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Pre-term birth rate of pregnant smokers cut in half if take Omega-3 – RCT May 2017

The effect of omega-3 supplementation on pregnancy outcomes by smoking status

Presentation at Meeting: This original research was presented in poster format at the Society for Maternal-Fetal Medicine’s 37th Annual Pregnancy Meeting, Las Vegas, NV, in January 23-28, 2017.
American Journal of Obstetrics and Gynecology http://dx.doi.org/10.1016/j.ajog.2017.05.033

VitaminDWiki

Abstract fails to mention how much Omega-3 was taken

Smoking reduces vitamin D contains the following

Two pathways are often proposed for how smoking decreases vitamin D:

  1. Smoking decreases Calcium. and Vitamin D is used up in replacing the Calcium
  2. Smoking injures the body, and vitamin D is used up in repairing the body

It appears that taking Vitamin D while smoking will

  1. Decrease the incidence of the many health problems associated with smoking - even lung cancer
  2. Decrease the desire to smoke

Items in both categories Pregnancy and Omega-3 are listed here:

Healthy pregnancies need lots of vitamin D has the following summary

Problem
ReducesProof
1. Miscarriage 2.5 times Observe
2. Pre-eclampsia 3.6 timesRCT*
3. Gestational Diabetes 3 times RCT*
4. Good 2nd trimester sleep quality 3.5 times Observe
5. Vaginosis 10 times RCT*
6. Premature birth 2 times RCT*
7. C-section - unplanned 1.6 timesObserve
8. Depression AFTER pregnancy 1.4 times RCT*
9. Small for Gestational Age 3 times Observe
10. Infant height, weight, head size
     within normal limits
RCT*
11. Childhood Wheezing 1.3 times RCT*
12. Additional child is Autistic 4 times Intervention
13.Young adult Multiple Sclerosis 1.9 timesObserve
14. Preeclampsia in young adult 3.5 timesRCT*
15. Childhood Mite allergy 5 times RCT*
16. Childhood Respiratory Tract visits 2.5 times RCT*


Spencer G. Kuper, MD' MD Spencer G. KuperEmail the author MD Spencer G. Kuper, Adi R. Abramovici, MD. Ms., Victoria C. Jauk, MPH, MSN, ANP-BC., Lorie M. Harper, MD, MSCI., Joseph R. Biggio, MD., Alan T. Tita, MD, PhD
University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, Alabama

Background
Smoking during pregnancy is associated with adverse maternal and neonatal outcomes such as preterm delivery, intrauterine growth restriction, stillbirth, and low birth weight. Since 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 prior singleton spontaneous preterm delivery. Subjects were randomized to begin omega-3 or placebo prior to 22 weeks which was continued until delivery. All women received 17 alpha-hydroxyprogesterone caproate intramuscularly weekly beginning between 16 to 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 grams),
  • 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 (RR 0.56, 95% CI 0.36-0.87) but not in nonsmokers (RR 1.04, 95% CI 0.84-1.29); p-value for interaction = 0.013.

Low birth weight was also less frequent in smokers receiving omega-3 supplementation (RR 0.57, 95% CI 0.36-0.90) compared to nonsmokers (RR 0.93, 95% CI 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.

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