Sildenafil Prolongs Pregnancy in Women with Preeclampsia

In women with preeclampsia, treatment with sildenafil citrate (kamagra) prolonged the pregnancy by an average of 4 days compared to placebo, according to an article published online July 7 in Obstetrics & Gynecology.

“Our results also showed that administration of sildenafil citrate reduces resistance to blood flow in the uteroplacental and fetoplacental circulations and is associated with a decrease in maternal mean blood pressure and that these changes are not associated with concomitant changes in resistance to Fetal cerebral blood flow, Alberto Trapani Jr., MD, PhD, of the Division of Tocoginecology of the Florianópolis University Campus of Trindade, Santa Catarina, Brazil, and his colleagues write.

“Reduction of mean arterial pressure, without compromising blood flow to the uterine artery, ensures that sildenafil may be useful as an antihypertensive drug in the context of placental vascular insufficiency.”

The researchers recruited 100 pregnant women with single pregnancies and preeclampsia and randomly assigned 50 mg of oral sildenafil citrate every 8 hours or placebo. In addition to study drugs, patients received α-methyldopa (500-1,500 mg / day) with an additional β-blocker agent (10-30 mg pindolol daily) as needed, as well as intravenous hydralazine (5-30 Mg). Two doses of betamethasone were used in patients with expected delivery in 72 hours.

The mean gestational age was 29.1 weeks in the sildenafil group and 30.2 weeks in the placebo group at baseline.

On average, women in the treatment group had a longer pregnancy 4 days after randomization compared to women in the placebo group (mean 14.4 days [95% confidence interval (CI), 12.5 – 16.6 days] compared to 10.4 days [95% CI, 8.4-12.3 days], P = 0.008).

Secondary outcomes also favored the treatment group, including a higher percentage reduction in pulsatility rates of the uterine and umbilical arteries (22.5% and 18.5% compared to placebo [2.1% and 2.5 , P <0.001) and a greater reduction in maternal blood (116.4 ± 5.1 mm Hg compared to 100.3 ± 5.6 mm Hg, p <0.05), but not placebo ( 110.6 ± 6.2 mm Hg compared to 114.7 ± 6.5 mm Hg, P = 0.21).

In addition, participants in the placebo group more frequently required an additional antihypertensive drug or an increase in the dose of α-methyldopa (58% vs 32%, p <0.001).

The researchers found no difference between the two groups in perinatal morbidity, mortality, or adverse events. Some estimates indicate that each additional day of pregnancy between 24 and 32 weeks gives about a 1% increase in child survival, but the current study was insufficient to detect these differences.

To confirm a benefit to the fetus, “studies with a larger number of patients and an earlier onset of medication are required,” the authors write.

An earlier study showed that treatment with sildenafil reduced maternal blood pressure, but had no effect on the duration of pregnancy. The authors speculate that the different results could be explained by the fact that the previous study had a lower number of cases, started treatment later in pregnancy (mean, 31.4 vs 29.1 weeks) and used a lower dose (20 vs. 50 mg).

The study was funded by the Federal University of Santa Catarina. The authors have disclosed no relevant financial relationships.