Premature Birth Clinical Trial
Official title:
Docosahexaenoic Acid (DHA) Supplementation During Pregnancy to Prevent Deep Placentation Disorders: A Randomized Clinical Trial and a Study of the Molecular Pathways of Abnormal Placentation Prevention
This study evaluates the effectiveness of maternal supplementation with Docosahexaenoic acid (DHA) early in pregnancy to reduce the incidence of deep placentation disorders: preterm birth, preterm labor, preterm premature rupture of membranes, preeclampsia and fetal growth restriction. Half of the participants in early pregnancy will receive DHA 600 mg per day, while the other half will receive placebo. Investigators will study also the ability of DHA supplementation, early in pregnancy, to enhance invasion and transformation of spiral arteries by trophoblast, as deep placentation indicators.
Status | Recruiting |
Enrollment | 2400 |
Est. completion date | April 2018 |
Est. primary completion date | March 2018 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Female |
Age group | 18 Years to 45 Years |
Eligibility |
Inclusion Criteria: - Women 18 years old or older at time of consent - Capability of the subject to comprehend and comply with study requirements - Live embryo or fetus (documented with positive fetal heart rate prior randomisation) - Gestational age before 16+0 weeks of pregnancy - Planning to deliver at Hospital Dr. Sótero del Río, Hospital Padre Hurtado, or Hospital Clínico Universidad Católica de Chile. Exclusion Criteria: - Preexisting diabetes mellitus. - Uterine anatomic malformation (bicornuate, septate uterus). - Already taking a prenatal supplement with DHA. - Bleeding disorder in which DHA was contraindicated. - Anticoagulant therapy. - Documented history of drug or alcohol abuse. - Embryo or Fetus with a known mayor abnormality. - Unable to give written informed consent. - In the judgment of the investigator, will be unwilling or unable to comply with study protocol. - Currently participating in another fatty acid trial |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention
Country | Name | City | State |
---|---|---|---|
Chile | Centro de Salud Familiar ANCORA Juan Pablo II | Santiago | |
Chile | Centro de Salud Familiar ANCORA Madre Teresa de Calcuta | Santiago | |
Chile | Centro de Salud Familiar ANCORA San Alberto Hurtado | Santiago | |
Chile | Centro Medico Lira 85 | Santiago | |
Chile | Centro Medico San Joaquin | Santiago |
Lead Sponsor | Collaborator |
---|---|
Pontificia Universidad Catolica de Chile | Laboratorio Gynopharm - CFR, University of Chile |
Chile,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Composite outcome: Preterm birth less than 34+0 gestational weeks or preeclampsia before 34+0 gestational weeks or severe fetal growth restrictions early than 34+0 gestational weeks. | Gestational age (first day of the last menstrual period (LMP) or estimated by ultrasound performed before 12+6 weeks of pregnancy). Severe growth restriction defined as birth weight less than the 2nd percentile of population (according to the current national recommended standard). Preeclampsia defined as blood pressure of 140 mm Hg systolic or higher or 90 mm Hg diastolic or higher that occurs after 20 weeks of pregnancy in a woman with previously normal blood pressure and proteinuria (urinary excretion of 0.3 g protein or higher in a 24-hour urine specimen). Or HELLP syndrome (Haemolysis, Elevated, Liver Enzymes, Low Platelets) or superimposed pre-eclampsia, defined as history of pre-existing hypertension (diagnosed pre-pregnancy or before 20+0 weeks' gestation) with new proteinuria. Or Eclampsia, defined as seizures that cannot be attributable to other causes, in a woman with preeclampsia. |
34 weeks of pregnancy | No |
Secondary | Stillbirth | Defined as death of the fetus of at least 500 grams birth weight or, if birth weight is unavailable, a gestational age of at least 20+0 weeks of gestation. | During pregnancy | No |
Secondary | Intrauterine growth restriction | Birth weight less than the 10th percentile of the population standard for the gestational age. | At delivery | No |
Secondary | Severe intrauterine growth restriction | birth weight less than the 2nd percentile of population (according to the current national recommended standard). | At birth | No |
Secondary | Preterm birth | Birth < week 37th, < week 32th, < week 28th | At birth | No |
Secondary | Perinatal death | number of deaths (fetal deaths and neonatal deaths) of babies =500 grams, if birth weight is unavailable, a gestational age =20+0 weeks, up to 28 completed days after birth. | From the 20th gestational week to the 28th day of life | No |
Secondary | Neonatal | Death of a baby that occurred during the first 28 days of life | From birth to the 28th day of life | No |
Secondary | Respiratory Distress Syndrome (RDS) | Defined as requiring assisted ventilation via endotracheal tube or CPAP (Continuous positive airway pressure) or supplemental oxygen greater or equal to 40% all within the first 24 hours of life and for a duration of greater than or equal to 24 hours, and either an x-ray compatible with RDS or surfactant given between the first 2 and 24 hours of life. | Until the 28th day of life | No |
Secondary | Bronchopulmonary Dysplasia (BPD) | Defined as requiring oxygen supplementation at 28 days postnatal age | Until the 28th day of life | No |
Secondary | Intraventricular Hemorrhage (IVH) | Diagnosed by imaging, categorized by: Grade 1: blood in germinal matrix Grade 2: blood in germinal matrix and extending into ventricles Grade 3: ventricular enlargement Grade 4: intraparenchymal lesion |
Until the 28th day of life | No |
Secondary | Proven Early onset Sepsis | Within first 48hr of life, confirmed by positive blood or cerebrospinal fluid cultures | Within the first 48 hours of life | No |
Secondary | Necrotizing Enterocolitis | Defined as Bell's stage II (definite case of necrotizing enterocolitis) or greater, or perforation of intestine identified by surgery, or at autopsy. (Neu J. Necrotizing enterocolitis: the search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 1996; 43(2): 409-32.) | Until the 28th day of life | No |
Secondary | Low birth weight | Number of Infants with a birth weight < 1500 grams, number of Infants with a birth weight < 2500 grams | At birth | No |
Secondary | Admitted to Neonatal Intensive Care Unit (NICU) | Until the 28th day of life | No | |
Secondary | Birth biometry | Measurement of ponderal index (birth weight/height^3×100), head circumference (cm), Birth weight (grams). | At birth | No |
Secondary | Cesarean section | Number of deliveries by cesarean section | At delivery | No |
Secondary | Preeclampsia | Defined as blood pressure of 140 mm Hg systolic or higher or 90 mm Hg diastolic or higher that occurs after 20 weeks of pregnancy in a woman with previously normal blood pressure and proteinuria, defined as urinary excretion of 0.3 g protein or higher in a 24-hour urine specimen. Or HELLP (Haemolysis, Elevated, Liver Enzymes, Low Platelets) syndrome Or Superimposed pre-eclampsia, defined as history of pre-existing hypertension (diagnosed pre- pregnancy or before 20+0 weeks' gestation) with new proteinuria. Or Eclampsia, defined as seizures that cannot be attributable to other causes, in a woman with preeclampsia. | From pregnancy to discharge after delivery | No |
Secondary | Gestational Diabetes (GDM) | Screening during pregnancy | During pregnancy | No |
Secondary | Premature rupture of membranes | Rupture of the amniotic sac before the onset of labor | During pregnancy | No |
Secondary | Maternal Venous Thrombosis | Venous Thrombosis confirmed by imaging during pregnancy | During pregnancy | Yes |
Secondary | Bleeding during pregnancy | Genital bleeding diagnosed during pregnancy | During pregnancy | No |
Secondary | Placental Abruptio | Prematurely detachment of a normal positioned placenta for the wall of uterus | During pregnancy | No |
Secondary | Postpartum bleeding | Estimated bleeding more than 500 ml after vaginal birth or 1000 ml after cesarean section | Postpartum period | No |
Secondary | Postpartum depression | Postpartum Depression defined by the Edinburgh Postnatal Depression Scale (EPDS) | At the 6th postpartum week | No |
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