The efficacy and safety of vitamin C administration to women with history of premature preterm rupture of membrane in prevention of such event in current pregnancy: Randomized controlled clinical trial

Main Article Content

Alaq Saeed Abdulhussain

Keywords

reterm premature rupture membrane, vitamin C, pregnancy, predisposing factors, Iraq

Abstract

Background: When rupture of membrane happens before onset of labor, the condition in obstetric practice is defined as “Prelabor rupture of membranes (PROM)” leading to leakage of amniotic fluid through ruptured chorioamniotic membranes and the conditions happens before thirty-seven weeks of pregnancy the term “preterm PROM (PPROM)” is applied. Lack of vitamin C has been suggested as a predisposing factor and vitamin C supplementation has been suggested as a preventive measure.


Aim of the study: This study was aimed to determine the efficacy and safety of administration of vitamin C women with history of premature preterm rupture of membrane in prevention of such event in current pregnancy.


Patients and methods: The present randomized controlled clinical trial was performed in Maternity and Children Teaching Hospital in Al-Diwaniyah province in Iraq. It included 100 women with previous history of premature preborn rupture of membrane who were randomly allocated into 2 groups. The first group, the study group included 55 women who received vitamin C supplementation orally staring from 14 weeks gestation and the second group, the reference group was the placebo group (n = 45). Data regarding age, previous abortion, body mass index, number of previous pregnancies and previous abortions were obtained and outcome variables included gestational age at which rupture of membrane happened, gestational age at which delivery happened and birth weight were collected.


Results: Vitamin C was able to significantly increase the GA at rupture or membrane (p = 0.033), form 29.00 ±2.92 weeks to 30.11 ±2.21 weeks. Vitamin C was also able to significantly increase the GA at birth (p = 0.019), form 32.04 ±2.88 weeks to 33.31 ±2.43 weeks. In addition, Vitamin C was also able to significantly increase the birth weight (p = 0.019) from 1951.10 ±869.72 gram to 2409.10 ±613.44 gram.


Conclusion: Vitamin C Administration to women with previous history of Premature Preterm Rupture of Membrane is efficient and safe in prevention of such event in current pregnancy.

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References

1. Menon R, and Richardson LS. Preterm prelabor rupture of the membranes: A disease of the fetal membranes. Semin Perinatol. 2017; 41(7): 409–419. https://doi.org/10.1053/j.semperi.2017.07.012
2. Dayal S, and Hong PL. Premature rupture of membranes. StatPearls, ed. Treasure Island, FL: StatPearls Publishing; 2021.
3. Addisu D, Melkie A, and Biru S. Prevalence of preterm premature rupture of membrane and its associated factors among pregnant women admit-ted in Debre Tabor General Hospital, North West Ethiopia: institutional-based cross-sectional study. Obstet Gynecol Int. 2020; 2020: 4034680. https://doi.org/10.1155/2020/4034680
4. Kumar D, Moore RM, Mercer BM, et al. The phys-iology of fetal membrane weakening and rupture: insights gained from the determination of physi-cal properties revisited. Placenta. 2016; 42: 59–73. https://doi.org/10.1016/j.placenta.2016.03.015
5. Hidalgo-Chicharro A, Abad-Torreblanca R, Navarro-Marí JM, et al. 32-Week premature rup-ture of membranes caused by oropharyngeal microbiota. JMM Case Rep. 2017; 4(10): e005121. https://doi.org/10.1099/jmmcr.0.005121
6. Assefa NE, Berhe H, Girma F, et al. Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case control study [published correction appears in BMC Pregnancy Childbirth. 2018 Oct 16; 18(1): 403] [published correction appears in BMC Pregnancy Childbirth. 2020 Jan 13; 20(1): 28]. BMC Pregnancy Childbirth. 2018; 18(1): 386. https://doi.org/10.1186/s12884-018-2016-6
7. Andres RL, Zhao Y, Klebanoff MA, et al. The impact of tobacco use on preterm premature rupture of the membranes. Am J Perinatol. 2013; 30(3): 185–190. https://doi.org/10.1055/s-0032-1322517
8. Caughey AB, Robinson JN, and Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol. 2008; 1(1): 11–22.
9. Enjamo M, Deribew A, Semagn S, et al. Determinants of premature rupture of membrane (PROM) among pregnant women in Southern Ethiopia: a case-control study. Int J Womens Health. 2022; 14: 455–466. https://doi.org/10.2147/IJWH.S352348
10. Lee HJ, Park TC, and Norwitz ER. Management of pregnancies with cervical shortening: a very short cervix is a very big problem. Rev Obstet Gynecol. 2009; 2(2): 107–115.
11. Hassanzadeh A, Paknahad Z, and Khoigani MG. The relationship between macro- and micro- nutrients intake and risk of preterm premature rupture of membranes in pregnant women of Isfahan. Adv Biomed Res. 2016; 5: 155. https://doi.org/10.4103/2277-9175.188949
12. Ghomian N, Hafizi L, and Takhti Z. The role of vitamin C in prevention of preterm premature rup-ture of membranes. Iran Red Crescent Med J. 2013; 15(2): 113–116. https://doi.org/10.5812/ircmj.5138
13. Sharma R, and Mehta S. Ascorbic acid concentra-tion and preterm premature rupture of membranes. J Obstet Gynaecol India. 2014; 64(6): 417–420. https://doi.org/10.1007/s13224-014-0570-z
14. Dayal S, and Hong PL. Premature rupture of mem-branes. [Updated 2021 Nov 2]. StatPearls. Treasure Island, FL: StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK532888/
15. Ronzoni S, Steckle V, D’Souza R, et al. Cytokine changes in maternal peripheral blood correlate with time-to-delivery in pregnancies complicated by premature prelabor rupture of the membranes. Reprod Sci. 2019; 26(9): 1266–1276. https://doi.org/10.1177/1933719118815590
16. Soydinc HE, Sak ME, Evliyaoglu O, et al. Prolidase, matrix metalloproteinases 1 and 13 activity, oxidative-antioxidative status as a marker of preterm premature rupture of membranes and chorioamnionitis in maternal vaginal washingfluids. Int J Med Sci. 2013; 10(10): 1344–1351. https://doi.org/10.7150/ijms.4802
17. Ghomian N, Hafizi L, and Takhti Z. The role of vitamin C in prevention of preterm premature rup-ture of membranes. Iran Red Crescent Med J. 2013; 15(2): 113–116. https://doi.org/10.5812/ircmj.5138
18. Pfeffer F, Casanueva E, Kamar J, et al. Modulation of 72-kilodalton type IV collagenase (Matrix metalloproteinase-2) by ascorbic acid in cul-tured human amnion-derived cells. Biol Reprod. 1998; 59(2): 326–329. https://doi.org/10.1095/biolreprod59.2.326
19 Bryant-Greenwood GD. The extracellular matrix of the human fetal membranes: structure and function. Placenta. 1998; 19(1): 1–11. https://doi.org/10.1016/S0143-4004(98)90092-3
20. Casanueva E, Ripoll C, Tolentino M, et al. Vitamin C supplementation to prevent premature rupture of the chorioamniotic membranes: a randomized trial. Am J Clin Nutr. 2005; 81(4): 859–863. https://doi.org/10.1093/ajcn/81.4.859
21. Hadley CB, Main DM, and Gabbe SG. Risk fac-tors for preterm premature rupture of the fetal membranes. Am J Perinatol. 1990; 7(4): 374–379. https://doi.org/10.1055/s-2007-999527
22. Premature rupture of the membranes. ACOG Practice Bulletin. Number 80. 2007 April. https://doi.org/10.1097/01.AOG.0000263888.69178.1f
23. Woods JR, Jr, Plessinger MA, and Miller RK. Vitamins C and E: missing links in preventing preterm premature rupture of membranes? Am J Obstet Gynecol. 2001 Jul; 185(1): 5–10. https://doi.org/10.1067/mob.2001.115868
24. Woods JR, Jr. Reactive oxygen species and preterm premature rupture of membranes – a review. Placenta. 2001 Apr; 22(Suppl A): S38–S44. https://doi.org/10.1053/plac.2001.0638
25. Spinnato JA, 2nd, Freire S, Pinto e Silva JL, et al. Antioxidant supplementation and premature rup-ture of the membranes: a planned secondary analy-sis. Am J Obstet Gynecol. 2008; 199(4): 433.e1–433.e4338. https://doi.org/10.1016/j.ajog.2008.07.011
26. Mercer BM, Rabello YA, Thurnau GR, et al. The NICHD-MFMU antibiotic treatment of preterm PROM study: impact of initial amniotic fluidvolume on pregnancy outcome. Am J Obstet Gynecol. 2006; 194(2): 438–445. https://doi.org/10.1016/j.ajog.2005.07.097
27. Simhan HN, and Canavan TP. Preterm prema-ture rupture of membranes: diagnosis, evalua-tion and management strategies. BJOG. 2005; 112(Suppl 1): 32–37. https://doi.org/10.1111/j.1471-0528.2005.00582.x
28. Barrett BM, Sowell A, Gunter E, et al. Potential role of ascorbic acid and beta-carotene in theprevention of preterm rupture of fetal membranes. Int J Vitam Nutr Res. 1994; 64(3): 192–197.
29. Hajifoghaha M, and Keshavarz T. Vitamin C sup-plementation and PROM. Iran J Obstet Gynecol Infertil. 2008; 11(2): 33–39.
30. Siega-Riz AM, Promislow JH, Savitz DA, et al. Vitamin C intake and the risk of preterm delivery. Am J Obstet Gynecol. 2003 Aug; 189(2): 519–525.https://doi.org/10.1067/S0002-9378(03)00363-6