Introduction
Preeclampsia and intrauterine growth restriction (IUGR) are serious complications of pregnancy that increase the morbidity and mortality of foetuses and parturients. Both these complications have been associated with the development of placental insufficiency. Abnormal placentation and its associated disorders may be encountered among parturients with obstetric antiphospholipid syndrome; 20%-30% of pregnancies among these parturients may result in preeclampsia, IUGR and foetal losses. The spectrum of uteroplacental insufficiency disorders results from various factors, including poor trophoblast uterine invasion early in pregnancy, impaired transformation of the uterine spiral arteries to high capacity-low impedance vessels, abnormalities in the development of chorionic villi, endothelial dysfunction and pathologic changes in the antiangiogenic environment. Prevention strategies for uteroplacental insufficiency are not currently known. Therefore, preeclampsia or IUGR occurring early in the course of pregnancy prompts early delivery, which can lead to neonatal death and disability arising from prematurity, and also maternal morbidity.
The role of statins in treating and preventing cardiovascular diseases is well established; their potential benefit in treating multiple non-cardiovascular outcomes is currently under investigation. Endothelial dysfunction in preeclampsia, IUGR and obstetric antiphospholipid syndrome has been associated with abnormalities in lipid profile, high levels of triglycerides and oxidative stress. statins inhibit HMG-CoA reductase, leading to reduced plasma cholesterol levels. statins also have antioxidant, anti-inflammatory, anti-thrombogenic and vasodilating effects. The preclinical evidence supporting the use of statins in the treatment of preeclampsia has been demonstrated in multiple animal models.
Current clinical knowledge regarding the efficacy of statins in the treatment of preeclampsia is inadequate. Individual studies have presented contradicting results. Accordingly, current guidelines do not recommend the usage of statins in the prevention or treatment of uteroplacental insufficiency disorders.
The aim of this systematic review and meta-analysis was to assess pregnancy outcomes associated with pravastatin treatment, among pregnancies with high risk for development of uteroplacental insufficiency and pregnancies that already developed associated disorders: preeclampsia and IUGR, with or without obstetric antiphospholipid syndrome.