Annie R McDougall, Gabrielle Dore, Lily Aboud, Maureen Makama, Phi Yen Nguyen, Kate Mills, Ben Sanderson, Roxanne Hastie, Anne Ammerdorffer, Joshua P Vogel
Journal: American journal of obstetrics & gynecology MFM 2023;5(11):101160
PMID: 37716440
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.
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.
Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.
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