Chocolate Consumption in Pregnancy and Reduced Likelihood of Preeclampsia

Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale University, New Haven, CT 06510, USA.
Epidemiology (Impact Factor: 6.2). 06/2008; 19(3):459-64. DOI: 10.1097/EDE.0b013e31816a1d17
Source: PubMed


Preeclampsia is a major pregnancy complication with cardiovascular manifestations. Recent studies suggest that chocolate consumption may benefit cardiovascular health.
We studied the association of chocolate consumption with risk of preeclampsia in a prospective cohort study of 2291 pregnant women who delivered a singleton livebirth between September 1996 and January 2000. Chocolate consumption was measured by self report in the first and third trimesters, and by umbilical cord serum concentrations of theobromine, the major methylxanthine component of chocolate. Preeclampsia was assessed by detailed medical record review for 1943 of the women. We derived adjusted odds ratios (aOR) and 95% confidence intervals (CIs) from logistic regression models controlling for potential confounders.
Preeclampsia developed in 3.7% (n = 63) of 1681 women. Cord serum theobromine concentrations were negatively associated with preeclampsia (aOR = 0.31; CI = 0.11-0.87 for highest compared with lowest quartile). Self-reported chocolate consumption estimates also were inversely associated with preeclampsia. Compared with women consuming under 1 serving of chocolate weekly, women consuming 5+ servings per week had decreased risk: aOR = 0.81 with consumption in the first 3 months of pregnancy (CI = 0.37-1.79) and 0.60 in the last 3 months (0.30-1.24).
Our results suggest that chocolate consumption during pregnancy may lower risk of preeclampsia. However, reverse causality may also contribute to these findings.

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    • "Theobromine could account for, or contribute to, enhancing the effect of flavanols. Indeed, recently, a few observational and experimental studies have been designed to evaluate the associations between chocolate consumption and/or theobromine, a biomarker of cocoa intake with preeclampsia, but the results were conflicting [12-14]. The primary objective of this systematic review is to investigate the effect of chocolate consumption on preeclampsia risk in pregnant women using observational and experimental studies. "
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    ABSTRACT: Previous studies have been limited in reporting the association between chocolate consumption, measured by interviewer-administered questionnaire or serum theobromine, a biomarker for cocoa, and risk of preeclampsia, and have showed somewhat conflicting results. A systematic review of observational and experimental studies will be carried out. We will examine PubMed, Embase, and the entire Cochrane Library. Studies of chocolate consumption compared or not with placebo or low flavanol chocolate during pregnancy will be evaluated to investigate the effect of chocolate consumption in pregnant women on the risk of preeclampsia or pregnancy-induced hypertension. Screening for inclusion, data extraction, and quality assessment will be performed independently by two reviewers in consultation with a third reviewer. Validity of the studies will be ascertained by using the Cochrane Collaboration's tool. Relative risk of preeclampsia will be the primary measure of treatment effect. Heterogeneity will be explored by subgroup analysis according to confounding factors and bias. This systematic review will contribute to establish the current state of knowledge concerning the possible association between chocolate consumption and prevention of preeclampsia. Furthermore, it will justify if additional experimental trials are necessary to better evaluate the benefits of chocolate consumption on the risk of preeclampsia.Trial registration: This systematic review has been registered in the PROSPERO international prospective register of systematic reviews. The registration number is: CRD42013005338.
    Full-text · Article · Dec 2013 · Systematic Reviews
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    • "A recent meta-analysis of randomized controlled trials (RTCs) confirmed that flavanol-rich chocolate has a beneficial influence on endothelial function and reduces systolic (SBP) and diastolic blood pressure (DBP) [9]. Recent cohort [10] and case–control studies [11] have indicated that chocolate consumption during pregnancy may lower the risk of PE, but their design did not permit the exploration of temporal relationships. Moreover, this association was not found in another case–control study [12]. "
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    ABSTRACT: BACKGROUND: Several randomized clinical trials (RCTs) indicate that flavanol-rich chocolate has beneficial effects on flow-mediated dilation (FMD) and blood pressure (BP). However, no RCTs have evaluated these outcomes in pregnant women. The objective of this 2-group, parallel, double-blind RCT was to examine the effects of flavanol-rich chocolate on FMD and BP in pregnant women with normal BP. METHODS: Forty-four healthy, pregnant women were randomized to the high-flavanol (n = 23) or low-flavanol (n = 21) chocolate consumption for 12 weeks. At randomization (0, 60, 120 and 180 min after a single 40-g dose of chocolate), 6 and 12 weeks after daily 20-g chocolate intake, we evaluated plasma concentrations of flavanols and theobromine, as well as the FMD and BP. RESULTS: Plasma epicatechin was significantly increased (p < 0.001) 180 min after the consumption of 40-g high-flavanol chocolate compared to low-flavanol chocolate. Theobromine concentrations were significantly higher 180 min and 12 weeks after the intake of experimental chocolate or low-flavanol chocolate (p < 0.001). FMD was not different between the 2 groups at all pre-defined time periods. No other significant within-group or between-group changes were observed. CONCLUSION: These results confirm the feasibility of a large-scale RCT comparing daily consumption of flavanol-rich chocolate to an equivalent placebo during pregnancy and demonstrate higher plasma epicatechin and theobromine concentration in the intervention group after acute ingestion.Trial registration: Identifier: NCT01659060.
    Full-text · Article · Apr 2013 · Nutrition Journal
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    • "Although Triche et al found evidence of an inverse dose-response relationship of theobromine levels in cord serum with preeclampsia risk (Triche et al, 2008), our questionnaire assessment of dietary chocolate intake was not adequately robust to detect a dose-response effect. Different chocolate products and sources contain varying amounts of cocoa; such heterogeneity in cocoa content makes it very difficult to assess for dose-response relationships using food frequency questionnaires. "
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    ABSTRACT: Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine whether regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH). Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at <16 weeks' gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n = 58), GH (n = 158), and normotensive pregnancies (n = 2351). Chocolate consumption (servings/week) during the first and third trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of less than 1 serving/week comprised the referent group. Adjusted odds ratios (aORs) were estimated by the use of logistic regression. Chocolate intake was more frequent among normotensive (80.7%) than preeclamptic (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (first trimester: aOR, 0.55; 95% confidence interval [95% CI], 0.32-0.95; third trimester: aOR, 0.56; 95% CI, 0.32-0.97). Only first trimester intake was associated with reduced odds of GH (aOR,0.65; 95% CI, 0.45-0.87). These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia.
    Full-text · Article · Aug 2010 · Annals of epidemiology
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