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.