The potential role of statins in preeclampsia and dyslipidemia during gestation: a narrative review

ABSTRACT

Introduction: Statins have several pleiotropic effects that have the potential to be beneficial during pregnancy. This study evaluates the available evidence for the teratogenicity of statins, and their utility in treating preeclampsia and dyslipidemia in pregnancy, as good alternatives in these domains are currently lacking.

Areas covered: The possible teratogenicity of statins is a primary focus of this paper. We also evaluated for some possible non-teratogenic effects, such as changes in birth weight and rates of spontaneous abortion, among mothers exposed to statins during pregnancy. Regarding potential uses, this study mainly discusses statin utility in preventing and treating preeclampsia and treating dyslipidemia in pregnancy. Within the latter, we explore the relationship between dyslipidemia and preeclampsia, the potential consequences of delaying statin therapy where indicated, and the impact of supra-physiological levels of cholesterol in utero on offspring. The literature search was conducted using Embase, Web of Science, PubMed, and Scopus.

Expert opinion: Based on current evidence, statins are likely not teratogenic. Limited, but promising evidence exists for their efficacy in treating and preventing preeclampsia. In utero exposure to high cholesterol may negatively impact offspring, and should be thoroughly investigated.

KEYWORDS:

• Statins
• preeclampsia
• teratogenesis
• pregnancy
• dyslipidemia

Article highlights

• Most animal studies demonstrating ill effects of statins on offspring were administering doses of statins high enough to be toxic to the mother.

• In humans, there is no good evidence that statins are teratogenic, and no specific pattern of malformations has been observed.

• One study found reduced birth weights among mothers exposed to statins.

• Pravastatin was successful in preventing and treating preeclampsia in a couple of small RCTs.

• Delaying statin therapy when cardiovascular risk factors are present may worsen outcomes for the mother.

• In utero exposure to high cholesterol has been associated with a worse atherosclerotic profile in normo-cholesterolemic offspring in one study.

This box summarizes key points contained in the article.

Declaration of interest

This review was self-funded, without any external financing [DPM] has given talks and attended conferences sponsored by MSD, AstraZeneca, and Libytec. [MB] is a part of the speakers bureau for: Abbott/Mylan, Abbott Vascular, Actavis, Akcea, Amgen, KRKA, MSD, Sanofi-Aventis and Valeant; he is also a consultant to Abbott Vascular, Akcea, Amgen, Daichii Sankyo, Esperion, Lilly, MSD, Pfizer, Resverlogix, Sanofi-Aventis. All other authors have noting to declare.