Abstract
First, we would like to thank Talaulikar and Manyonda for their valuable comments. The international trial of antioxidants in the prevention of preeclampsia was planned in 2001 and 2002 in response to the trial by Chappell et al.1Chappell L.C. Seed P.T. Briley A.L. et al.Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomized trial.Lancet. 1999; 354: 810-816Abstract Full Text Full Text PDF PubMed Scopus (698) Google Scholar The trial was registered in the Randomized Controlled Trial Registry and the recruitment started in 2004. It was clearly our responsibility to report the results of the trial. The doses of vitamins C and E used in our trial were determined on the basis of the study by Chappell et al,1Chappell L.C. Seed P.T. Briley A.L. et al.Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomized trial.Lancet. 1999; 354: 810-816Abstract Full Text Full Text PDF PubMed Scopus (698) Google Scholar in which these doses not only reduced the objective evidence of oxidative stress but also reduced the frequency of preeclampsia (PE) in a population selected primarily on the basis of Doppler screening.1Chappell L.C. Seed P.T. Briley A.L. et al.Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomized trial.Lancet. 1999; 354: 810-816Abstract Full Text Full Text PDF PubMed Scopus (698) Google Scholar The etiology of PE remains poorly understood and many theories have been proposed, including the role of oxidative stress.2Dekker G.A. Sibai B.M. Etiology and pathogenesis of preeclampsia: current concepts.Am J Obstet Gynecol. 1998; 179: 1359-1375Abstract Full Text Full Text PDF PubMed Scopus (638) Google Scholar, 3Redman C.W. Sargent I.L. Latest advances in understanding preeclampsia.Science. 2005; 308: 1592-1594Crossref PubMed Scopus (1991) Google Scholar However, it still remains unclear whether oxidative stress plays a fundamental role in the pathophysiology of PE. We do agree that, before undertaking large-scale trials, it is important to have evidence concerning biological plausibility of an effect, and that solid data should be obtained on delineation of the dose-response relationships as well as the identification of the critical time windows during which supplementation may alter the risk of PE. The myth of vitamins C and E for the prevention of preeclampsia: just when will the penny drop?American Journal of Obstetrics & GynecologyVol. 203Issue 6PreviewWe read with interest the results of the trial by Xu et al1 titled “An international trial of antioxidants in the prevention of preeclampsia (INTAPP).” This is the sixth large clinical trial that has failed to demonstrate any benefit of vitamins C and E in preventing preeclampsia (PE). Hundreds of thousands (if not millions) of dollars, man hours, and other research resources have been expended on these studies. Yet, it should have become quite evident a few years back after the first couple of studies that vitamins C and E neither prevent nor ameliorate PE. Full-Text PDF
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