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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (3): 470-478. doi: 10.19723/j.issn.1671-167X.2020.03.012

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Relationship between serum vitamin E concentration in first trimester and the risk of developing hypertension disorders complicating pregnancy

Wen-ying MENG1,Wan-tong HUANG2,Jie ZHANG2,Ming-yuan JIAO3,Lei JIN4,Lei JIN2,△()   

  1. 1. Department of Obstetrics, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
    2. Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    3. Department of Clinical Laboratory, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
    4. Department of Maternal Health Care, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
  • Received:2020-02-16 Online:2020-06-18 Published:2020-06-30
  • Contact: Lei JIN E-mail:songyi@bjmu.edu.cn
  • Supported by:
    National Key R&D Program of China(2018YFC1004301)

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Abstract:

Objective: To investigate the incidence of hypertension disorders complicating pregnancy (HDCP) and vitamin E (VE) nutritional status among pregnant women in Beijing, and to determine the relationship between serum VE concentration in the first trimester of pregnancy and the risk of developing HDCP.Methods: A retrospective cohort study was performed including 22 283 cases of pregnant women who underwent singleton deliveries in Tongzhou Maternal & Child Health Hospital of Beijing from January 2016 through December 2018 and received tests of serum VE concentrations in the first trimester of pregnancy. Nonconditional Logistic regression model was used to analyze the association between serum VE concentration levels and the risk of developing HDCP.Results: The total incidence of HDCP was 5.4%, with the incidence of gestational hypertension around 2.1% and the incidence of preeclampsia-eclampsia around 3.3%. The median concentration of serum VE in early pregnancy was 10.1 (8.8-11.6) mg/L, and 99.7% of the participants had normal serum VE concentrations. The incidence of gestational hypertension and that of preeclampsia-eclampsia had been annually increasing in three years; a linear-by-linear association had also been observed between the serum VE concentrations and the years of delivery. According to the results of the univariable and the multivariable Logistic regression analyses, higher risks of developing HDCP had been observed among women with higher serum VE concentrations. Compared to those with serum VE concentrations in interquartile range (P25-P75) of all the participants, the women whose serum VE concentrations above P75 were at higher risks to be attacked by HDCP (OR = 1.34, P < 0.001), gestational hypertension (OR = 1.39, P = 0.002), or preeclampsia-eclampsia (OR = 1.34, P = 0.001), as suggested by the results of the multivariable Logistic regression model analyses. In addition, the women with serum VE concentrations of 11.2 mg/L or above had a significantly higher risk of developing HDCP than those whose serum VE concentrations of P40-P60 of all the participants, and this risk grew higher as serum VE concentrations in the first trimester of pregnancy increased.Conclusion: Women in Beijing are at good nutritional status. From January 2016 to December 2018, the incidence of HDCP increased with serum VE concentration level, and serum VE concentration of 11.2 mg/L is an indicator of an increased risk of developing HDCP, suggesting that pregnant women should take nutritional supplements containing VE carefully.

Key words: Hypertension, Eclampsia, Pregnancy, Vitamin E, Cohort study

CLC Number: 

  • R172

Figure 1

Flow diagram of study sample selection"

Table 1

General characteristics of the participants by their vitamin E nutritional status"

Characteristics Total number
(n = 22 283),
n (%)		 VE normala
(n = 22 206),
n (%)		 VE deficienta
(n = 13),
n (%)		 VE excessivea
(n = 64),
n (%)		 P
Delivery year
2016 7 216 (32.4) 7 194 (32.4) 10 (76.9) 12 (18.8) 0.001b
2017 7 677 (34.5) 7 653 (34.5) 1 (7.7) 23 (35.9)
2018 7 390 (33.2) 7 359 (33.1) 2 (15.4) 29 (45.3)
Maternal age/years
17 - 1 996 (9.0) 1 988 (9.0) 4 (30.8) 4 (6.3) 0.001b
25 - 10 501 (47.1) 10 476 (47.2) 6 (46.2) 19 (29.7)
30 - 7 313 (32.8) 7 287 (32.8) 2 (15.4) 24 (37.5)
35 - 51 2 473 (11.1) 2 455 (11.1) 1 (7.7) 17 (26.6)
Ethnic
Han 20 959 (94.1) 20 885 (94.1) 12 (92.3) 62 (96.9) 0.523b
Others 1 324 (5.9) 1 321 (5.9) 1 (7.7) 2 (3.1)
Education level
Middle school or lower 1 905 (8.5) 1 902 (8.6) 2 (15.4) 1 (1.6) 0.080b
High school or secondary technical school 4 219 (18.9) 4 199 (18.9) 4 (30.8) 16 (25.0)
College 7 168 (32.2) 7 140 (32.2) 5 (38.5) 23 (35.9)
University or above 8 991 (40.3) 8 965 (40.4) 2 (15.4) 24 (37.5)
Pre-pregnant BMI
Normal 14 079 (63.2) 14 046 (63.3) 9 (69.2) 24 (37.5) <0.001b
Underweight 2 340 (10.5) 2 334 (10.5) 2 (15.4) 4 (6.3)
Overweight 4 501 (20.2) 4 473 (20.1) 2 (15.4) 26 (40.6)
Obesity 1 363 (6.1) 1 353 (6.1) 0 (0.0) 10 (15.6)
Parity
Nulliparity 12 039 (54.0) 11 996 (54.0) 7 (53.8) 36 (56.3) 0.957
Multiparity 10 244 (46.0) 10 210 (46.0) 6 (46.2) 28 (43.8)
Family history of hypertension
No 21 337 (95.8) 21 261 (95.7) 13 (100.0) 63 (98.4) 0.731b
Yes 946 (4.2) 945 (4.3) 0 (0.0) 1 (1.6)
Family history of diabetes
No 21 871 (98.2) 21 795 (98.1) 13 (100.0) 63 (98.4) 1.000 b
Yes 412 (1.8) 411 (1.9) 0 (0.0) 1 (1.6)

Table 2

Trend of serum vitamin E concentrations by year of delivery in first trimester of pregnancy among the participants from January 2016 through December 2018"

Year of delivery n Median (P25- P75)/
(mg/L)a		 Number of women in different serum vitamin E concentration levels, n (%)
< P20 P20- P40 P40- P60 P60- P80 > P80 Pb
2016 7 216 9.7 (8.5-11.2) 1 776 (24.6) 1 573 (21.8) 1 392 (19.3) 1 313 (18.2) 1 162 (16.1) <0.001
2017 7 677 10.2 (9.0-11.8) 1 269 (16.5) 1 500 (19.5) 1 522 (19.8) 1 618 (21.1) 1 768 (23.0)
2018 7 390 10.3 (8.9-11.8) 1 319 (17.8) 1 406 (19.0) 1 383 (18.7) 1 541 (20.9) 1 741 (23.6)
Total 22 283 10.1 (8.8-11.6) 4 364 (19.6) 4 479 (20.1) 4 297 (19.3) 4 472 (20.1) 4 671 (21.0)

Table 3

The incidences of HDCP among participants from January 2016 through December 2018 [n (%)]"

Year of delivery n HDCP Gestational hypertension Mild preeclampsia Severe preeclampsia Eclampsia
2016 7 216 345 (4.8) 150 (2.1) 95 (1.3) 100 (1.4) 0 (0.0)
2017 7 677 428 (5.6) 147 (1.9) 152 (2.0) 126 (1.6) 3 (< 0.1)
2018 7 390 432 (5.8) 179 (2.4) 115 (1.6) 136 (1.8) 2 (< 0.1)
Total 22 283 1 205 (5.4) 476 (2.1) 362 (1.6) 362 (1.6) 5 (< 0.1)
χtrend2a - 8.058 2.286 1.420 5.435b
P - 0.005 0.131 0.233 0.020

Table 4

The incidences of HDCP among participants by their vitamin E nutritional status [n (%)]"

VE nutritional statusa n HDCP Gestational hypertension Mild preeclampsia Severe preeclampsia Eclampsia
Normal 22 206 1 197 (5.4) 472 (2.1) 359 (1.6) 361 (1.6) 5 (< 0.1)
Deficient 13 1 (7.7) 1 (7.7) 0 (0.0) 0 (0.0) 0 (0.0)
Excessive 64 7 (10.9) 3 (4.7) 3 (4.7) 1 (1.6) 0 (0.0)
Total 22 283 1 205 (5.4) 476 (2.1) 362 (1.6) 362 (1.6) 5 (< 0.1)

Table 5

Association between serum vitamin E concentrations in first trimester of pregnancy and the risks of HDCP"

Outcome VE concentration
levels /(mg/L)		 n Incidences,
n (%)		 Crude
OR (95%CI)		 P Adjusted
OR (95%CI)a		 P
HDCP
8.8 - 11.6 11 360 567 (5.0) 1.00 1.00
< 8.8 5 442 250 (4.6) 0.92 (0.79 - 1.07) 0.263 0.98 (0.84 - 1.14) 0.766
> 11.6 5 481 388 (7.1) 1.45 (1.27 - 1.66) <0.001 1.34 (1.17 - 1.53) <0.001
Gestational hypertension
8.8 - 11.6 11 008 215 (2.0) 1.00 1.00
< 8.8 5 303 111 (2.1) 1.07 (0.85 - 1.35) 0.550 1.13 (0.89 - 1.42) 0.321
> 11.6 5 243 150 (2.9) 1.48 (1.20 - 1.83) <0.001 1.39 (1.13 - 1.72) 0.002
Preeclampsia-eclampsia
8.8 - 11.6 11 145 352 (3.2) 1.00 1.00
< 8.8 5 331 139 (2.6) 0.82 (0.67 - 1.00) 0.052 0.88 (0.72 - 1.07) 0.206
> 11.6 5 331 238 (4.5) 1.43 (1.21 - 1.70) <0.001 1.34 (1.13 - 1.59) 0.001

Table 6

Variation of pre-pregnant body mass index of the participants by years of delivery [n(%)]"

Year of delivery n Underweight Normal Overweight Obesity Pa
2016 7 216 790 (10.9) 4 596 (63.7) 1 353 (18.8) 477 (6.6) 0.651
2017 7 677 786 (10.2) 4 788 (62.4) 1 644 (21.4) 459 (6.0)
2018 7 390 764 (10.3) 4 695 (63.5) 1 504 (20.4) 427 (5.8)
Total 22 283 2 340 (10.5) 14 079 (63.2) 4 501 (20.2) 1 363 (6.1)

Table 7

The relationships between pre-pregnant BMI and incidence of HDCP or serum vitamin E concentration levels in the women at first trimester of pregnancy"

Pre-pregnant BMI n HDCP VE concentration/(mg/L)
Incidence (n, %)a AOR (95%CI)b Median (P25 - P75) Pc Pd Pe
Underweight 2 340 62 (2.6) 0.64 (0.49 - 0.83) 9.8 (8.5 - 11.2) <0.001 <0.001 -
Normal 14 079 568 (4.0) 1.00 10.0 (8.7 - 11.5) - -
Overweight 4 501 374 (8.3) 2.15 (1.87 - 2.47) 10.4 (9.1 - 12.0) <0.001 0.723
Obesity 1 363 201 (14.7) 4.12 (3.46 - 4.91) 10.5 (9.1 - 12.2) <0.001
All participants 22 283 1 205 (5.4) - 10.1 (8.8 - 11.6) - -

Figure 2

The crude odds ratios (95%CI) for incidences of HDCP at different serum vitamin E concentration levels in women in first trimester of pregnancy (n = 22 283) COR, crude odds ratio; CI, confidence interval; VE, vitamin E."

Figure 3

The adjusted odds ratios (95%CI) for incidences of HDCP at different serum vitamin E concentration levels in women in first trimester of pregnancy (n = 22 283) The potential confounders in the multivariable Logistic regression models were: year of delivery; maternal age; education level; parity; pre-pregnant BMI; family history of hypertension; family history of diabetes. AOR, adjusted odds ratio; CI, confidence interval."

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