Melatonin to Prevent Brain Injury in Unborn Growth Restricted Babies

Phase 4

Completed

• Conditions: Fetal Growth Retardation
• Interventions: Drug: Melatonin

• Registration Number: NCT01695070
• Lead Sponsor: Monash University

Brief Summary

Intrauterine growth restriction is the term used to describe a condition where an unborn baby does not reach its optimum size. In the short and long term, intrauterine growth restricted babies have a higher risk of serious disease and even death. It is well established that very low levels of oxygen in the baby's blood can harm the baby's health through a state known as oxidative stress. Currently, there is no established treatment available to treat intrauterine growth restriction or its complications. In experimental animal studies however, the naturally occuring hormone, melatonin, has been shown to significantly reduce oxidative stress and improve health of the unborn babies that have suffered from intrauterine growth restriction. This study aims to find out if the use melatonin twice per day throughout pregnancies affected by intrauterine growth restriction will lower the level of oxidative stress experienced by the unborn baby. If this is the case melatonin may help protect the unborn baby from damage caused by oxidative stress, this will be studied in a separate future study.

Detailed Description

Not available

Study Timeline

• Study Start: 2012-09
• Study First Submitted: 2012-09-07
• Study First Submitted QC: 2012-09-26
• Study First Posted: 2012-09-27
• Primary Completion: 2014-10
• Status Verified: 2014-11
• Study Completion: 2014-11
• Last Update Submitted: 2014-11-14
• Last Update Posted: 2014-11-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 16

Inclusion Criteria

• Estimated fetal weight <10th percentile in combination with abnormal fetoplacental Doppler studies.
• Singleton pregnancy.
• Live fetus.
• Gestational age: from 23+0 weeks until 34+0 weeks.
• Normal fetal anatomy on ultrasound.
• Confirmed gestational age.
• No indication for immediate delivery.
• Basic understanding of the English language.
• 18 years or older.
• Consent obtained.

Exclusion Criteria

• Fetal demise.
• Multiple pregnancy.
• Known abnormal karyotype.
• Presence of any congenital abnormality.
• Unknown duration of pregnancy.
• IUGR attributable to non-placental factors.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Melatonin	Melatonin	Women with IUGR will take 4mg prolonged release melatonin oral tablets twice daily. Treatment will occur as soon as the diagnosis of intrauterine growth restriction is made and the patient has been enrolled to this study until birth. The overall duration of treatment will vary due to the nature of intrauterine growth restriction.

Primary Outcome Measures

Name	Time	Method
Oxidative stress in the umbilical artery	Once, at birth.	Umbilical artery oxidative stress by measuring levels of malondialdehyde (MDA) and 8-isoprostane. Levels of MDA will be assessed using a Thiobarbituric Acid Reactive Substances Assay Kit (Cayman Chemical Item Number 10009055). Levels of 8-isoprostane will be assessed using an 8-Isoprostane Enzyme Immuno Assay Kit (Cayman Chemical Item Number 516351).

Secondary Outcome Measures

Name	Time	Method
Oxidative stress in maternal venous serum	Once within one week before start treatment and once per week during the treatment period (estimated to be an average of 4 weeks).	Maternal serum oxidative stress will be assessed by measuring levels of malondialdehyde (MDA) and 8-isoprostane. Levels of MDA will be assessed using a Thiobarbituric Acid Reactive Substances Assay Kit (Cayman Chemical Item Number 10009055). Levels of 8-isoprostane will be assessed using an 8-Isoprostane Enzyme Immuno Assay Kit (Cayman Chemical Item Number 516351).
Fetoplacental Doppler studies	Once within one week before start treatment and twice per week during the treatment period (estimated to be an average of 4 weeks).	Fetoplacental Doppler studies (umbilical artery, uterine artery, middle cerebral artery, ductus venosus). Fetoplacental Doppler studies are performed in the clinical assessment of women diagnosed with intrauterine growth restriction by sonography.
Composite neonatal outcome.	Participants will be followed for the duration of hospital stay, up to 12 months.	Composite neonatal outcome (admission to NICU, duration of admission, need and duration of respiratory support, intraventricular haemorrhage, necrotising enterocolitis, abnormal neurological assessment, mortality before discharge). This composite neonatal outcome will be measured by collecting medical record data after clinical assessments.
Placental oxidative stress	Once, at birth.	Placental oxidative stress is assessed by measuring levels of malondialdehyde (MDA) and 8-isoprostane. Levels of MDA will be assessed using a Thiobarbituric Acid Reactive Substances Assay Kit (Cayman Chemical Item Number 10009055). Levels of 8-isoprostane will be assessed using an 8-Isoprostane Enzyme Immuno Assay Kit (Cayman Chemical Item Number 516351)
Gestational age at birth.	Once, at birth.	Gestational age at birth will be calculated using the last menstrual period and ultrasound characteristics.

Trial Locations

Locations (1)

Southern Health: Monash Medical Centre and Jessie McPherson Private Hospital; 🇦🇺 Clayton, Victoria, Australia