First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh

Background: Tocopherols were discovered for their role in animal reproduction, but little is known about the contribution of deficiencies of vitamin E to human pregnancy loss. Objective: We sought to determine whether higher first-trimester concentrations of a-tocopherol and g-tocopherol were associated with reduced odds of miscarriage (pregnancy losses ,24 wk of gestation) in women of rural Bangladesh. Design: A case-cohort study in 1605 pregnant Bangladeshi women [median (IQR) gestational age: 10 wk (8‐13 wk)] who participated in a placebo-controlled vitamin A‐ or b-carotene‐supplementation trial was done to assess ORs of miscarriage in women with low a-tocopherol (,12.0 mmol/L) and g-tocopherol (,0.81 mmol/L; upper tertile cutoff of the g-tocopherol distribution in women who did not miscarry). Results: In all women, plasma a- and g-tocopherol concentrations were low [median (IQR): 10.04 mmol/L (8.07‐12.35 mmol/L) and 0.66 mmol/L (0.50‐0.95 mmol/L), respectively]. In a logistic regression analysis that was adjusted for cholesterol and the other tocopherol, low a-tocopherol was associated with an OR of 1.83 (95% CI: 1.04, 3.20), whereas a low g-tocopherol concentration was associated with an OR of 0.62 (95% CI: 0.41, 0.93) for miscarriage. Subgroup analyses revealed that opposing ORs were evident only in women with BMI (in kg/m 2 ) $18.5 and serum ferritin concentration #150 mg/L, although low BMI and elevated ferritin conferred stronger risk of miscarriage. Conclusions: In pregnant women in rural Bangladesh, low plasma a-tocopherol was associated with increased risk of miscarriage, and low g- tocopherol was associated with decreased risk of miscarriage. Maternal vitamin E status in the first trimester may influence risk of early pregnancy loss. The JiVitA-1 study, from which data for this report were derived, was registered at clinicaltrials.gov as GHS-A-00-03-00019-00. Am J Clin Nutr doi: 10.3945/ajcn. 114.094920.