427. STRIDER: Sildenafil therapy in dismal prognosis early-onset fetal growth restriction – A systematic review with individual participant data

Ganzevoort, Wessel; Dadelszen, Peter von; Baker, Phil; Kariya, Chirag; Lim, K.; Christian, Gluud; Alfirević, Z̄arko; Sharp, Andrew; Groom, Katie

doi:10.1016/j.preghy.2018.08.028

Cited by 4 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This allowed for broader access to funding, variations in regional approval and faster recruitment for a condition with such a low prevalence. All four trials within the Consortium have been funded independently by national peer-reviewed funding bodies and executed independently, with a plan for independent publication [4][5][6][7] . All trials were designed in collaboration across the Consortium; thus, although there were variations in inclusion criteria and primary outcome measures, these were clearly defined a priori to ensure compatibility for assessment, in prospectively planned individual participant data (IPD) and trial-level meta-analyses 8,9 .…”

mentioning

confidence: 99%

Clinicians should stop prescribing sildenafil for fetal growth restriction (FGR): comment from the STRIDER Consortium

Groom

Ganzevoort

Alfirević

et al. 2018

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

mentioning

confidence: 99%

Clinicians should stop prescribing sildenafil for fetal growth restriction (FGR): comment from the STRIDER Consortium

Groom

Ganzevoort

Alfirević

et al. 2018

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

“…The results of randomized trials of sildenafil and other phosphodiesterase type 5 inhibitors are keenly awaited. The international Sildenafil Therapy In Dismal Prognosis Early-Onset Intrauterine Growth Restriction (STRIDER) Consortium includes 5 placebo-controlled randomized trials in the United Kingdom, 76 New Zealand and Australia, 77 The Netherlands, 78 Canada, 79 and Ireland. 80 These trials have been conceived and designed through an international collaboration and include women with early-onset FGR.…”

Section: Expert Reviews Ajogorgmentioning

confidence: 99%

The role of aspirin, heparin, and other interventions in the prevention and treatment of fetal growth restriction

Groom

David

2018

American Journal of Obstetrics and Gynecology

130

101

View full text Add to dashboard Cite

Fetal growth restriction and related placental pathologies such as preeclampsia, stillbirth, and placental abruption are believed to arise in early pregnancy when inadequate remodeling of the maternal spiral arteries leads to persistent high-resistance and low-flow uteroplacental circulation. The consequent placental ischaemia, reperfusion injury, and oxidative stress are associated with an imbalance in angiogenic/antiangiogenic factors. Many interventions have centered on the prevention and/or treatment of preeclampsia with results pertaining to fetal growth restriction and small-for-gestational-age pregnancy often included as secondary outcomes because of the common pathophysiology. This renders the study findings less reliable for determining clinical significance. For the prevention of fetal growth restriction, a recent large-study level meta-analysis and individual patient data meta-analysis confirm that aspirin modestly reduces small-for-gestational-age pregnancy in women at high risk (relative risk, 0.90, 95% confidence interval, 0.81-1.00) and that a dose of ≥100 mg should be recommended and to start at or before 16 weeks of gestation. These findings support national clinical practice guidelines. In vitro and in vivo studies suggest that low-molecular-weight heparin may prevent fetal growth restriction; however, evidence from randomized control trials is inconsistent. A meta-analysis of multicenter trial data does not demonstrate any positive preventative effect of low-molecular-weight heparin on a primary composite outcome of placenta-mediated complications including fetal growth restriction (18% vs 18%; absolute risk difference, 0.6%; 95% confidence interval, 10.4-9.2); use of low-molecular-weight heparin for the prevention of fetal growth restriction should remain in the research setting. There are even fewer treatment options once fetal growth restriction is diagnosed. At present the only management option if the risk of hypoxia, acidosis, and intrauterine death is high is iatrogenic preterm birth, with the use of peripartum maternal administration of magnesium sulphate for neuroprotection and corticosteroids for fetal lung maturity, to prevent adverse neonatal outcomes. The pipeline of potential therapies use different strategies, many aiming to increase fetal growth by improving poor placentation and uterine blood flow. Phosphodiesterase type 5 inhibitors that potentiate nitric oxide availability such as sildenafil citrate have been extensively researched both in preclinical and clinical studies; results from the Sildenafil Therapy In Dismal Prognosis Early-Onset Intrauterine Growth Restriction consortium of randomized control clinical trials are keenly awaited. Targeting the uteroplacental circulation with novel therapeutics is another approach, the most advanced being maternal vascular endothelial growth factor gene therapy, which is being translated into the clinic via the doEs Vascular endothelial growth factor gene therapy safEly impRove outcome in seveRe Early-onset fetal growth reSTriction co...

show abstract

Intrauterine Growth Retardation - A Review Article

Minh

Quoc

Dinh

2018

JMP

View full text Add to dashboard Cite

Small for gestational age (SGA) and fetal growth restriction (FGR) is difficult to define exactly. In this pregnancy condition, the fetus does not reach its biological growth potential as a consequence of impaired placental function, which may be because of a variety of factors. Fetuses with FGR are at risk for perinatal morbidity and mortality, and poor long-term health outcomes, such as impaired neurological and cognitive development, and cardiovascular and endocrine diseases in adulthood. At present no gold standard for the diagnosis of SGA/FGR exists. The first aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines. Another aim to summary a number of interventions which are being developed or coming through to clinical trial in an attempt to improve fetal growth in placental insufficiency. Key words: fetal growth restriction (FGR), Small for gestational age (SGA)

show abstract

427. STRIDER: Sildenafil therapy in dismal prognosis early-onset fetal growth restriction – A systematic review with individual participant data

Cited by 4 publications

References 0 publications

Clinicians should stop prescribing sildenafil for fetal growth restriction (FGR): comment from the STRIDER Consortium

Clinicians should stop prescribing sildenafil for fetal growth restriction (FGR): comment from the STRIDER Consortium

The role of aspirin, heparin, and other interventions in the prevention and treatment of fetal growth restriction

Intrauterine Growth Retardation - A Review Article

Contact Info

Product

Resources

About