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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04604535
Other study ID # 263871
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date October 22, 2020
Est. completion date December 30, 2022

Study information

Verified date October 2020
Source King's College Hospital NHS Trust
Contact Katherine Lau
Phone 07738247830
Email katherine.lau@nhs.net
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This is a randomised placebo controlled trial investigating the effects of dietary nitrate supplementation on hypertension in pregnancy


Description:

Reduced nitrate and nitrite concentrations have been found in women with preeclampsia (PE) and studies have shown increased concentrations of an endogenously generated Nitric Oxide Synthase inhibitor, amongst women with PE. Nitrate and nitrite are required to produce Nitric Oxide (NO). NO is released from the endothelial lining of blood vessels, and acts to relax smooth muscle within the vasculature, acting as a potent vasodilator. Reduced NO concentrations are hence thought to contribute towards the systemic vascular constriction seen in PE. Hypertensive diseases in pregnancy are an important cause of morbidity and mortality in both maternal, fetal and neonatal health. Treatment options are limited in pregnancy and hence alternative methods to improve blood pressure control should be sought. In this randomised placebo controlled double blinded trial we aim to assess the effect of dietary nitrate supplementation on the hypertensive diseases of pregnancy and the subsequent maternal, fetal-neonatal outcomes. The safety and acceptability of dietary nitrate supplementation will also be confirmed in this study.


Recruitment information / eligibility

Status Recruiting
Enrollment 320
Est. completion date December 30, 2022
Est. primary completion date June 30, 2022
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 18 Years and older
Eligibility Inclusion Criteria: - Aged =18 - Able to give written informed consent - Singleton pregnancies, between 24+0 to 36+6 weeks gestation with new onset gestational hypertension (defined by ISSHP2018 as new onset BP >140/90 and no evidence of proteinuria, biochemical or haematological abnormalities or fetal growth restriction) Or - Singleton pregnancies, between 24+0 - 36+6 weeks gestation, with chronic hypertension (defined by ISSHP2018 as BP =140/90 predating the pregnancy or recognised at <20 week's gestation) Or - Singleton pregnancies, between 24+0 - 36+6 weeks gestation, with preeclampsia (defined by ISSHP2018 as Gestational hypertension accompanied by = 1 of the following new onset conditions at or after 20 weeks' gestation: - Proteinuria (24h urine collection>300mg/day, Protein-creatinine ratio>30 mg/mmol) - Other markers of maternal organ dysfunction, including: - Acute Kidney Injury (AKI) (creatinine =90µmol/L; 1mg/dL) - Liver involvement (elevated transaminases e.g. alanine transaminase (ALT) or aspartate aminotransferase (AST) >40IU/L) with or without right upper quadrant or epigastric abdominal pain - Neurological complications e.g. eclampsia, altered mental status, blindness, stroke, clonus, severe headaches and persistent visual scotomata - Haematological complications (thrombocytopenia - platelet count <150 000/µL, disseminated intravascular coagulation, haemolysis - Uteroplacental dysfunction (fetal growth restriction, abnormal umbilical artery doppler wave form analysis, or stillbirth) Exclusion Criteria: - Unable to tolerate taste of beetroot juice concentrate during taste test - Multiple pregnancy - History of acute or chronic liver conditions (aside from preeclampsia) - Fetal aneuploidies or major fetal anomalies - Unwillingness to comply with all study-related procedures e.g. Women who have used mouthwash or tongue scraping in last 7 days and are not able/unwilling unable to stop this for the duration of the study - Women on treatment for gingivitis - Women with persistent hyperemesis or ptyalism - On Proton-pump-inhibitors/antacids other treatment for gastritis/peptic ulcer/gastric ulcers - Those with long term antibiotic use e.g. prophylaxis of urinary tract infections (UTIs) or those who are likely to need repeated courses of antibiotics e.g. history of recurrent UTI - Women with known allergy/intolerance to beetroot or lemon - Type 1 and Type 2 diabetics - Moderate iron deficiency anaemia with haemoglobin <100g/dL and/or ferritin <15µg/L - Any blood disorder or significant illness that may affect platelet function and coagulation. However, patients taking low-dose aspirin (150mg) for preeclampsia prophylaxis who are at increased risk of developing preeclampsia will be included in the study. - History of alcohol or recreational drug abuse use within the past 6 months - Systemic autoimmune disease e.g. Rheumatoid Arthritis, antiphospholipid syndrome connective tissue disease e.g. Systemic Lupus Erythematous or other conditions known to be associated with chronic inflammation such as inflammatory bowel disease - Chron's disease/Ulcerative Colitis - Women not intending to deliver at the recruiting site - Participating in another intervention study that influences the outcomes of this study - Those with serious mental illness or learning difficulties and unable to give written informed consent - Those who are detained as a prisoner or detained in any secured unit, including those held under the Mental Health Act - Those not fluent in local language, and absence of appropriate interpreter despite use of services such as Language Line

Study Design


Intervention

Dietary Supplement:
Concentrated beetroot juice
70mL concentrated beetroot juice (400mg nitrate)
Placebo
70mL concentrated nitrate deplete beetroot juice (<0.01mmol/L nitrate)

Locations

Country Name City State
United Kingdom King's College Hospital London

Sponsors (3)

Lead Sponsor Collaborator
King's College Hospital NHS Trust Barts and the London School of Medicine and Dentistry, Fetal Medicine Foundation

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type Measure Description Time frame Safety issue
Primary Gestational age of delivery secondary to preeclampsia From recruitment until delivery
Secondary Gestational age of delivery (due to any cause) From recruitment until delivery
Secondary Will beetroot juice supplementation increase or decrease the likelihood of maternal complications, including severe maternal complications From recruitment until 8 weeks postnatal
Secondary Will beetroot juice supplementation increase or decrease the likelihood of severe hypertension Defined as = 160/110 mmHg From recruitment until 8 weeks postnatal
Secondary Will beetroot juice supplementation result in significant changes in systolic blood pressure and diastolic blood pressure From recruitment until 8 weeks postnatal
Secondary Will beetroot juice supplementation result in a significant change in the maximal number and dosages of antihypertensive medications required for blood pressure control From recruitment until 8 weeks postnatal
Secondary Will beetroot juice supplementation result in a significant change in maternal blood values and urinary protein excretion Measured by creatinine, aspartate aminotransferase, alanine aminotransferase, uric acid, platelets, random urine protein creatinine ratio, protein concentration in a 24hour urine collection From recruitment until 8 weeks postnatal
Secondary Can the safety of beetroot juice supplementation in pregnancy be confirmed Measurement of maternal methemoglobinaemia levels, maternal nitrosamine levels, maternal thyroid function, neonatal cord bloods, neonatal methemoglobinaemia levels From recruitment until 8 weeks postnatal
Secondary To confirm the acceptability of beetroot juice supplementation in pregnancy A post-trial questionnaire At 8 weeks postnatal
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