Pravastatin Improves Obstetric Outcomes in Anti-Phospholipid Syndrome Patients Save

Pregnancy complications of anti-phospholipid syndrome (APS) have included recurrent abortions, spontaneous fetal loss, preeclampsia, and premature birth. The etiopathogenesis of these events has been presumed to be placental thrombosis or infarction. Although such patients appear to benefit from anticoagulation, there is no consistent evidence of decidual thrombosis or placental vasculopathy, and often inflammatory pathology is present. 

Pravastatin has been studied as an intervention for placental insufficiency that may result in fetal loss, preeclampsia, etc. Due to the similarities in pathophysiology among preeclampsia, IUGR, and atherosclerotic cardiovascular disease, statins have been proposed to treat or prevent such obstetrical complications.

Researchers from Kings College and St. Thomas Hospital in London have studied 21 pregnant women with APS with preeclampsia (PE) and/or intrauterine growth retardation (IUGR) despite treatment either low-dose aspirin (LDA) and low–molecular weight heparin (LDA+LMWH) to assess outcomes if pravastatin were used as an intervention.

The control group (10 patients) received LDA+LMWH and the intervention group (11 patients) received pravastatin (20 mg/d) in addition to LDA+LMWH at the onset of PE and/or IUGR.

The control group resulted in preterm deliveries and only 6 of 11 neonates survived. Of the 6 surviving neonates, 3 showed abnormal development.

Those treated with both pravastatin and LDA+LMWH exhibited increased placental blood flow and improvements in PE features. These beneficial effects were observed as early as 10 days after pravastatin treatment onset. Pravastatin treatment combined with LDA+LMWH was also associated with live births that occurred close to full term in all patients.

Although the study is limited by the sized of the study population, the results suggest that pravastatin may improve pregnancy outcomes in women with refractory obstetric APS when taken at the onset of PE or IUGR and until the end of pregnancy. These dramatic results in women with APS support the need for further evaluation and larger trials to assess statins when treating PE, IUGR, especially in at-risk patients such as those with APS.