The impact of statin use on fetal development: a meta-analysis

Allyah S. Abbas, Susan Morton, Mathew Shun-Shun, Shir Raman, Shakila Thangaratinam, Asif Ahmed

Research output: Contribution to journalMeeting abstract

Abstract

INTRODUCTION: Statin use inadvertently during pregnancy and proposed use of statins for the treatment of preeclampsia, led us to question the evidence behind their current contraindicated status. Several studies have evaluated the relationship between statin use in pregnancy with fetal outcome but their results have not been quantitatively assessed by meta-analysis. Our objective was to undertake a systematic review of all published clinical evidence to assess the effects of statin use in pregnancy on subsequent fetal wellbeing.
METHODS: A comprehensive search strategy was performed of all electronic databases and the Merck reporting database for studies published from 1966 to 2014. Two reviewers independently screened citations and undertook study quality assessment and data extraction. We obtained summary estimates of adverse fetal events that were classified as potentially fatal, clinically significant morbidity or minor adverse event. We identified 602 titles and reviewed 30 articles for inclusion and exclusion criteria. Meta-analysis was performed on seven studies (3 cohort, 3 case-series and 1 case-control).
RESULTS: Of the 922 cases of statin exposure in pregnancy, 27 exposures were associated with lethal or clinically significant fetal morbidity and 10 with minor adverse events. Statin exposure was limited to the first trimester in all but two cases. The pooled rate of lethal or clinically significant fetal abnormalities in pregnant women exposed to statins was 0.01 (95% CI 0.00-0.04), less than the European rate of 0.026 (95% CI 2.54- 2.57)EUROCAT. The rate of fetal abnormality for simvastatin was 0.03 (95% CI 0.00-0.08), atorvostatin 0.11 (95% CI 0.00-0.52), pravastatin 0.01 (95% CI 0.00-0.2) and lovastatin use 0.04 (95% CI 0.00-0.28). Systems based anomalies were also calculated, congenital heart disease was 0.8 (95% CI 0.02-0.12) compared with the background rate of 0.79 (95% CI 0.78- 0.80).
CONCLUSIONS: The published data suggests that statins may not be teratogenic when given inadvertently during pregnancy and prospective studies such as The StAmP Trial may provide more data
Original languageEnglish
Article numberT-192
Pages (from-to)A169
Number of pages1
JournalReproductive Sciences
Volume22
Issue numberSuppl.1
DOIs
Publication statusPublished - 13 Mar 2015

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Fetal Development
Meta-Analysis
Pregnancy
Databases
Morbidity
Pravastatin
Lovastatin
Simvastatin
First Pregnancy Trimester
Pre-Eclampsia
Pregnant Women
Heart Diseases
Cohort Studies
Prospective Studies

Cite this

Abbas, A. S., Morton, S., Shun-Shun, M., Raman, S., Thangaratinam, S., & Ahmed, A. (2015). The impact of statin use on fetal development: a meta-analysis . Reproductive Sciences, 22(Suppl.1), A169. [T-192]. https://doi.org/10.1177/1933719115579631
Abbas, Allyah S. ; Morton, Susan ; Shun-Shun, Mathew ; Raman, Shir ; Thangaratinam, Shakila ; Ahmed, Asif. / The impact of statin use on fetal development : a meta-analysis . In: Reproductive Sciences. 2015 ; Vol. 22, No. Suppl.1. pp. A169.
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abstract = "INTRODUCTION: Statin use inadvertently during pregnancy and proposed use of statins for the treatment of preeclampsia, led us to question the evidence behind their current contraindicated status. Several studies have evaluated the relationship between statin use in pregnancy with fetal outcome but their results have not been quantitatively assessed by meta-analysis. Our objective was to undertake a systematic review of all published clinical evidence to assess the effects of statin use in pregnancy on subsequent fetal wellbeing. METHODS: A comprehensive search strategy was performed of all electronic databases and the Merck reporting database for studies published from 1966 to 2014. Two reviewers independently screened citations and undertook study quality assessment and data extraction. We obtained summary estimates of adverse fetal events that were classified as potentially fatal, clinically significant morbidity or minor adverse event. We identified 602 titles and reviewed 30 articles for inclusion and exclusion criteria. Meta-analysis was performed on seven studies (3 cohort, 3 case-series and 1 case-control). RESULTS: Of the 922 cases of statin exposure in pregnancy, 27 exposures were associated with lethal or clinically significant fetal morbidity and 10 with minor adverse events. Statin exposure was limited to the first trimester in all but two cases. The pooled rate of lethal or clinically significant fetal abnormalities in pregnant women exposed to statins was 0.01 (95{\%} CI 0.00-0.04), less than the European rate of 0.026 (95{\%} CI 2.54- 2.57)EUROCAT. The rate of fetal abnormality for simvastatin was 0.03 (95{\%} CI 0.00-0.08), atorvostatin 0.11 (95{\%} CI 0.00-0.52), pravastatin 0.01 (95{\%} CI 0.00-0.2) and lovastatin use 0.04 (95{\%} CI 0.00-0.28). Systems based anomalies were also calculated, congenital heart disease was 0.8 (95{\%} CI 0.02-0.12) compared with the background rate of 0.79 (95{\%} CI 0.78- 0.80). CONCLUSIONS: The published data suggests that statins may not be teratogenic when given inadvertently during pregnancy and prospective studies such as The StAmP Trial may provide more data",
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Abbas, AS, Morton, S, Shun-Shun, M, Raman, S, Thangaratinam, S & Ahmed, A 2015, 'The impact of statin use on fetal development: a meta-analysis ', Reproductive Sciences, vol. 22, no. Suppl.1, T-192, pp. A169. https://doi.org/10.1177/1933719115579631

The impact of statin use on fetal development : a meta-analysis . / Abbas, Allyah S.; Morton, Susan; Shun-Shun, Mathew; Raman, Shir; Thangaratinam, Shakila; Ahmed, Asif.

In: Reproductive Sciences, Vol. 22, No. Suppl.1, T-192, 13.03.2015, p. A169.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - The impact of statin use on fetal development

T2 - a meta-analysis

AU - Abbas, Allyah S.

AU - Morton, Susan

AU - Shun-Shun, Mathew

AU - Raman, Shir

AU - Thangaratinam, Shakila

AU - Ahmed, Asif

PY - 2015/3/13

Y1 - 2015/3/13

N2 - INTRODUCTION: Statin use inadvertently during pregnancy and proposed use of statins for the treatment of preeclampsia, led us to question the evidence behind their current contraindicated status. Several studies have evaluated the relationship between statin use in pregnancy with fetal outcome but their results have not been quantitatively assessed by meta-analysis. Our objective was to undertake a systematic review of all published clinical evidence to assess the effects of statin use in pregnancy on subsequent fetal wellbeing. METHODS: A comprehensive search strategy was performed of all electronic databases and the Merck reporting database for studies published from 1966 to 2014. Two reviewers independently screened citations and undertook study quality assessment and data extraction. We obtained summary estimates of adverse fetal events that were classified as potentially fatal, clinically significant morbidity or minor adverse event. We identified 602 titles and reviewed 30 articles for inclusion and exclusion criteria. Meta-analysis was performed on seven studies (3 cohort, 3 case-series and 1 case-control). RESULTS: Of the 922 cases of statin exposure in pregnancy, 27 exposures were associated with lethal or clinically significant fetal morbidity and 10 with minor adverse events. Statin exposure was limited to the first trimester in all but two cases. The pooled rate of lethal or clinically significant fetal abnormalities in pregnant women exposed to statins was 0.01 (95% CI 0.00-0.04), less than the European rate of 0.026 (95% CI 2.54- 2.57)EUROCAT. The rate of fetal abnormality for simvastatin was 0.03 (95% CI 0.00-0.08), atorvostatin 0.11 (95% CI 0.00-0.52), pravastatin 0.01 (95% CI 0.00-0.2) and lovastatin use 0.04 (95% CI 0.00-0.28). Systems based anomalies were also calculated, congenital heart disease was 0.8 (95% CI 0.02-0.12) compared with the background rate of 0.79 (95% CI 0.78- 0.80). CONCLUSIONS: The published data suggests that statins may not be teratogenic when given inadvertently during pregnancy and prospective studies such as The StAmP Trial may provide more data

AB - INTRODUCTION: Statin use inadvertently during pregnancy and proposed use of statins for the treatment of preeclampsia, led us to question the evidence behind their current contraindicated status. Several studies have evaluated the relationship between statin use in pregnancy with fetal outcome but their results have not been quantitatively assessed by meta-analysis. Our objective was to undertake a systematic review of all published clinical evidence to assess the effects of statin use in pregnancy on subsequent fetal wellbeing. METHODS: A comprehensive search strategy was performed of all electronic databases and the Merck reporting database for studies published from 1966 to 2014. Two reviewers independently screened citations and undertook study quality assessment and data extraction. We obtained summary estimates of adverse fetal events that were classified as potentially fatal, clinically significant morbidity or minor adverse event. We identified 602 titles and reviewed 30 articles for inclusion and exclusion criteria. Meta-analysis was performed on seven studies (3 cohort, 3 case-series and 1 case-control). RESULTS: Of the 922 cases of statin exposure in pregnancy, 27 exposures were associated with lethal or clinically significant fetal morbidity and 10 with minor adverse events. Statin exposure was limited to the first trimester in all but two cases. The pooled rate of lethal or clinically significant fetal abnormalities in pregnant women exposed to statins was 0.01 (95% CI 0.00-0.04), less than the European rate of 0.026 (95% CI 2.54- 2.57)EUROCAT. The rate of fetal abnormality for simvastatin was 0.03 (95% CI 0.00-0.08), atorvostatin 0.11 (95% CI 0.00-0.52), pravastatin 0.01 (95% CI 0.00-0.2) and lovastatin use 0.04 (95% CI 0.00-0.28). Systems based anomalies were also calculated, congenital heart disease was 0.8 (95% CI 0.02-0.12) compared with the background rate of 0.79 (95% CI 0.78- 0.80). CONCLUSIONS: The published data suggests that statins may not be teratogenic when given inadvertently during pregnancy and prospective studies such as The StAmP Trial may provide more data

U2 - 10.1177/1933719115579631

DO - 10.1177/1933719115579631

M3 - Meeting abstract

VL - 22

SP - A169

IS - Suppl.1

M1 - T-192

ER -

Abbas AS, Morton S, Shun-Shun M, Raman S, Thangaratinam S, Ahmed A. The impact of statin use on fetal development: a meta-analysis . Reproductive Sciences. 2015 Mar 13;22(Suppl.1):A169. T-192. https://doi.org/10.1177/1933719115579631