Clinical trial NCT06004674: Using Placental Pathology to Prevent Recurrent Adverse Pregnancy Outcomes: a Pilot Project
Official title: Using Placental Pathology to Prevent Recurrent Adverse Pregnancy Outcomes: a Pilot Project (UPPPP Trial)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Adverse Pregnancy Outcome
Keywords: miscarriage
preeclampsia
preterm delivery
stillbirth
Low birth weight
Lead sponsor: Endeavor Health
Sponsor class: OTHER
First posted: 2023-08-22
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The goal of this randomized clinical trial is to evaluate if we can use placental pathology in a prior pregnancy which had an adverse outcome, such as early delivery, stillbirth, a baby born smaller than expected, or severe forms of high blood pressure during pregnancy, to guide treatment in the subsequent pregnancy and reduce risk of recurrent adverse pregnancy events.

The main questions it aims to answer are:

* Whether enoxaparin prevents recurrent adverse pregnancy outcomes among patients with a prior adverse pregnancy outcome that occurred in the setting of maternal vascular malperfusion (MVM).
* If enoxaparin reduces the occurrence or severity of MVM among patients with a prior adverse pregnancy outcome that occurred in the setting of MVM.

Detailed description: In this clinical trial, participants will undergo consent, blood samples will be collected, and participants will be randomized in a 1:1 ratio to the enoxaparin or control groups at their first study visit.

* Participants will return for a study visit within 1 week following randomization.
* If assigned to the enoxaparin, the participant will be asked to take a dose of the enoxaparin once a day (40 mg daily) daily from 12 0/7 weeks and/or the start of enrollment (whichever is later) and continue until 36 weeks gestational age, after which enoxaparin will be discontinued.
* Participants in the control group will have care as usual, with no additional medications.
* During this study, a study team member will collect a blood sample from all participants at 20-24 weeks, 32-34 weeks, and at delivery.
* Participants in the enoxaparin group will have their blood work checked a week after starting medication to ensure that they have no unanticipated side effects.

Researchers will compare the enoxaparin group to the control group to see if enoxaparin prevents or reduces the occurrence or severity of maternal vascular malperfusion (MVM) among patients with a prior adverse pregnancy outcome.

Eligibility criteria: Eligibility Criteria:

Inclusion (must meet all three criteria):

1. Subjects with a prior adverse outcome in a prior pregnancy. Adverse outcome is defined as prior singleton preterm birth ( \< 37 weeks), SGA infant (defined as birthweight \< 10th percentile), preeclampsia with severe features, or stillbirth (fetal demise after 20 weeks gestation), as certified by an obstetrician
2. Patients with maternal vascular malperfusion on pathology from pregnancy with prior adverse pregnancy outcome, as certified by a perinatal placental pathologist
3. Current singleton pregnancy at \<16 6/7 weeks gestational age.

Exclusion Criteria:

1. Anticoagulation planned for current pregnancy (including warfarin, enoxaparin, heparin)
2. Known major fetal anomaly
3. Contraindication to enoxaparin: Specifically active major bleeding, known thrombocytopenia (platelets \<100), hypersensitivity to enoxaparin sodium, hypersensitivity to heparin or pork products, hypersensitivity to benzyl alcohol
4. Chronic kidney disease with eGFR\< 60
5. Known chronic liver disease with baseline AST/ALT \> 3 x upper limit of normal
6. Subjects with mechanical prosthetic heart valves

Primary outcomes:
measure: Composite Adverse Pregnancy outcome
timeFrame: Enrollment through 6 weeks postpartum
Secondary outcomes:
measure: Maternal vascular malperfusion (MVM)
timeFrame: Placenta collected at time of delivery
measure: Preeclampsia with severe features
timeFrame: Enrollment through 6 weeks postpartum
measure: Small for gestational age infant
timeFrame: At time of delivery
measure: Preterm delivery < 37 weeks
timeFrame: Assessed at time of delivery
measure: Neonatal Death
timeFrame: Assessed from time of delivery to 6 weeks postpartum
measure: Maternal Death
timeFrame: Assessed from enrollment to 6 weeks postpartum
Other outcomes:
Locations:
city: Evanston
country: United States
facility: NorthShore University HealthSystem
state: Illinois
Study officials:
affiliation: Endeavor Health
name: Sunitha Suresh
role: PRINCIPAL_INVESTIGATOR
References: