Study Finds Pravastatin Use in Pregnancy Improves Child Neurodevelopmental Outcomes
According to a recent study published in the American Journal of Obstetrics & Gynecology, pravastatin use improves motor and cognitive functions in children and is not associated with safety risks.
Background
Preeclampsia affects 3% to 8% of pregnant women and causes over 70,000 maternal deaths and over 500,000 preterm births per year worldwide. Long-term adverse cognitive, neurodevelopmental, and motor outcomes in offspring are also associated with preeclampsia. Preventing preeclampsia may reduce the prevalence of these outcomes.
Data has indicated that pravastatin, a hydrophilic hydroxymethylglutaryl-coenzyme A reductase inhibitor, may be used for preeclampsia prevention. It has also been associated with improved perinatal outcomes in patients with antiphospholipid syndrome during pregnancy.
Study Design
The study aimed to determine how antenatal pravastatin treatment in high-risk pregnant patients impacts child long-term health, growth, and neurodevelopment. It was conducted as an ancillary follow-up cohort study.
Participants included children of individuals who participated in the Obstetric-Fetal Pharmacology Research Centers Network trial, which compared outcomes of pravastatin vs placebo. Mothers in the trial had singleton, nonanomalous pregnancies and a history of preeclampsia.
Patients in the first trial were randomized into a 10-mg pravastatin group or placebo group, while those in the second trial were randomized into a 20-mg pravastatin group or placebo group. Children of these patients aged over 2 years who consented were included in the ancillary study.
Participating families attended a follow-up visit with their child at the original clinic center of participation. Families unable to visit the center were visited by research staff at their home. Otherwise, a virtual interview or consultation of the child’s medical records was conducted.
Results
The study collected medical history and measured weight, height, and motor function of participating children. Cognitive, motor, and language scores were evaluated using the Bayley Scales of Infant and Toddler Development III or Differential Ability Scales-Second Edition depending on child age.
Outcomes included child height, weight, body mass index (BMI) percentiles, rates of extreme BMI percentiles, vision or hearing impairments, and general medical complications. Motor outcomes were evaluated on the Gross Motor Function Classification System and Manual Abilities Classification System.
Developmental and cognitive outcomes included cognitive, motor, and language scores. For children assessed with the Bayley Scales of Infant and Toddler Development III, the mean score was 100, with scores under 85 categorized as below the mean.
In the pravastatin group, a gestational age at birth of 37.5±1.4 weeks was reported, compared to the placebo group with a gestational age of 36.5±2.5. The median follow-up time of 4.7 years did not differ between the two groups.
In the placebo group, 6.7% were underweight and 26.7% were obese, compared to 0% and 14.3% respectively in the pravastatin group. Hearing impairments were not reported, and other medical or behavioral complications did not differ between groups.
No limitations in gross motor function were observed in the pravastatin group, while difficulty walking and reduced manual abilities were reported in 13.3% and 26.7% of the placebo group, respectively.
A higher mean General Conceptual Ability (GCA) score was also observed in the pravastatin group compared to the placebo group, along with a lower rate of GCA scores below 85. However, these differences were not statistically significant.
Conclusion
The study results indicated improved long-term neurodevelopmental outcomes among children of parents who used pravastatin during pregnancy. The investigators concluded that this study supported further use of pravastatin in clinical trials.
Reference
Costantine MM, Clifton RG, Boekhoudt TM, Longo M, Saade GR. Long-term neurodevelopmental follow-up of children exposed to pravastatin in utero. American Journal of Obstetrics & Gynecology. 2023;229(2):53.E1-53.E12. doi:10.1016/j.ajog.2023.02.016
SDGs, Targets, and Indicators
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 4: Quality Education
- SDG 5: Gender Equality
- SDG 10: Reduced Inequalities
The article discusses the impact of pravastatin use during pregnancy on child neurodevelopmental outcomes. This is directly related to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. It is also connected to SDG 4, which focuses on quality education, as improved neurodevelopmental outcomes can contribute to better cognitive and motor functions necessary for learning. Additionally, the article highlights the importance of reducing inequalities (SDG 10) by providing access to pravastatin treatment for high-risk pregnant patients, ensuring equal opportunities for better health outcomes. Lastly, SDG 5, which promotes gender equality, is indirectly connected as preeclampsia affects pregnant women, and addressing its prevention and associated complications can contribute to better maternal health.
2. What specific targets under those SDGs can be identified based on the article’s content?
- Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age.
- Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care, and pre-primary education.
- Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
- Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.
Based on the article’s content, the specific targets that can be identified are:
– Target 3.2: The use of pravastatin during pregnancy can contribute to improving child neurodevelopmental outcomes, reducing the risk of preventable deaths or adverse cognitive outcomes.
– Target 4.2: The improved motor and cognitive functions resulting from pravastatin use can enhance early childhood development and education outcomes.
– Target 5.6: Ensuring access to safe and effective preventive treatments like pravastatin during pregnancy contributes to reproductive health and rights.
– Target 10.3: Providing equal access to pravastatin treatment for high-risk pregnant patients helps reduce inequalities in health outcomes for both mothers and children.
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
Yes, there are indicators mentioned in the article that can be used to measure progress towards the identified targets:
- Child height, weight, and body mass index (BMI) percentiles: These indicators can be used to assess the physical growth and development of children, which is relevant to Target 3.2.
- Gross Motor Function Classification System and Manual Abilities Classification System: These systems can be used to evaluate motor outcomes in children, providing indicators for assessing progress towards Target 3.2.
- Cognitive, motor, and language scores: The Bayley Scales of Infant and Toddler Development III and Differential Ability Scales-Second Edition are used to evaluate these scores, which are indicators for measuring progress towards Target 4.2.
- General Conceptual Ability (GCA) score: This score, along with the rate of GCA scores below 85, can be used as indicators to measure progress towards Target 4.2.
These indicators help measure the impact of pravastatin use during pregnancy on child neurodevelopmental outcomes, contributing to the progress towards the identified targets.
4. Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age. | – Child height, weight, and BMI percentiles – Gross Motor Function Classification System and Manual Abilities Classification System |
| SDG 4: Quality Education | Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care, and pre-primary education. | – Cognitive, motor, and language scores – General Conceptual Ability (GCA) score |
| SDG 5: Gender Equality | Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences. | – Child height, weight, and BMI percentiles – Gross Motor Function Classification System and Manual Abilities Classification System |
| SDG 10: Reduced Inequalities | Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard. | – Child height, weight, and BMI percentiles – Gross Motor Function Classification System and Manual Abilities Classification System |
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Source: contemporaryobgyn.net
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