Association of maternal prenatal selenium concentration and preterm birth: a multicountry meta-analysis
Creators: name: Juma, Mohammed Hamad
name: Kabir, Furqan
name: Maleta, Kenneth
name: Ashorn, Ulla
name: Pervin, Jesmin
name: Gupta, Juhi K
name: Mehmood, Usma
name: Hallman, Mikko
name: Alfirevic, Ana
name: Jehan, Fyezah
name: Murray, Jeffrey C
name: Dutta, Arup
name: Rand, Larry
name: Hotwani, Aneeta
name: Muglia, Louis
name: Goodfellow, Laura
name: Rahman, Sayedur
name: Khalid, Javairia
name: Belling, Elizabeth
name: Bahl, Rajiv
name: Stringer, Jeffrey
name: Ahmed, Tahmeed
name: Murphy, Susan
name: Kong, Fansheng
name: Chowdhury, Nabidul Haque
name: Ryckman, Kelli K
name: Landero, Julio A
name: Lacher, Criag
name: Al Mahmud, Abdullah
name: Litch, James A
name: Roth, Daniel E
name: Kennedy, Stephen H
name: Ali, Said
name: Jelliffe-Pawlowski, Laura L
name: Deb, Saikat
name: Alfirevic, Zarko
name: Khan, Waqasuddin
name: Khanam, Rasheda
name: Zhang, Ge
name: Ahmed, Salahuddin
name: Le, Thanh Q
name: Xu, Huan
name: Sazawal, Sunil
name: Care, Angharad
name: Fan, Yuemei
name: Rahman, Monjur
name: Nisar, Imran
name: Price, Joan T
name: Baruch-Gravett, Courtney
name: INTERBIO-21st Study Consortium
name: Nizar, Ambreen
name: Ashorn, Per
name: Hoyo, Cathrine
name: Dhingra, Usha
name: Combs, Gerald F
name: Musonda, Patrick
name: Aftab, Fahad
name: Baqui, Abdullah
name: Chappell, Joanne
name: Hirst, Jane
name: Rahman, Anisur
name: Islam, Munirul
name: Monangi, Nagendra
name: Vwalika, Bellington
Publisher: name: BMJ
Year: 2021

description: <p>BACKGROUND: Selenium (Se), an essential trace mineral, has been implicated in preterm birth (PTB). We aimed to determine the association of maternal Se concentrations during pregnancy with PTB risk and gestational duration in a large number of samples collected from diverse populations. METHODS: Gestational duration data and maternal plasma or serum samples of 9946 singleton live births were obtained from 17 geographically diverse study cohorts. Maternal Se concentrations were determined by inductively coupled plasma mass spectrometry analysis. The associations between maternal Se with PTB and gestational duration were analysed using logistic and linear regressions. The results were then combined using fixed-effect and random-effect meta-analysis. FINDINGS: In all study samples, the Se concentrations followed a normal distribution with a mean of 93.8 ng/mL (SD: 28.5 ng/mL) but varied substantially across different sites. The fixed-effect meta-analysis across the 17 cohorts showed that Se was significantly associated with PTB and gestational duration with effect size estimates of an OR=0.95 (95% CI: 0.9 to 1.00) for PTB and 0.66 days (95% CI: 0.38 to 0.94) longer gestation per 15 ng/mL increase in Se concentration. However, there was a substantial heterogeneity among study cohorts and the random-effect meta-analysis did not achieve statistical significance. The largest effect sizes were observed in UK (Liverpool) cohort, and most significant associations were observed in samples from Malawi. INTERPRETATION: While our study observed statistically significant associations between maternal Se concentration and PTB at some sites, this did not generalise across the entire cohort. Whether population-specific factors explain the heterogeneity of our findings warrants further investigation. Further evidence is needed to understand the biologic pathways, clinical efficacy and safety, before changes to antenatal nutritional recommendations for Se supplementation are considered.</p>