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This review examines the role of oxidative stress (OS) in pregnancy, highlighting that an imbalance between reactive oxygen/nitrogen species and antioxidant defenses can lead to complications such as pre-eclampsia, intrauterine growth restriction, and fetal loss. Key biomarkers like malondialdehyde (MDA) and superoxide dismutase (SOD) are used to assess OS, and trace elements (e.g., selenium, zinc) are critical for antioxidant defense. The clinical significance lies in identifying potential biomarkers and therapeutic targets to mitigate pregnancy complications.
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**Background:** Oxidative stress (OS) arises from an imbalance between the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) and the body's antioxidant defense mechanisms. Pregnancy inherently increases susceptibility to OS due to systemic inflammation, elevated metabolic demands, and placental activity. Excessive OS can damage cellular components, leading to pregnancy complications such as pre-eclampsia, recurrent pregnancy loss, intrauterine growth restriction (IUGR), and fetal developmental anomalies. Trace elements like copper (Cu), zinc (Zn), manganese (Mn), and selenium (Se) are essential for enzymatic and non-enzymatic antioxidant defenses. Direct measurement of ROS is challenging due to their short half-lives, so biomarkers such as malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) are used as indirect indicators.
**Methods:** This is a narrative review of the literature on OS in pregnancy. The authors searched PubMed, Embase, and Web of Science for comprehensive reviews and original research articles in English, excluding brief communications, case reports, and gray literature. A total of 172 papers were selected for review. No restrictions were placed on publication date. The review synthesizes findings on the mechanisms of OS, its impact on maternal and fetal health, the role of trace elements, and the use of biomarkers.
**Key Results:** The review reports that OS is linked to numerous pregnancy complications. For example, elevated MDA levels are associated with pre-eclampsia, and a meta-analysis by Solis-Paredes et al. found that women with gestational diabetes mellitus (GDM) have lower adiponectin levels than those without GDM. Studies on embryo culture show that 5% oxygen tension improves live birth rates compared to 20% oxygen (e.g., Van Montfoort et al. found a beneficial effect on live births with 5% oxygen). In terms of trace elements, Cu deficiency impairs antioxidant mechanisms, while excess Cu promotes OS. Fe supplementation can increase OS, as evidenced by elevated MDA in maternal serum and placenta. Zn deficiency is linked to reduced implantation rates and increased risk of pre-eclampsia. Se deficiency is associated with miscarriage, pre-eclampsia, and GDM, and supplementation may reduce these risks. Biomarkers such as MDA (reference range 0.32–53.8 nmol/mL in serum) and SOD (approximately 4315 U/mg in healthy individuals) are used to assess OS. The review also notes that undernutrition increases OS and contributes to low birth weight and stunting.
**Clinical Implications:** The review underscores the importance of monitoring OS biomarkers to identify women at risk for pregnancy complications. It suggests that maintaining adequate levels of trace elements (Zn, Se, Cu, Mn) through diet or supplementation may help mitigate OS and improve pregnancy outcomes. However, caution is advised with supplementation, as excess Fe or Cu can exacerbate OS. The authors recommend establishing a standardized panel of OS markers (e.g., ROS, 8-OHdG, MDA, TAC, GSH) for use in obstetrics and gynecology research. Animal models are valuable for studying OS mechanisms, but further research is needed to clarify the interplay between micronutrients and OS in human pregnancy.