Pravastatin Versus Placebo in Pregnancies at High Risk of Term Preeclampsia

Statins lower inflammation and improve blood-vessel function, which raised hope they might prevent preeclampsia — the dangerous hypertensive disorder of pregnancy. This well-designed trial put that hope to a rigorous test, and it failed.

Women at high risk of term preeclampsia were randomized in late pregnancy to pravastatin or placebo. The rates of preeclampsia were essentially identical (14.6 versus 13.6 percent), with no significant benefit and no improvement in secondary maternal or neonatal outcomes. Late-pregnancy pravastatin simply did not work for this indication.

The value of a clean negative trial is real: it spares future patients an ineffective intervention and redirects research. It does not address whether earlier initiation or a different statin might behave differently — only that this regimen, at this timing, conferred no benefit.

We rate the evidence strong. It is a properly powered, placebo-controlled randomized trial; its negative result is a reliable answer to a specific clinical question, even though the agent under test is well outside this library’s central focus on coronary disease.