Does sildenafil affect cardiovascular outcomes in pregnancies complicated by foetal growth restriction?

  • Khalil A & al.
  • Ultrasound Obstet Gynecol
  • 20 Aug 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In pregnancies complicated by early onset-foetal growth restriction (FGR), the use of sildenafil was associated with an increase in heart rate (HR) and decrease in blood pressure (BP) and arterial stiffness.
  • However, these effects were mild and short-lasting.

Why this matters

  • Findings provide reassurance that any cardiovascular change associated with the use of sildenafil during pregnancy are modest and have no short- or long-term clinical effect on the mother or baby.

Study design

  • In this multicentre randomised controlled trial, 135 women with singleton pregnancies and severe early-onset FGR were randomly assigned to receive either a dose of sildenafil 25 mg 3 times daily (n=69) or placebo (n=65) until 32 weeks’ gestation or delivery.
  • Effect of sildenafil on maternal haemodynamics was evaluated.
  • Funding: National Institute for Health Research and Medical Research Council.

Key results

  • Women who received sildenafil vs placebo had increased HR by 4 bpm (5 [95% CI, 1-12] bpm vs 1 [95% CI, −5 to 8] bpm; P=.004) and reduced systolic BP by 1 mmHg (−4 [95% CI, −9 to 1] mmHg vs −3 [95% CI, −8 to 5] bpm; P=.048).
  • After adjusting for maternal BP, sildenafil vs placebo was associated with a reduction in aortic pulse wave velocity (−0.90 [95% CI, −1.31 to −0.51] m/sec vs −0.26 [95% CI, −0.75 to 0.59] m/sec; P=.001).
  • Sildenafil was associated with a non-significant decrease in the stroke volume index (−5.5 [95% CI, −11.0 to −0.5] m/m2/beat vs 0 [95% CI, −0.5 to 4.0] m/m2/beat; P=.056).

Limitation

  • Small sample size.

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