Pravastatin for Preventing and Treating Preeclampsia: A Systematic Review

Importance We have performed a systematic search to summarize the role of statins for preventing and treating severe preeclampsia. Objective The aim of this study was to examine whether pravastatin is a useful and safe alternative for treating preeclampsia during pregnancy. Evidence Acquisition A systematic MEDLINE (PubMed) search was performed (1979 to June 2017), which was restricted to articles published in English, using the relevant key words of statins, pregnancy, preeclampsia, obstetrical antiphospholipid syndrome, and teratogenicity. Results The initial search provided 296 articles. Finally, 146 articles were related to the use of statins during pregnancy, regarding their effect on the fetus and the treatment of preeclampsia. Ten studies were related to in vitro studies, 25 in animals, and 24 in humans (13 case report series and 11 cohort studies). We found 84 studies on reviews of such guidelines on cardiovascular disease (35 studies), use of statins in the antiphospholipid syndrome (25 studies), statin's specific use during pregnancy (13 studies), or preeclampsia treatment (11 studies). Conclusions Although the studies are of poor quality, the rate of major congenital abnormalities in the newborn exposed to statins during pregnancy is no higher than the expected when compared with overall risk population. The review shows a potential beneficial role of statins in preventing and treating severe preeclampsia that needs to be evaluated through well-designed clinical trials. Relevance This update could influence positively the clinical practice, giving an alternative therapy for clinicians who treat preeclampsia, particularly in severe cases. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to recall that statins exert a useful number of pleiotropic effects related to their antiproliferative and immunosuppressive actions; describe the potential role of statins as beneficial and safe drugs during pregnancy, thereby preventing and treating early and severe preeclampsia; and list the properties that make pravastatin the best statin to treat preeclampsia.