Statins in pregnancy

Statin may reduce premature births in women with lipid syndrome.

A drug which has been widely used in the general population to prevent cardiovascular disease appears to help prevent pregnancy complications in women with antiphospholipid syndrome, new research has found.

The new statin treatment may hold promise in reducing premature births and increasing babies' chances of survival for mothers with an autoimmune disease.

The small preliminary study of 21 women, published in the Journal of Clinical Investigation, found that all babies of mothers treated with statins survived compared with the standard treatment group; maternal health also improved after treatment with statins.

Antiphospholipid syndrome (APS) is an autoimmune disorder where the body produces abnormal antibodies called antiphospholipid antibodies that mistakenly attack cell membrane components called phospholipids.

APS increases the risk of preeclampsia and intrauterine growth restriction (IUGR) in pregnancy. During pregnancy, antiphospholipid antibodies can affect the development of the placenta and thus diminish the blood flow across the placenta. This can result in reduced foetal growth in a quarter of pregnancies and foetal distress leading to premature birth in half of pregnancies.

The researchers, from King's College London and the University of Thessaloniki in Greece, recruited 11 pregnant women with antiphospholipid syndrome. The women were treated with pravastatin, a statin therapy that does not reach the foetus, plus the standard treatment for their condition. Pravastatin has also previously been shown to prevent adverse pregnancy outcomes in animal studies of APS and preeclampsia.

The women treated with pravastatin were compared with 10 women with APS who had only received the current standard treatment of low dose aspirin and heparin.

All 11 babies in the pravastatin treatment group were born alive, but just seven of the 11 babies in the standard care group survived beyond birth (of the remainder, three were stillbirths and one baby died three hours after birth).

The researchers determined that pravastatin treatment lowered blood pressure and proteinuria, increased placental blood flow and prevented IUGR reducing the rate of premature birth, with eight out of the 11 patients delivering at 36 weeks or later. In contrast, with the standard care group, emergency C-sections were performed for seven of the women due to foetal distress or maternal health concerns. The median age at birth was 26 weeks in the standard group compared to a median of 36 weeks in the pravastatin group.

The premature babies in the standard care group spent longer periods in the neonatal intensive care unit and three of the surviving infants had poorer health outcomes, such as neurological and gastrointestinal abnormalities.

“Many pregnant women with antiphospholipid syndrome do not respond to conventional antithrombotic treatment and face serious complications, such as preeclampsia and severe intrauterine growth restriction, threatening their lives and their babies' lives,” said Professor Guillermina Girardi, senior author from the Department of Women's Health at King's College London.

“Our study was a small case series that was not randomised and historic controls were used for comparison, so larger randomised clinical trials are needed to fully establish the safety and effectiveness of this treatment before it can be recommended for clinical use. The potential benefits of statin treatment for women who develop preeclampsia without APS are also worth investigating,” she added.


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