Key result
Pravastatin treatment significantly prolonged pregnancy by a mean difference of 0.44 weeks compared to no statin treatment in women with or at high risk for uteroplacental insufficiency disorders.
Why the study?
Uteroplacental insufficiency-associated disorders share pathophysiology and risk factors with cardiovascular diseases treated with statins, prompting evaluation of pregnancy outcomes with statin treatment.
Does pravastatin improve pregnancy outcomes in women with uteroplacental insufficiency disorders?
Meta-Analysis (n=1,391)
Does pravastatin improve pregnancy outcomes in women with uteroplacental insufficiency disorders?
Pravastatin treatment may prolong pregnancy duration and reduce NICU admissions in pregnancies complicated by uteroplacental insufficiency disorders.
Answers are grounded in this paper and cite their sources.
May support pravastatin to modestly extend gestation in high-risk pregnancies; extends meta-analytic evidence on obstetric statin use.
Background: Uteroplacental insufficiency associated disorders, such as preeclampsia, fetal growth restriction and obstetrical antiphospholipid syndrome, share pathophysiology and risk factors with cardiovascular diseases treated with statins. Objective: To evaluate pregnancy outcomes among women with uteroplacental insufficiency disorders who were treated with statins. Search Strategy: Electronic databases were searched from inception to January 2022 Selection Criteria: Cohort studies and randomized controlled trials. Data collection and analysis: Pooled odds ratios were calculated using a random-effects model; meta-regression was utilized when applicable. Main Results: The analysis included ten studies describing 1,391 women with uteroplacental insufficiency disorders: 703 treated with pravastatin and 688 not treated with statins. Women treated with pravastatin demonstrated significant prolongation of pregnancy (mean difference 0.44 weeks, 95%CI:0.01–0.87, p = 0.04, I 2 = 96%) and less neonatal intensive care unit admissions (OR = 0.42, 95%CI: 0.23–0.75, p = 0.004, I 2 = 25%). In subgroup analysis, prolongation of pregnancy from study entry to delivery was statistically significant in cohort studies (mean difference 8.93 weeks, 95%CI:4.22–13.95, p = 0.00) but not in randomized control studies. Trends were observed toward a decrease in preeclampsia diagnoses (OR = 0.54, 95%CI:0.27–1.09, p = 0.09, I = 44%), perinatal death (OR = 0.32, 95%CI:0.09–1.13, p = 0.08, I 2 = 54%) and an increase in birth weight (mean difference = 102 g, 95%CI: -14–212, p = 0.08, I 2 = 96%). A meta-regression analysis demonstrated an association between earlier gestational age at initiation of treatment and a lower risk of preeclampsia development (R 2 = 1). Conclusion: Pravastatin treatment prolonged pregnancy duration and improved associated obstetrical outcomes in pregnancies complicated with uteroplacental insufficiency disorders in cohort studies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ identifier CRD42020165804 17/2/2020.
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Hirsch et al. (2022) conducted a meta-analysis in Uteroplacental insufficiency disorders (n=1,391). Pravastatin vs. Placebo, no treatment, or standard care (aspirin/LMWH) was evaluated on Prolongation of pregnancy from study entry to delivery (MD 0.44, 95% CI 0.01-0.87, p=0.04). Pravastatin treatment significantly prolonged pregnancy by a mean difference of 0.44 weeks compared to no statin treatment in women with or at high risk for uteroplacental insufficiency disorders.
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