Antioxidants in the treatment of severe pre-eclampsia: An explanatory randomised controlled trial

Objective To determine whether antioxidant therapy alters the disease process in severe early onset preeclampsia, in support of the hypothesis that increased lipid peroxides and reactive oxygen species production play an important role in the pathogenesis of the disease. Design Randomised, double-blind, placebo controlled trial. Setting Two tertiary care, referral hospitals in Johannesburg, South Africa. Participants Women with severe pre-eclampsia diagnosed between 24 and 32 weeks of gestation. Intervention Combined antioxidant treatment with vitamin E (800 IU/day), vitamin C (1000 mg/day), and allopurinol(200 mg/day). Main outcome measures Primary outcomes: 1. prolongation of pregnancy and 2. biochemical assessment of lipid peroxides and antioxidants. Secondary outcomes: data on maternal complications, side effects of treatment, infant outcomes and regular assessment of haematologic and renal parameters. Results The proportion of women delivered within 14 days in the antioxidant group was 52% (14/27) compared with 76% (22/29) in the placebo group (relative risk 0.68, 95% confidence interval 0.45-1.04). One woman in each group had eclampsia. Eleven women (42%) in the antioxidant and 16 (59%) in the placebo group required two antihypertensives for blood pressure control. Trial medications were well tolerated with few side effects. Lipid peroxide levels were not significantly altered in the antioxidant and placebo groups. Serum uric acid levels decreased and vitamin E levels increased significantly. Conclusion The results of this explanatory randomised trial do not encourage the routine use of antioxidants against pre-eclampsia. However, further research with modified strategies such as earlier initiation of therapy or different combinations seem worthwhile.