516: The effect of pravastatin administration on fetal and utero-placental blood hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction

Abstract

To study the impact of pravastatin (20 mg/d) administration on the fetal growth and feto-utero-placental hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction (FGR). The study group comprised of pregnancies complicated by severe early-onset FGR (EFW below the 3rd percentile and GA< 33+0 weeks) that were admitted in the Maternal Fetal Medicine Unit (MFMU) Pravastatin (20 mg/d, orally) was added to their treatment at the time of admission, as part of an ongoing prospective study. Fetal growth was assessed once weekly. Measurement of the amniotic fluid volume and Doppler studies of the umbilical artery (UmA), middle cerebral artery (MCA), uterine artery (UtA) and ductus venosus (DV) were performed twice per week. The primary aim was to study the evolution of the pulsatility index (PI) of the above parameters on serial ultrasound evaluations. Furthermore, we compared the interval from admission to delivery between the study group and a similar group of cases that were admitted in the MFMU before the initiation of the pravastatin study. The historic control group was matched for gestational age, UtA Doppler and estimated fetal weight at the time of admission. Overall, eleven pregnancies were included in this ongoing study, of which 8 were singleton and 3 were twin. The mean gestational age at admission was 27.4 (± 2.9) weeks and 30.9 (± 2.7) weeks at delivery. The mean UtA-PI improved significantly between days 0 and 14 (84.9 vs. 76.1 percentile respectively, P=0.05). There was no improvement in fetal Doppler studies but, the admission-to-delivery interval was significantly higher in pregnancies treated by pravastatin compared to the historic controls (25.7 vs. 6.7 days, P=.01). In these preliminary data, pravastatin administration in cases with severe early-onset FGR was associated with an improvement both of the mean UtA-PI as well as of the pregnancy prolongation interval compared to the controls.