KL 37 Statins for prevention of pre-eclampsia

Abstract

Pre-eclampsia is associated with serious maternal and perinatal morbidity and in low resource nations accounts for over 20% of all maternal and perinatal mortality. An effective prophylaxis or targeted therapy against pre-eclampsia is desperately needed. Statins inhibit sFlt-1 secretion from endothelial and trophoblast cells in vitro and increase PlGF levels in vivo. Statins may therefore offer a targeted and non-invasive prophylaxis against pre-eclampsia. Previously however, statins taken during pregnancy, especially lipophilic statins that cross plasma membranes, have been linked with major congenital malformations. After adjustment for underlying maternal diabetes however, a large subsequent registry showed no such association between first trimester statin use and congenital anomalies. Nevertheless, uncertainty remains about the safety of statins used after the first trimester on long-term childhood development. We investigated whether statins might offer a potential therapy for pre-eclampsia by conducting the StAmP trial, Statins to Ameliorate Pre-Eclampsia. This double blind multicenter, placebo-controlled randomized trial assessed the effect of a hydrophilic statin Pravastatin on s-FLT1 levels in women with early onset pre-eclampsia. The preliminary results of Stamp and other reports of statins to ameliorate pre-eclampsia will be discussed.