American Journal of Epidemiology Advance Access originally published online on June 13, 2006
American Journal of Epidemiology 2006 164(5):470-477; doi:10.1093/aje/kwj218
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Original Contribution |
Periconceptional Multivitamin Use Reduces the Risk of Preeclampsia
1 Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
2 Magee-Womens Research Institute, Pittsburgh, PA
3 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
4 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
5 Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
Correspondence to Dr. Lisa Bodnar, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, A742 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261 (e-mail: bodnar{at}edc.pitt.edu).
The objective was to assess the independent effect of regular periconceptional multivitamin use on the risk of preeclampsia. Pregnant women (n = 1,835) enrolled in the Pregnancy Exposures and Preeclampsia Prevention Study (Pittsburgh, Pennsylvania, 1997–2001) at less than 16 weeks' gestation were asked whether they regularly used multivitamins or prenatal vitamins in the past 6 months. Women were classified as users or nonusers. The unadjusted prevalence of preeclampsia was 4.4% in nonusers and 3.8% in users. After adjustment for race/ethnicity, marital status, parity, prepregnancy physical activity, and income in a multiple logistic regression model, regular use of multivitamins was associated with a 45% reduction in preeclampsia risk compared with nonuse (odds ratio (OR) = 0.55, 95% confidence interval (CI): 0.32, 0.95). Prepregnancy overweight modified this effect. After confounder adjustment, lean multivitamin users had a 71% reduction in preeclampsia risk compared with lean nonusers (OR = 0.29, 95% CI: 0.12, 0.65). In contrast, there was no relation between multivitamin use and preeclampsia among overweight women (OR = 1.08, 95% CI: 0.52, 2.25). A sensitivity analysis for unmeasured confounding by fruit and vegetable intake supported these conclusions. If confirmed by others, these results suggest that regular use of a multivitamin supplement in the periconceptional period may help to prevent preeclampsia, particularly among lean women.
body mass index; dietary supplements; obesity; pre-eclampsia; pregnancy; vitamins; women
Abbreviations: CI, confidence interval; OR, odds ratio
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