Imminent abortion needs more serious attention since it remains a
big problem in Indonesia considering its epidemiology, morbidity,
mortality, and prognosis. In fact, some cases can still be
prevented. The objective of this study was to determine pathogenesis,
diagnosis, and prognosis of imminent abortion through the role of
antioxidant vitamin C in the interaction of superoxide dismutase (SOD),
interferon-γ (IFN-γ), interleukin-4 (IL-4), vascular cells adhesion
molecule-1 (VCAM-1), and decidual spiral artery resistance index (DSA
RI). This study took 10 months from March to December 2007 at Obstetrics
and Gynecology Department of Medical Faculty
of Padjadjaran University/Hasan Sadikin Hospital, Bandung. Sixty
pregnant women who met the inclusion and exclusion criteria were divided into
two groups with the random clinical trial method, double-blind with repeated
measurements. Data were analyzed statistically using t test, Mann-Whitney,
Rank Spearman, Wilcoxon, t paired, and diagnostic test. The results
of this study showed that the incidence of abortion in vitamin C group was 9
cases (30%) and placebo group was 13 cases (43.3%). There was a significant
difference in SOD, IFN-γ, IL-4 and VCAM-1 level between groups of women
with and without abortion (p < 0.001). There was a significant
difference of SOD level between women with abortion 655.8 (163.6) U/gHb and
placebo group 824.5 (106.7) U/gHb after vitamin C administration (p = 0.008).
The cutoff point of SOD was ￡992 U/gHbwhich showed quite high sensitivity,
specificity, accuracy, and significant difference (p < 0.001). The
cutoff point abortion of DSA resistance index was ≥0.55 with 45% accuracy (p =
0.002). The highest change of IL-4 level was 60.7% in vitamin C group and
VCAM-1 was -2.2% (p < 0.05) after vitamin C administration. There
was a negative correlation in SOD changes toward IL-4 changes after vitamin C administration
(r = -0.523) (p = 0.003), a positive correlation between SOD changes and
IL-4 changes (0.597) (p < 0.001), a negative correlation between SOD changes
and VCAM-1 changes (r = -0.737) (p < 0.001) and a negative correlation
between SOD changes and DSA RI changes (r = -0.208) (p = 0.022). There
were significant changes in the increment of IL-4 and SOD level (p < 0.001)
and a decline in IFN-γ, VCAM-1 and DSA RI (p < 0.001) before and after vitamin C
administration. In conclusion, there was a correlation between
the increase of SOD level with the decrease of INF-γ level
and the increase of IL-4 level in imminent abortion after vitamin C
administration. There was a correlation between the increase of
SOD level with the decrease of DSA RI and the decrease of
VCAM-1 level in imminent abortion after vitamin C administration. In abortion,
there was a decrease of SOD and IL-4 level, as well as
an increase of IFN-γ,
VCAM-1, and DSA RI level.
Cite this paper
Handono, B. , Wirakusumah, F. , Mose, J. and Achmad, T. (2015) The Role of Antioxidant Vitamin C on Imminent Abortion through Interaction of Superoxide Dismutase, Interferon-γ, Interleukin-4, Vascular Cells Adhesion Molecule-1, and Decidual Spiral Arteries Blood Flow. Open Journal of Obstetrics and Gynecology
, 103-114. doi: 10.4236/ojog.2015.52014
 Cunningham, F.G., Leveno, K.J., Bloom, S.L., Hauth, J.C., Gilstrap III, L.C. and Wenstrom, K.D. (2005) Williams Obstetrics. 22nd Edition, McGraw Hill, New York.
 Jenkins, C., Wilson, R., Roberts, J., Miller, H., McKillop, J.H. and Walker, J.J. (2000) Antioxidants: Their Role in Pregnancy and Miscarriage. Antioxidants & Redox Signaling, 24, 623-628. http://dx.doi.org/10.1089/15230860050192369
 Wilson, R. (2004) Antioxidants and Miscarriage. In: Wilson, W., Ed., Recurrent Abortus and Preeclampsia the Roles Played by the Immune System and Antioxidants, World Scientific, New Jersey, 83-101.
 Kupesic, S., Matijevic, R. and Kurjak, A. (2001) Early Pregnancy Loss. In: Kurjak, A.C. and Carrera, J.M., Eds., The Embryo as a Patient, The Parthenon Publishing Group, New York, 70-80.
 Wilson, R., Ling, H., MacLean, M.A., et al. (1999) Thyroid Antibody Titre and Avidity in Patients with Recurrent Miscarriage. Fertility and Sterility, 71, 558-561. http://dx.doi.org/10.1016/S0015-0282(98)00509-3
 Vural, P, Akgul, C., Yildirim, A. and Canbaz, M. (2000) Antioxidant Defence in Recurrent Abortion. Clinica Chimica Acta, 295, 169-177. http://dx.doi.org/10.1016/S0009-8981(99)00255-7
 Kurjak, A. and Kupesic, S. (1999) Blood Flow Studies in Early Pregnancy. In: Kurjak, A.K.S., Ed., Color Doppler in Obstetrics, Gynecology and Infertility, Art-Studio Azinovic-Medison, Zagreb-Seoul, 87-108.
 Vives, A., Balasch, J., Yague, J., Quinto, L., Ordi, J. and Vanrell, J.A. (1999) Type-1 and Type-2 Cytokines and Human Decidual Tissue and Trophoblasts from Normal and Abnormal Pregnancies Detected by Reverse Trancriptase Polymerase Chain Reaction (RT-PCR). American Journal of Reproductive Immunology, 42, 361-368.
 Jaffe, R. (1992) Color Doppler Imaging in Obstetrics and Gynecology. McGraw-Hill, New York.
 Narimoto, K., Noda, Y. and Shiotani, M. (1990) Immunohistochemical Assessment of Superoxide Dismutase Expression in the Human Endometrium throughout the Menstrual Cycle. Acta Histochemica et Cytochemica, 23, 487-498.
 Sugino, N., Nakamura, Y. and Takeda, O. (1995) Change in Activities of Superoxide Dismutase and Lipid Peroxide in Corpus Luteum during Pregnancy in Rats. Journal of Reproduction and Fertility, 97, 347-351.
 Sugino, N., Telleria, C.M. and Gibori, G. (1998) Differential Regulation of Copper-Zinc Superoxide Dismutase and Manganese Superoxide Dismutase in the Rat Corpus Luteum: Induction of Manganese Superoxide Dismutase Messenger Ribonucleic Acid by Inflamatory Cytokines. Biology of Reproduction, 59, 208-215.
 Sugino, N., Shimamura, K. and Takiguchi, S. (1996) Changes in Activity of Superoxide Dismutase in the Human Endometrium throughout the Menstrual Cycle and in Early Pregnancy. Human Reproduction, 11, 1073-1078.
 Wilson, R., Moore, J. and Jenkin, C. (2003) Abnormal IL-2 Receptor Levels in Non Pregnant Women with a History of Recurrent Miscarriage. Human Reproduction, 18, 1529-1530. http://dx.doi.org/10.1093/humrep/deg287