Role of pravastatin in the prevention of preeclampsia: A systematic review and meta-analysis of randomized-controlled trials

Context: Preeclampsia prevention is important for reducing maternal mortality and morbidity worldwide. Recent studies have explored the use of to prevent preeclampsia and improve maternal, perinatal, or neonatal outcomes. However, the results are still debatable. Aims: To evaluate the role of pravastatin in the prevention of preeclampsia in pregnant women. Methods: This study is a systematic review and meta-analysis of randomized controlled trials (RCTs) involving studies with healthy pregnant women receiving pravastatin vs. control to observe the risk of preeclampsia. Literature searching was conducted in PubMed, Science Direct, EBSCO/CINAHL, PROQUEST, and SCOPUS. Statistical analyses were performed using the Review Manager 5.4.1 software. Results: Five studies were initially identified for meeting the inclusion criteria; 2 studies were treatment studies and had to be excluded, and one small study only used pravastatin for a few weeks, leaving only two studies for statistical analysis. Administration of pravastatin was associated with a reduced risk of preeclampsia (OR: 0.51; 95% CI: 0.29-0.90; p= 0.02) and preterm delivery (OR: 0.31; 95% CI: 0.16-0.58; p<0.01). The risk of preeclampsia with severe features and small for gestational ages was not different. Only one study (INOVASIA) reported on preterm preeclampsia, prophylactic pravastatin was associated with a marked and significant reduction of preterm preeclampsia rates (OR: 0.034; 95% CI: 0.202-0.905). Pregnant women receiving pravastatin had better perinatal outcomes in terms of birthweight, Apgar scores, NICU admission, length of stay, and respiratory distress syndrome. Conclusions: Pravastatin has the potential to prevent the occurrence of preeclampsia, premature birth, and perinatal morbidity in pregnant women. However, it is necessary to conduct more RCTs with a larger sample size and appropriate follow-up of the offspring to further examine the efficacy of pravastatin in preeclampsia prevention.