The correlation between serum selenium levels in pregnant females and preterm birth: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Lu ^1,2 , WEI Lili ^3,4 ,  LIU Donghai ^1,2 , WANG Jiabin ^2,5 , WANG Yanxia ² , MAO Baohong ² , HU Yaguang ² , QIU Jie ^2,5 ,  YANG Kehu ^3,4,5

1. Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou 730000, P.R.China;
2. Gansu Provincial Maternity and Child-care Hospital, Lanzhou 730050, P.R.China;
3. Evidence-based Medicine Center of Lanzhou University, Lanzhou 730000, P.R.China;
4. Key Laboratory of Evidence-Based Medicine and Clinical Transformation in Gansu Province, Lanzhou 730000, P.R.China;
5. School of Public Health, Lanzhou University, Lanzhou 730000, P.R.China;

Corresponding author：

LIU Donghai, Email: ldhai2005@163.com; YANG Kehu, Email: kehuyang2006@126.com

Keywords：

Selenium; Pregnant; Preterm birth; Meta-analysis; Case-control study; Cohort study

DOI：

10.7507/1672-2531.201909079

Video：

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Objectives To systematically review the correlation between maternal serum selenium levels during pregnancy and premature birth.Methods Databases including PubMed, The Cochrane Library, EMbase, Web of Science, CNKI and CBM were searched to collect studies on correlation between maternal serum selenium levels during pregnancy with preterm birth in the offspring from inception to January, 2020. Two reviewers independently screened literature, extracted data and evaluated risk of bias of the included literature. Then, meta-analysis was conducted by using RevMan 5.3 software.Results A total of 12 studies involving 2 484 patients were included. The results of meta-analysis showed that compared with control group, the preterm group had lower serum selenium levels in pregnant females (SMD=−0.89, 95%CI −1.56 to −0.22, P=0.01). The results of the subgroup analysis showed that heterogeneity among subjects was still large when grouped accorcding to the continent to which a country belongs, the time of blood sample collection and test method in pregnant females.Conclusions Low maternal serum selenium levels during pregnancy may increase the risk of preterm birth. Due to the limitation of the quantity and quality of the included studies, the above conclusions are required to be verified by more high quality studies.

Citation： LIU Lu, WEI Lili, LIU Donghai, WANG Jiabin, WANG Yanxia, MAO Baohong, HU Yaguang, QIU Jie, YANG Kehu. The correlation between serum selenium levels in pregnant females and preterm birth: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(9): 1045-1051. doi: 10.7507/1672-2531.201909079 Copy

1.	Rayman MP, Wijnen H, Vader H, <italic>et al</italic>. Maternal selenium status during early gestation and risk for preterm birth. CMAJ, 2011, 183(5): 549-555.
2.	Barman M, Brantsæter AL, Nilsson S, <italic>et al</italic>. Maternal dietary selenium intake is associated with increased gestational length and decreased risk of preterm delivery. Br J Nutr, 2020, 123(2): 209-219.
3.	Hofman PL, Regan F, Jackson WE, <italic>et al</italic>. Premature birth and later insulin resistance. N Engl J Med, 2004, 351(21): 2179-2186.
4.	Hovi P, Andersson S, Eriksson JG, <italic>et al</italic>. Glucose regulation in young adults with very low birth weight. N Engl J Med, 2007, 356(20): 2053-2063.
5.	Hammouda SA, Abd Al-Halim OA, Mohamadin AM. Serum levels of some micronutrients and congenital malformations: a prospective cohort study in healthy saudi-arabian first-trimester pregnant women. Int J Vitam Nutr Res, 2013, 83(6): 346-354.
6.	江燕萍, 欧艳秋, 韩凤珍, 等. 孕母全血中硒浓度与子代先天性心脏病发生的关系. 中华疾病控制杂志, 2017, 21(10): 1066-1070.
7.	黎祺, 魏捷, 吴欣锐, 等. 中老年人膳食硒与高血压关系的横断面研究. 中华疾病控制杂志, 2017, 21(3): 219-222.
8.	Tindell R, Tipple T. Selenium: implications for outcomes in extremely preterm infants. J Perinatol, 2018, 38(3): 197-202.
9.	Mariath AB, Bergamaschi DP, Rondó PH, <italic>et al</italic>. The possible role of selenium status in adverse pregnancy outcomes. Br J Nutr, 2011, 105(10): 1418-1428.
10.	Carmichael SL, Yang W, Shaw GM, <italic>et al</italic>. Maternal dietary nutrient intake and risk of preterm delivery. Am J Perinatol, 2013, 30(7): 579-588.
11.	Fowles ER. Prenatal nutrition and birth outcomes. J Obstet Gynecol Neonatal Nurs, 2004, 33(6): 809-822.
12.	Ferguson LR, Karunasinghe N. Nutrigenetics, nutrigenomics, and selenium. Front Genet, 2011, 2: 15.
13.	Mistry HD, Williams PJ. The importance of antioxidant micronutrients in pregnancy. Oxid Med Cell Longev, 2011, 2011: 841749.
14.	Hovdenak N, Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol, 2012, 164(2): 127-132.
15.	Chao HC. Impact of maternal selenium supplementation on neonates. Pediatr Neonatol, 2012, 53(6): 327-328.
16.	Makwe CC, Nwabua FI, Anorlu RI. Selenium status and infant birth weight among HIV-positive and HIV-negative pregnant women in Lagos, Nigeria. Nig Q J Hosp Med, 2015, 25(3): 209-215.
17.	Pieczyńska J, Grajeta H. The role of selenium in human conception and pregnancy. J Trace Elem Med Biol, 2015, 29: 31-38.
18.	Thomson CD. Assessment of requirements for selenium and adequacy of selenium status: a review. Eur J Clin Nutr, 2004, 58(3): 391-402.
19.	Bogden JD, Kemp FW, Chen XH, <italic>et al</italic>. Low-normal serum selenium early in human pregnancy predicts lower birth weight. Braz J Anesthesiol, 2006, 26(10): 497-502.
20.	杨克虎, 田金徽, 李伦. 网状Mete分析方法与实践. 北京: 中国医药科技出版社, 2017.
21.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
22.	Irwinda R, Wibowo N, Putri AS. The concentration of micronutrients and heavy metals in maternal serum, placenta, and cord blood: a cross-sectional study in preterm birth. J Pregnancy, 2019, 2019: 5062365.
23.	Yıldırım E, Derici MK, Demir E, <italic>et al</italic>. Is the concentration of cadmium, lead, mercury, and selenium related to preterm birth? Biol Trace Elem Res, 2019, 191(2): 306-312.
24.	Bebars GM, Kamel BA, Allam E. Comparison between preterm and full term neonatal cord selenium in correlation to maternal serum selenium levels. Gaz Egypt Paediatr Assoc, 2018, 66(4): 96-99.
25.	孙晓蓉. 妊娠不良结局孕妇孕期血清微量元素的变化分析. 广西医学, 2014, 36(7): 956-958.
26.	Tsuzuki S, Morimoto N, Hosokawa S, <italic>et al</italic>. Associations of maternal and neonatal serum trace element concentrations with neonatal birth weight. PLoS One, 2013, 8(9): e75627.
27.	Tara F, Rayman MP, Boskabadi H, <italic>et al</italic>. Selenium supplementation and premature (pre-labour) rupture of membranes: a randomised double-blind placebo-controlled trial. J Obstet Gynaecol, 2010, 30(1): 30-34.
28.	Iranpour R, Zandian A, Mohammadizadeh M, et al. Comparison of maternal and umbilical cord blood selenium levels in term and preterm infants. 中国当代儿科杂志, 2009, 11(7): 513-516.
29.	Makhoul IR, Sammour RN, Diamond E, <italic>et al</italic>. Selenium concentrations in maternal and umbilical cord blood at 24-42 weeks of gestation: basis for optimization of selenium supplementation to premature infants. Clin Nutr, 2004, 23(3): 373-381.
30.	Gathwala G, Yadav OP, Sangwan K, <italic>et al</italic>. A study on plasma selenium level among pregnant women at Rohtak, Haryana. Indian J Public Health, 2003, 47(2): 45-48.
31.	Dobrzynski W, Trafikowska U, Trafikowska A, <italic>et al</italic>. Decreased selenium concentration in maternal and cord blood in preterm compared with term delivery. Analyst, 1998, 123(1): 93-97.
32.	Black RE. Micronutrients in pregnancy. Br J Nutr, 2001, 85(Suppl 2): S193-S197.
33.	Benstoem C, Goetzenich A, Kraemer S, <italic>et al</italic>. Selenium and its supplementation in cardiovascular disease--what do we know? Nutrients, 2015, 7(5): 3094-3118.
34.	Nordberg GF, Fowler BA, Nordberg M, et al. Handbook on the toxicology of metals (4^th edition). Elsevier, 2015.
35.	Darnton-Hill I, Mkparu UC. Micronutrients in pregnancy in low- and middle-income countries. Nutrients, 2015, 7(3): 1744-1768.
36.	Szybiński Z, Walas S, Zagrodzki P, <italic>et al</italic>. Iodine, selenium, and other trace elements in urine of pregnant women. Biol Trace Elem Res, 2010, 138(1-3): 28-41.
37.	Izquierdo Alvarez S, Castañón SG, Ruata ML, <italic>et al</italic>. Updating of normal levels of copper, zinc and selenium in serum of pregnant women. J Trace Elem Med Biol, 2007, 21(Suppl 1): 49-52.
38.	Kilinc M, Coskun A, Bilge F, <italic>et al</italic>. Serum reference levels of selenium, zinc and copper in healthy pregnant women at a prenatal screening program in southeastern Mediterranean region of Turkey. J Trace Elem Med Biol, 2010, 24(3): 152-156.
39.	Choi R, Sun J, Yoo H, <italic>et al</italic>. A prospective study of serum trace elements in healthy Korean pregnant women. Nutrients, 2016, 8(11): 749.
40.	Hatfield DL, Schweizer U, Tsuji PA, et al. Selenium: its molecular biology and role in human health (4^th edition). Springer International Publishing, 2016.
41.	Khera A, Vanderlelie JJ, Holland O, <italic>et al</italic>. Overexpression of endogenous anti-oxidants with selenium supplementation protects trophoblast cells from reactive oxygen species-induced apoptosis in a bcl-2-dependent manner. Biol Trace Elem Res, 2017, 177(2): 394-403.
42.	Chen CY, Chen CP, Lin KH. Biological functions of thyroid hormone in placenta. Int J Mol Sci, 2015, 16(2): 4161-4179.
43.	Lozano M, Murcia M, Soler-Blasco R, <italic>et al</italic>. Prenatal Se concentrations and anthropometry at birth in the INMA study (Spain). Environ Res, 2020, 181: 108943.
44.	McAlpine JM, McKeating DR, Vincze L, <italic>et al</italic>. Essential mineral intake during pregnancy and its association with maternal health and birth outcomes in south east Queensland, Australia. Nutr Metab Insights, 2019, 12: 1178638819879444.
45.	Okunade KS, Olowoselu OF, Osanyin GE, <italic>et al</italic>. Selenium deficiency and pregnancy outcome in pregnant women with HIV in Lagos, Nigeria. Int J Gynaecol Obstet, 2018, 142(2): 207-213.
46.	Wells EM, Herbstman JB, Lin YH, <italic>et al</italic>. Cord blood methylmercury and fetal growth outcomes in baltimore newborns: potential confounding and effect modification by omega-3 fatty acids, selenium, and sex. Environ Health Perspect, 2016, 124(3): 373-379.

1. Rayman MP, Wijnen H, Vader H, <italic>et al</italic>. Maternal selenium status during early gestation and risk for preterm birth. CMAJ, 2011, 183(5): 549-555.
2. Barman M, Brantsæter AL, Nilsson S, <italic>et al</italic>. Maternal dietary selenium intake is associated with increased gestational length and decreased risk of preterm delivery. Br J Nutr, 2020, 123(2): 209-219.
3. Hofman PL, Regan F, Jackson WE, <italic>et al</italic>. Premature birth and later insulin resistance. N Engl J Med, 2004, 351(21): 2179-2186.
4. Hovi P, Andersson S, Eriksson JG, <italic>et al</italic>. Glucose regulation in young adults with very low birth weight. N Engl J Med, 2007, 356(20): 2053-2063.
5. Hammouda SA, Abd Al-Halim OA, Mohamadin AM. Serum levels of some micronutrients and congenital malformations: a prospective cohort study in healthy saudi-arabian first-trimester pregnant women. Int J Vitam Nutr Res, 2013, 83(6): 346-354.
6. 江燕萍, 欧艳秋, 韩凤珍, 等. 孕母全血中硒浓度与子代先天性心脏病发生的关系. 中华疾病控制杂志, 2017, 21(10): 1066-1070.
7. 黎祺, 魏捷, 吴欣锐, 等. 中老年人膳食硒与高血压关系的横断面研究. 中华疾病控制杂志, 2017, 21(3): 219-222.
8. Tindell R, Tipple T. Selenium: implications for outcomes in extremely preterm infants. J Perinatol, 2018, 38(3): 197-202.
9. Mariath AB, Bergamaschi DP, Rondó PH, <italic>et al</italic>. The possible role of selenium status in adverse pregnancy outcomes. Br J Nutr, 2011, 105(10): 1418-1428.
10. Carmichael SL, Yang W, Shaw GM, <italic>et al</italic>. Maternal dietary nutrient intake and risk of preterm delivery. Am J Perinatol, 2013, 30(7): 579-588.
11. Fowles ER. Prenatal nutrition and birth outcomes. J Obstet Gynecol Neonatal Nurs, 2004, 33(6): 809-822.
12. Ferguson LR, Karunasinghe N. Nutrigenetics, nutrigenomics, and selenium. Front Genet, 2011, 2: 15.
13. Mistry HD, Williams PJ. The importance of antioxidant micronutrients in pregnancy. Oxid Med Cell Longev, 2011, 2011: 841749.
14. Hovdenak N, Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol, 2012, 164(2): 127-132.
15. Chao HC. Impact of maternal selenium supplementation on neonates. Pediatr Neonatol, 2012, 53(6): 327-328.
16. Makwe CC, Nwabua FI, Anorlu RI. Selenium status and infant birth weight among HIV-positive and HIV-negative pregnant women in Lagos, Nigeria. Nig Q J Hosp Med, 2015, 25(3): 209-215.
17. Pieczyńska J, Grajeta H. The role of selenium in human conception and pregnancy. J Trace Elem Med Biol, 2015, 29: 31-38.
18. Thomson CD. Assessment of requirements for selenium and adequacy of selenium status: a review. Eur J Clin Nutr, 2004, 58(3): 391-402.
19. Bogden JD, Kemp FW, Chen XH, <italic>et al</italic>. Low-normal serum selenium early in human pregnancy predicts lower birth weight. Braz J Anesthesiol, 2006, 26(10): 497-502.
20. 杨克虎, 田金徽, 李伦. 网状Mete分析方法与实践. 北京: 中国医药科技出版社, 2017.
21. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
22. Irwinda R, Wibowo N, Putri AS. The concentration of micronutrients and heavy metals in maternal serum, placenta, and cord blood: a cross-sectional study in preterm birth. J Pregnancy, 2019, 2019: 5062365.
23. Yıldırım E, Derici MK, Demir E, <italic>et al</italic>. Is the concentration of cadmium, lead, mercury, and selenium related to preterm birth? Biol Trace Elem Res, 2019, 191(2): 306-312.
24. Bebars GM, Kamel BA, Allam E. Comparison between preterm and full term neonatal cord selenium in correlation to maternal serum selenium levels. Gaz Egypt Paediatr Assoc, 2018, 66(4): 96-99.
25. 孙晓蓉. 妊娠不良结局孕妇孕期血清微量元素的变化分析. 广西医学, 2014, 36(7): 956-958.
26. Tsuzuki S, Morimoto N, Hosokawa S, <italic>et al</italic>. Associations of maternal and neonatal serum trace element concentrations with neonatal birth weight. PLoS One, 2013, 8(9): e75627.
27. Tara F, Rayman MP, Boskabadi H, <italic>et al</italic>. Selenium supplementation and premature (pre-labour) rupture of membranes: a randomised double-blind placebo-controlled trial. J Obstet Gynaecol, 2010, 30(1): 30-34.
28. Iranpour R, Zandian A, Mohammadizadeh M, et al. Comparison of maternal and umbilical cord blood selenium levels in term and preterm infants. 中国当代儿科杂志, 2009, 11(7): 513-516.
29. Makhoul IR, Sammour RN, Diamond E, <italic>et al</italic>. Selenium concentrations in maternal and umbilical cord blood at 24-42 weeks of gestation: basis for optimization of selenium supplementation to premature infants. Clin Nutr, 2004, 23(3): 373-381.
30. Gathwala G, Yadav OP, Sangwan K, <italic>et al</italic>. A study on plasma selenium level among pregnant women at Rohtak, Haryana. Indian J Public Health, 2003, 47(2): 45-48.
31. Dobrzynski W, Trafikowska U, Trafikowska A, <italic>et al</italic>. Decreased selenium concentration in maternal and cord blood in preterm compared with term delivery. Analyst, 1998, 123(1): 93-97.
32. Black RE. Micronutrients in pregnancy. Br J Nutr, 2001, 85(Suppl 2): S193-S197.
33. Benstoem C, Goetzenich A, Kraemer S, <italic>et al</italic>. Selenium and its supplementation in cardiovascular disease--what do we know? Nutrients, 2015, 7(5): 3094-3118.
34. Nordberg GF, Fowler BA, Nordberg M, et al. Handbook on the toxicology of metals (4^th edition). Elsevier, 2015.
35. Darnton-Hill I, Mkparu UC. Micronutrients in pregnancy in low- and middle-income countries. Nutrients, 2015, 7(3): 1744-1768.
36. Szybiński Z, Walas S, Zagrodzki P, <italic>et al</italic>. Iodine, selenium, and other trace elements in urine of pregnant women. Biol Trace Elem Res, 2010, 138(1-3): 28-41.
37. Izquierdo Alvarez S, Castañón SG, Ruata ML, <italic>et al</italic>. Updating of normal levels of copper, zinc and selenium in serum of pregnant women. J Trace Elem Med Biol, 2007, 21(Suppl 1): 49-52.
38. Kilinc M, Coskun A, Bilge F, <italic>et al</italic>. Serum reference levels of selenium, zinc and copper in healthy pregnant women at a prenatal screening program in southeastern Mediterranean region of Turkey. J Trace Elem Med Biol, 2010, 24(3): 152-156.
39. Choi R, Sun J, Yoo H, <italic>et al</italic>. A prospective study of serum trace elements in healthy Korean pregnant women. Nutrients, 2016, 8(11): 749.
40. Hatfield DL, Schweizer U, Tsuji PA, et al. Selenium: its molecular biology and role in human health (4^th edition). Springer International Publishing, 2016.
41. Khera A, Vanderlelie JJ, Holland O, <italic>et al</italic>. Overexpression of endogenous anti-oxidants with selenium supplementation protects trophoblast cells from reactive oxygen species-induced apoptosis in a bcl-2-dependent manner. Biol Trace Elem Res, 2017, 177(2): 394-403.
42. Chen CY, Chen CP, Lin KH. Biological functions of thyroid hormone in placenta. Int J Mol Sci, 2015, 16(2): 4161-4179.
43. Lozano M, Murcia M, Soler-Blasco R, <italic>et al</italic>. Prenatal Se concentrations and anthropometry at birth in the INMA study (Spain). Environ Res, 2020, 181: 108943.
44. McAlpine JM, McKeating DR, Vincze L, <italic>et al</italic>. Essential mineral intake during pregnancy and its association with maternal health and birth outcomes in south east Queensland, Australia. Nutr Metab Insights, 2019, 12: 1178638819879444.
45. Okunade KS, Olowoselu OF, Osanyin GE, <italic>et al</italic>. Selenium deficiency and pregnancy outcome in pregnant women with HIV in Lagos, Nigeria. Int J Gynaecol Obstet, 2018, 142(2): 207-213.
46. Wells EM, Herbstman JB, Lin YH, <italic>et al</italic>. Cord blood methylmercury and fetal growth outcomes in baltimore newborns: potential confounding and effect modification by omega-3 fatty acids, selenium, and sex. Environ Health Perspect, 2016, 124(3): 373-379.

Chinese Journal of Evidence-Based Medicine

The correlation between serum selenium levels in pregnant females and preterm birth: a meta-analysis

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