Indonesia Pravastatin to Prevent Preeclampsia Study

Universitas Airlangga280 enrolled

Overview

BACKGROUND Preeclampsia is a major cause of maternal and neonatal morbidity worldwide. There is currently no cure for preeclampsia, the only definitive treatment is termination of pregnancy by induction of labour or caesarean section. Statin has been proposed to represent a new approach to improve disease outcome/prevent preeclampsia based on its multilayered activity toward pregnancy protection, including: protection of vascular endothelial cells survival, induce expression of heme oxygenase 1 (HO-1), inhibiting the release of soluble FMS-like tirosine kinase-1 (sFlt-1) and soluble endoglin (sEng), two main culprits in the pathophysiology of preeclampsia. OBJECTIVE The aim of this study is to observe the effect of pravastatin administration in patients with high risk of preeclampsia in order to reduce maternal and neonatal mortality and morbidity. METHODS This is a prospective randomized controlled clinical trial. The research will be held in 5 maternal fetal medicine centers in Indonesia (multicenter study). The recruitment will be done by permuted block random sampling methods, with sample size around 280 patients divides into two group. Patients with high risk of preeclampsia will be randomized either to get pravastatin 2 x 20 mg per oral and aspirin 1 x 80 mg (treatment group) or low dose aspirin only (control group). The patient will be followed regularly until delivery to obtain detailed maternal and neonatal outcome. OUTCOME Primary Outcomes: Maternal preeclampsia, severe preeclampsia, gestational hypertension, indicated preterm delivery less than 37 weeks, indicated preterm delivery less than 34 weeks, maternal complications, length of hospital stay, and any serious adverse event. Secondary Outcomes: Composite fetal/neonatal mortality and morbidity (stillbirth, neonatal death, respiratory distress syndrome, intracerebral hemorrhage, neonatal sepsis, intra uterine growth restriction \[Small for Gestational Age (SGA) \< 5th centile\], and necrotizing enterocolitis), birthweight, birthweight percentile, level of care (well baby, intermediate, NICU), NICU length of stay, ventilator usage, and length of perinatal hospital stay. KEYWORDS: pravastatin, preeclampsia, neonatal mortality, neonatal morbidity

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Eligibility

Sex: FEMALEMin age: 15 YearsMax age: 45 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Gestational Age 10 wk - 19 wk 6 day * History of previous preeclampsia requiring birth \< 37 weeks (risk 30%), or * Patients with a combination of at least 2 major risk factors plus an abnormal uterine artery Doppler at 11-20 weeks gestation (risk preeclampsia 30%): * Major clinical risk factors (Obesity, strong family history of preeclampsia \[mother or sister\], maternal age \> 40 years old, chronic hypertension, Policystic Ovarian Syndrome (PCOS), Chronic kidney disease, diabetes mellitus, multiple pregnancies, first pregnancy, pregnancy interval more than 10 years, new partner/husband, Reproductive technologies (IVF pregnancy), heritable thrombophilias, Booking Blood pressure \>130/80 mmHg, family history of early onset cardiovascular disease, lower socioeconomic status) * Abnormal uterine artery Doppler defined as (Second trimester screening: average resistance index \> 0.58 and/or or early-diastolic diastolic notch. First trimester screening: Pulsatility index \> 95th centile or PI \> 1.5) or: * First trimester screening (11+0 to 14+1 weeks): Combination of maternal risk factors, elevated MAP, and increased Uterine artery pulsatility index (UTPI). * Second trimester screening (19+0 to 24+6 weeks): Combination of maternal risk factors, elevated MAP, and increased Uterine artery pulsatility index (UTPI). * Combination of elevated mean arterial pressure (MAP \> 90 mmHg) in the second trimester with abnormal uterine artery Doppler * Combination elevated booking blood pressure (\> 130/85 mmHg) with abnormal uterine artery Doppler * Live fetus, no detectable fetal anomaly Exclusion Criteria: * Condition where the pregnancies should be terminated within 48 hours, on the basis of any indication (patients consume pravastatin less than 2 days). * Contraindication to the statin use: * Hypersensitivity to pravastatin * Active liver disease * Pre pregnant renal insufficiency/kidney failure (history of hemodialysis) * Current use of statin * Participation in any other controlled trial of investigational medical products in pregnancy

Locations (7)

Sanglah General Hospital

Denpasar, Bali, Indonesia

NOT_YET_RECRUITING

Dr. Moewardi Hospital

Surakarta, Central Java, Indonesia

NOT_YET_RECRUITING

Ramelan Naval Hospital

Surabaya, East Java, Indonesia

NOT_YET_RECRUITING

Dr. Soetomo Hospital

Surabaya, East Java, Indonesia

RECRUITING

Adam Malik General Hospital

Medan, North Sumatra, Indonesia

NOT_YET_RECRUITING

Dr. Wahidin Sudirohusodo General Hospital

Makassar, South Sulawesi, Indonesia

NOT_YET_RECRUITING

Hasan Sadikin General Hospital

Bandung, West Java, Indonesia

RECRUITING

Outcomes

Primary Outcomes

Preeclampsia

Including preeclampsia, preeclampsia with severe features, and gestational hypertension.

Time frame: From date of randomization until date of delivery

Preterm delivery

Including indicated preterm delivery \< 34 weeks and \< 37 weeks

Time frame: 20 - 34 weeks, and 34 - 37 weeks

Maternal complication

Any maternal complication caused by preeclampsia: eclampsia, seizure, HELLP syndrome, acute pulmonary edema, acute kidney injury, Cardivascular accident, liver failure, sepsis, and pneumonia

Time frame: From date of randomization until date of delivery

Secondary Outcomes

Perinatal outcome

Gestational age at birth (days), birthweight (gram), birthweight percentile (INTERGROWTH), Apgar Score

Time frame: At delivery

Composite neonatal morbidity and mortality

stillbirths, neonatal death, respiratory distress syndrome, intracerebral hemorrhage, neonatal sepsis, necrotizing enterocolitis, length NICU admission, and length of stay

Time frame: At delivery

Indonesia Pravastatin to Prevent Preeclampsia Study

Overview

Conditions

Interventions

Eligibility

Locations (7)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts