Vitamin E supplementation could reduce the risk of malformations to children born to mothers with pre-gestational obesity. This is the conclusion of a study published in the journal Antioxidants, conducted and led by researchers from the Metabolism and Vascular Function Group (MET-VASC) at CEU USP, in collaboration with Harvard University, Boston (USA). Researchers from the Universities of Valencia, Veracruz (Mexico) and Havana (Cuba) also participated with doctors Marta Viana, Martín Alcalá, Isabel Sánchez-Vera and Esther Carrera and pre-doctoral researcher Fabiola Álvarez, from CEU USP, and Dr. Loeken, from Harvard University.

The research shows that obesity prior to gestation increases the appearance of congenital malformations, mainly those related to the development of the neural tube. Extrapolated to humans, this type of malformation prevents gestation from reaching full term and,  in doing so, causes pathologies such as meningocele or spina bifida in the newborn. "We observed that 25% of the embryos of obese mothers had severe malformations, while this percentage was reduced to 11% in the embryos of obese mothers supplemented with vitamin E, consistent with findings in studies on pregnancies of thin rats", states Dr Sánchez-Vera.

This study focuses on oxidative stress as the origin of the appearance of these malformations. "Our body physiologically generates highly reactive chemical species with pro-oxidant characteristics. To keep their level under control and prevent them from damaging large molecules, such as proteins, lipids or even DNA, we have a series of enzymes and antioxidant compounds that are responsible for maintaining the balance. If this balance is lost in favor of oxidative species, we speak of oxidative stress", explains Dr. Viana. She also stresses that "the problem is that both obesity and pregnancy are situations that, in isolation, produce oxidative stress. Therefore, when combined, an additional effect is produced that dewfeats the mother's antioxidant defenses, causing this damage to reach the embryo in formation".

This research reveals the key role of the major endogenous water-soluble endogenous antioxidant, glutathione, which we all have in our bodies. In mothers with pregestational obesity, this antioxidant is consumed to cope with oxidative damage. Therefore, there is a smaller amount available both for the embryo itself, and also for it to develop its spine or brain correctly in the early stages of gestation. Treatment with an exogenous antioxidant, vitamin E, provides protection against oxidation to both the mother and the embryo, thereby preventing glutathione from being depleted and allowing normal development of the embryo's structures in the first weeks of pregnancy.

According to Dr. Alcalá, "the loss of glutathione as a basis for the appearance of malformations had already been studied in other situations such as smoking, ionizing radiation or the use of some drugs such as valproate. This study, however, in addition to being the first time in which it is related to maternal obesity, provides a simple solution through vitamin E supplementation". Dr. Carrera and Fabiola Álvarez point out that "several clinical trials have attempted to analyze the potential beneficial effect of antioxidants to prevent complications associated with pregnancy, but the results have never been particularly enlightening. It is also worth noting that practically none of the previous trials separately analyzed the effect of pregestational obesity in the mother, where we believe the effect could be very beneficial". 

Maternal obesity increases the risk of comorbidities before, during and after gestation, both for the mother and the fetus. Mothers with pre-pregnancy obesity may have fertility problems, increased risk of spontaneous and recurrent miscarriages, preeclampsia, gestational diabetes, and complications during delivery. Newborns are also at increased risk of shoulder dystocia, of being born with inadequate birth weight and even of becoming obese individuals in the future. The results of the study on animals highlight the importance for overweight and obese women planning to become pregnant to work with their physicians, nutritionists, nurses and pharmacists to lose weight. This study opens the door to reconsideration of antioxidant supplementation in pregnant women at potential risk - thus ensuring a sustainable and environmentally friendly production system, by reducing the use of agrochemicals with consequent health benefits.