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Statins damage fetal growth, study confirms

Pregnant women or those thinking of starting a family should avoid using statins, according to a letter published in the Journal of Cellular and Molecular Medicine.

Researchers from the University of Manchester have shown that statins are detrimental to the early development of the human placenta and, given that reduced placental growth is strongly correlated with poor pregnancy outcome, they recommended that statins should be avoided if pregnancy is suspected or confirmed.

The findings are particularly pertinent because the rapid rise in obesity, metabolic syndrome and type II diabetes means such drugs are increasingly prescribed to women of reproductive age.

Current clinical guidelines contraindicate the use of statins during pregnancy as cholesterol is essential for normal fetal development. However, a recent study (British Journal of Clinical Pharmacology 2007;64:496) has suggested these detrimental effects may only be restricted to more lipophilic compounds (such as simvastatin) as there have been no reports of fetal congenital abnormalities associated with the more hydrophilic statins, such as pravastatin.

But, the Manchester study shows that even hydrophilic drugs can affect placental development. As well as modulating cholesterol levels, statins affect other chemicals in the body including the insulin-like growth factor system, which controls fetal growth.

Data from the study show that the effect of statins is not dependent on their lipophilicity in the placenta. This may be due to the expression of organic anion-transporting polypeptides, known to enhance the active uptake of statins.

Although the hydrophilic statins have not been reported to increase the incidence of fetal malformations, the study data suggest that they reduce placental size. This is associated with impaired nutrient uptake and intrauterine growth restriction which, the researchers say, is highly likely to result in a poor outcome.

Citation: The Pharmaceutical Journal URI: 10043874

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