Oral plus vaginal alpha-lipoic acid in women at risk for preterm delivery

Abstract

Objective: The etiology of preterm labor is multifactorial. An inflammatory response is always involved with the activation of NF-kB that determines synthesis and release of inflammatory molecules, implicated in fetal membrane activation, cervical modifications, abdominal pain and spontaneous uterine contractions. There is a close relationship between preterm birth and cervical shortening in the second quarter of pregnancy. We evaluated the benefits of alpha-lipoic acid administration on women considered at risk of preterm delivery due to the presence of symptoms (pelvic pain and uterine contractions) or reduced cervical length. Patients and Methods: This prospective observational study was carried out at the Gynecology and Obstetrics Unit of Palermo University Hospital (Palermo, Italy), from October 2015 to April 2016. The inclusion criteria were: women aged 18-35, with gestational age between 24 and 33 weeks of amenorrhea, pregnancy at risk of preterm delivery due to cervical length between 35-25 mm (in presence of symptoms) or < 30 and > 15 mm (if asymptomatic), intact membranes and negative for vaginosis. Patients were treated daily with alpha lipoic acid orally (300 mg, twice a day for 30 days) and vaginally (10 mg, once a day for 10 days), or untreated (controls). Patients were evaluated at the baseline (T 0), after 7 days, after 30 days, and at 34 weeks of gestation considering: maternal characteristics, symptomology and cervical length. Results: Among 60 analyzed women, 50 were treated orally and vaginally with alpha-lipoic acid, whereas 10 did not undergo any therapy. In the treated group, 10 patients were asymptomatic and 40 symptomatic. The symptoms disappeared in 37 patients. In the untreated group, 4 women were symptomatic and 6 asymptomatic. At the end all women were symptomatic. Mean cervical length showed a reduction in the untreated group compared to the treated group. Conclusions: The vaginal/oral-combined administration with alpha-lipoic acid showed effectiveness in reducing symptoms and preventing cervical shortening in our set of patients. No adverse effects were detected during the treatment.