Pre-Eclampsia Clinical Trial
Official title:
The Effects of Dietary Nitrate Supplementation on Pregnancies Complicated by Chronic and New Onset Hypertension
This is a randomised placebo controlled trial investigating the effects of dietary nitrate supplementation on hypertension in pregnancy
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 |
Country | Name | City | State |
---|---|---|---|
United Kingdom | King's College Hospital | London |
Lead Sponsor | Collaborator |
---|---|
King's College Hospital NHS Trust | Barts and the London School of Medicine and Dentistry, Fetal Medicine Foundation |
United Kingdom,
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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