Impact of Maternal Pomegranate Juice on Brain Injury in Infants With Intrauterine Growth Restriction (IUGR) (POM-1)
Infants with intrauterine growth restriction are known to be at increased risk for long term neurodevelopmental delay into adulthood. The main mechanism for this is likely decreased blood flow to the brain secondary to altered placental blood flow. Antioxidants may serve to protect the developing brain from this process. Animal studies have shown that pomegranate juice protects the fetal brain from injury in a model of stroke. This clinical trial is intended to evaluate if giving mothers pomegranate juice during the last several weeks of pregnancy can help protect intrauterine growth restricted babies' brains.
Intrauterine Growth Restriction
Dietary Supplement: Pomegranate Juice
Dietary Supplement: Placebo
|Study Design:||Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Double Blind (Caregiver, Investigator)
Primary Purpose: Prevention
|Official Title:||Impact of Maternal Pomegranate Juice on Brain Injury in Infants With Intrauterine Growth Restriction (IUGR)|
- CNS injury at term by MR Imaging [ Time Frame: 36 - 41 weeks (post delivery) ] [ Designated as safety issue: No ]
- Qualitative MRI injury- white matter injury (WMI) and gray matter injury (GMI)
- Brain Metrics on MR imaging
- Diffusion- apparent diffusion coefficient (ADC) and fractional anisotropy (FA)
- Spectroscopy- lactate and NAA levels in the basal ganglia
- Advanced MRI development indices - brain volumes, surface based morphology (SBM, folding indices)
- Placental morphology: weight and size [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Gestational age at delivery [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Birth weight [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Ellagic acid levels from cord blood [ Time Frame: To discharge ] [ Designated as safety issue: No ]
- Dubowitz neurologic exam at term [ Time Frame: To discharge ] [ Designated as safety issue: No ]
- Time to full oral feeds [ Time Frame: To discharge ] [ Designated as safety issue: No ]
- ROP [ Time Frame: To discharge ] [ Designated as safety issue: No ]
- NEC [ Time Frame: To discharge ] [ Designated as safety issue: No ]
- Length of ventilatory support [ Time Frame: To discharge ] [ Designated as safety issue: No ]
- Time to discharge [ Time Frame: To discharge ] [ Designated as safety issue: No ]
- Placental micrography: number of villi, vasculature, collagen content [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Placental immunohistochemistry: proliferation, apoptosis and differentiation [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Placental: immunoassays: HSP90, lipid hydroperoxide, nitrotyrosine assay, paraoxonase 1 expression, superoxide dismutases [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Placental RNA microarray [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Umbilical cord gases [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Pregnancy complications: preeclampsia [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Neonatal wellbeing: APGAR scores, need for resuscitation [ Time Frame: At birth ] [ Designated as safety issue: No ]
- Maternal compliance [ Time Frame: To delivery ] [ Designated as safety issue: No ]
- Daily dietary report
- Increase in polyphenol levels
- Analysis both by 'intention to treat' and 'as treated' [ Time Frame: To discharge ] [ Designated as safety issue: No ]
|Study Start Date:||December 2008|
|Estimated Study Completion Date:||October 2014|
|Estimated Primary Completion Date:||July 2014 (Final data collection date for primary outcome measure)|
Experimental: Pomegranate juice
This arm with receive 8oz of pomegranate juice per day.
Dietary Supplement: Pomegranate Juice
8 oz of pomegranate juice daily vs placebo juice identical in all respects except pomegranate
Placebo Comparator: Placebo
This group will take 8oz of placebo juice that lacks pomegranate daily
Dietary Supplement: Placebo
Juice that matches the makeup of pomegranate in regards to sugar, vitamin C, etc. The only difference is that it lacks pomegranate juice.
This study is divided into two separate phases.
Phase I evaluated if the antioxidants produced from pomegranate juice cross the placenta in normal healthy pregnancies. Twenty women were enrolled, 10 who will take 8 oz of pomegranate juice daily and then 10 others who will take 8 oz of placebo juice without pomegranate daily. Blood samples were first collected from the woman at the time enrollment and then from both the woman and the cord blood at the time of delivery. These blood samples were analyzed to measure the levels of antioxidant metabolites from the pomegranate juice. This phase was deigned to confirm placental transfer of antioxidant pomegranate metabolites. The results confirmed placenta transfer of pomegranate metabolites. Further, placental tissues from 12 patients (4 in the pomegranate group and 8 in the control group) were collected for analysis of oxidative stress. The preliminary in vivo results were extended to oxidative stress and cell death assays in vitro. Placental explants and cultured primary human trophoblasts were exposed to pomegranate juice or glucose (control) under defined oxygen tensions and chemical stimuli. We found decreased oxidative stress in term human placentas from women who labored after prenatal ingestion of pomegranate juice compared with apple juice as control. Moreover, pomegranate juice reduced in vitro oxidative stress, apoptosis, and global cell death in term villous explants and primary trophoblast cultures exposed to hypoxia, the hypoxia mimetic cobalt chloride, and the kinase inhibitor staurosporine. Punicalagin, but not ellagic acid, both prominent polyphenols in pomegranate juice, reduced oxidative stress and stimulus-induced apoptosis in cultured syncytiotrophoblasts.
Phase II focuses on pregnancies with intrauterine growth restriction. If they meet entry criteria, then woman will be enrolled and randomized into 1 of 2 groups.
Treatment group: Expecting mothers in this group will start a daily regimen of 8 oz glass of pomegranate juice. They will keep a daily diary documenting their compliance. They will continue this daily intake up until delivery of their infant.
Placebo group: These women will start a daily regimen of an 8 oz of pomegranate free juice placebo that matches taste, calories, and appearance to regular pomegranate juice but lacks polyphenols. They will also keep a diary of daily intake to help ensure compliance similar to the treatment group. They too will continue to take the placebos up until the time they deliver.
Both groups: All women will be followed up on a weekly basis to assess compliance. A detailed diet history will be collected from the women at the time of enrollment, midway through the 3rd trimester and at the time of delivery. Furthermore, all women will have a detailed social history collected at the time of enrollment. Upon delivery, cord blood will be collected and sent for ellagic acid, a polyphenic component. All placental material will be sent for formal pathological exam and analyzed for markers of placental injury.
If clinically stable, the infants will receive MRI evaluations to evaluate for possible brain injury.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00788866
|Contact: Methodius Tuuli, MDfirstname.lastname@example.org|
|Contact: Amanda Strand, RNemail@example.com|
|United States, Missouri|
|St Louis Children's Hospital||Recruiting|
|St Louis, Missouri, United States, 63110|
|Contact: Terry DeVault 314-454-4520|
|Principal Investigator:||Michael Nelson, MD, MPH||Washington University School of Medicine|