollo de preeclampsia.

Metodos: Se realizó un estudio de casos y controles anidado en una cohorte retrospectiva de mujeres embarazadas primigravidas que asistieron al programa de control prenatal entre el año 2010 hasta el años 2014. La historia clínica de 387 casos de preeclampsia fueron comparadas con 1,054 controles en pacientes embarazadas primigestantes, normotensas. Las gestantes expuestas fueron consideradas como aquellas gestantes que recibieron solo calcio, en el primer periodo de evaluación, o calcio más ácido linoleico conjugado, segundo periodo de evaluación, desde las semanas 12 a la 16 del embarazo. Los posibles factores de confusión se controlaron admitiendo solo las primigestantes y estratificando, por edad, educación y grupo étnico de la paciente.

Resultados: La edad promedio de las pacientes fue de 26.4 años (rango 13-45), 85% con etnia mestiza y educación secundaria completa. La exposición a CC+ALC tuvo un efecto protector en las adolescentes (13 a 18 años) (OR= 0.00, IC 95%= 0.00-0.44; p= 0.005), mientras que la exposición a CC no modificó la incidencia de preeclampsia (OR= 0.96, IC 95% %= 0.73-1.27; p= 0.82).

Conclusión: 1. La suplementación de solo calcio durante el embarazo no tuvo efecto preventivo para la preeclampsia, 2. La suplementación con calcio y ácido linoleico conjugado previno la aparición de preeclampsia en adolescentes.

Keywords: Preeclampsia; adolescence; calcium; conjugated linoleic acid; prevention.

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Conflict of interest statement

Conflict of interests: The authors declare having no conflict of interests with the present study. The authors also clarify that Dr. Alzate was funded by Tecnoquimicas S.A. to guide the design, analysis, and publication of this evaluation

Figures

Figure 1.
Figure 1.. Figure 1. Evaluation of the intervention: from left to right the cohort of pregnant women advances; from right to left the evaluation ask if the effect-preeclampsia- is related or not to the intervention CC or CC+CLA, since week 12-16 of the pregnancy.
Figure 2.
Figure 2.. Selection criteria of cases and controls for study with exposure to calcium carbonate or calcium plus conjugated linoleic acid, Cali-Colombia 2010-2014.
See this image and copyright information in PMC

Comment in

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