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The effect of selenium supplementation in pregnant women on maternal, fetal, and newborn outcomes: a systematic review and meta-analysis.
McDougall, AR, Dore, G, Aboud, L, Makama, M, Nguyen, PY, Mills, K, Sanderson, B, Hastie, R, Ammerdorffer, A, Vogel, JP
American journal of obstetrics & gynecology MFM. 2023;5(11):101160
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Observational data show preterm birth risk is increased with low maternal selenium serum levels. Selenium is routinely included in supplements marketed to pregnant women, although studies have drawn conflicting findings about whether it provides benefit. The aim of this study was to identify and analyse the available interventional and observational evidence of the effect of selenium supplementation during pregnancy on preterm birth (PTB) prevention. This study was a systematic review of thirty-two studies - 5 observational studies and 27 randomised trials. Results showed that there was no association between selenium supplementation and any clinical outcome. Authors concluded that since there was insufficient evidence in all outcomes, selenium supplementation during pregnancy cannot be recommended as a part of routine antenatal care.
Abstract
OBJECTIVE Low maternal selenium status has been associated with poor pregnancy outcomes, including preterm birth. This study aimed to evaluate available evidence of the effects of selenium supplementation during pregnancy on preterm birth and related maternal, fetal, and newborn outcomes. DATA SOURCES MEDLINE, Embase, CINAHL, Global Index Medicus, and the Cochrane Library were systematically searched on June 23, 2022, without language or time restrictions. STUDY ELIGIBILITY CRITERIA Randomized controlled trials and nonrandomized interventional studies were included if they compared the effects of selenium supplementation with placebo or no treatment among pregnant women. The review protocol was registered in the International Prospective Register of Systematic Reviews (identification number: CRD42022383669). METHODS For outcomes reported by ≥1 study, a meta-analysis was conducted. Because of the small number of studies and high clinical heterogeneity between populations, random-effects models were used. The Risk of Bias 2 and Risk Of Bias In Non-randomized Studies - of Interventions tools were used to assess study quality, and Grading of Recommendations Assessment, Development, and Evaluation analysis was used to determine the certainty of evidence for each outcome. RESULTS Literature searches identified 5105 unique records, and 32 studies met the eligibility criteria. Of note, 11 reports were not included for analysis following research integrity assessments. Moreover, 10 trials and 3 observational studies met the inclusion criteria; however, only 8 trials (1851 women) and 1 prospective cohort study (71,728 women) reported on at least 1 review outcome. Our results could not determine the effect of selenium supplementation on preterm birth at <37 weeks of gestation (relative risk, 0.65; 95% confidence interval, 0.26-1.63; very low certainty evidence) and <34 weeks of gestation (relative risk, 1.05; 95% confidence interval, 0.59-1.44; very low certainty evidence). CONCLUSION There is limited evidence on the effects of selenium supplementation during pregnancy. Further trials, with larger sample sizes, more representative populations, and reliable assessment of maternal selenium status at trial entry, are required.
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'The long tail of Covid-19' - The detection of a prolonged inflammatory response after a SARS-CoV-2 infection in asymptomatic and mildly affected patients.
Doykov, I, Hällqvist, J, Gilmour, KC, Grandjean, L, Mills, K, Heywood, WE
F1000Research. 2020;9:1349
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‘Long COVID’ or the persistence of symptoms after SARS-CoV-2 infection, such as fatigue, is becoming increasingly common. As the emergence of the virus is still relatively recent in research terms, little is known about the long-term impact of the viruses infection. This study sought to generate further insights into the management and diagnostic of long COVID, by assessing a range of inflammatory markers from blood serum samples. Examined were 10 samples of health care workers with previous asymptomatic or moderate SARS-CoV-2 infections, compared to 10 samples of SARS-CoV-2 naive health care workers. The serum was analyzed by mass spectrometry using a customized panel of the 96 immune response associated proteins. Despite being mild to moderate cases, the results showed that even 40-60 days after infection, significant disturbance in the immune systems inflammatory response could be observed. Particularly markers that reflect anti-inflammatory pathways and mitochondrial stress. The study highlighted six of the most noteworthy proteins and included a brief description of their role. The authors suggest that analysing proteins by using targeted proteomic technology, could serve as a cost-effective strategy to further investigate the changes in inflammatory responses post SARS-CoV-2 infection. Which could help to aid the identification of potential treatment targets in the future. Relevant findings from this small study for clinical practice are that even mild to moderate SARS-CoV-2 infection can alter the inflammatory responses for months afterwards.
Abstract
'Long Covid', or medical complications associated with post SARS-CoV-2 infection, is a significant post-viral complication that is being more and more commonly reported in patients. Therefore, there is an increasing need to understand the disease mechanisms, identify drug targets and inflammatory processes associated with a SARS-CoV-2 infection. To address this need, we created a targeted mass spectrometry based multiplexed panel of 96 immune response associated proteins. We applied the multiplex assay to a cohort of serum samples from asymptomatic and moderately affected patients. All patients had tested positive for a SARS-CoV-2 infection by PCR and were determined to be subsequently positive for antibodies. Even 40-60 days post-viral infection, we observed a significant remaining inflammatory response in all patients. Proteins that were still affected were associated with the anti-inflammatory response and mitochondrial stress. This indicates that biochemical and inflammatory pathways within the body can remain perturbed long after SARS-CoV-2 infections have subsided even in asymptomatic and moderately affected patients.