Abstract
Objective: To evaluate the impact of high-flavanol and high-theobromine (HFHT) chocolate in women at risk of preeclampsia (PE). Study design: We conducted a single-center randomized controlled trial including women with singleton pregnancy between 11 and 14 weeks gestation who had bilateral abnormal uterine artery (UtA) waveforms (notching) and elevated pulsatility index (PI). Participants were randomized to either HFHT or low-flavanol and low-theobromine (LFLT) chocolate (30 grams daily for a total of 12 weeks). UtA PI, reported as multiple of medians (MoM) adjusted for gestational age, was assessed at baseline and 12 weeks after randomization. Results: One hundred thirty-one women were randomized with mean gestational age of 12.4 ± 0.6 weeks and a mean UtA PI of 1.39 ± 0.31 MoM. UtA PI adjusted for gestational age significantly decreased from baseline to the second visit (12 weeks later) in the two groups (p < 0.0001) but no significant difference was observed between the groups (p = 0.16). Conclusions: Compared with LFLT chocolate, daily intake of HFHT chocolate was not associated with significant changes of UtA PI. Nevertheless, the improvement observed in both groups suggests that chocolate could improve placental function independently of flavanol and/or theobromine content.
Highlights
Preeclampsia (PE) is a multisystemic disorder that originates in early pregnancy and is one of the most common causes of maternal and fetal mortality and morbidity in the world, including developed countries [1,2,3]
We observed no significant difference in terms of uterine artery (UtA) pulsatility index (PI) with 12 weeks consumption of high-flavanol and high-theobromine (HFHT) compared to low-flavanol and low-theobromine (LFLT) chocolate from 11-14 weeks of gestation
These findings suggest that concentrations of flavanol or theobromine in chocolate had no significant impact on deep placentation, but chocolate could have a positive effect on deep placentation that would be independent to flavanol or theobromine content
Summary
Preeclampsia (PE) is a multisystemic disorder that originates in early pregnancy and is one of the most common causes of maternal and fetal mortality and morbidity in the world, including developed countries [1,2,3]. PE, defined by new-onset gestational hypertension and proteinuria, is commonly associated with deep placentation disorders and is characterized by generalized maternal dysfunction of the endothelium [4, 5]. Low-dose aspirin has been shown to reduce the risk of PE only when started in early pregnancy [7]. This situation underlines the importance to devote efforts in integrating methods aimed to detect pregnant women at risk of PE as part of usual antenatal care in early pregnancy. The UtA pulsatility index (PI) is typically increased in presence of PE and abnormal utero-placental circulation
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