Pravastatin to Prevent Preeclampsia

Inclusion Criteria:

1. 16 years or older at time of consent with ability to give informed consent

2. Single or twin gestation with cardiac activity in one or both fetuses. Higher ordermultifetal gestations reduced to twins, either spontaneously or therapeutically, arenot eligible unless the reduction occurred by 13 weeks 6 days project gestationalage.

3. Gestational age at randomization between 12 weeks 0 days and 16 weeks 6 days basedon clinical information and evaluation of the earliest ultrasound.

4. Documented history (by chart or delivery/operative note review) of priorpreeclampsia with delivery less than or equal to 34 weeks 0 days gestation in anyprevious pregnancy. If in the index pregnancy, the woman was induced by 34 weeks 0days gestation and delivered within 48 hours in the same hospitalization, that womanwould be eligible.

5. Normal serum transaminase (AST/ALT) concentrations documented in the last 6 months.

Exclusion Criteria:

1. Monoamniotic gestation because of the risk of fetal demise

2. Known chromosomal, genetic or major malformations

3. Fetal demise or planned termination of pregnancy. Selective reduction by 13 weeks 6days gestation, from triplets to twins or twins to singleton is not an exclusion.

4. Contraindications for statin therapy:

5. Hypersensitivity to pravastatin or any component of the product

6. Active liver disease: acute hepatitis or chronic active hepatitis

7. Statin use in current pregnancy

8. Patients with any of the following medical conditions:

9. Uncontrolled hypothyroidism with a TSH level above 10 mIU/L, because ofincreased risk of myopathy

10. HIV positive, because of increased risk of myopathy with use of proteaseinhibitors

11. Chronic renal disease with baseline serum creatinine ≥1.5 mg/dL, because ofassociation with adverse pregnancy outcomes

12. Current use of concomitant medication with potential for drug interaction withstatins (i.e.,, cyclosporine, fibrates, niacin, erythromycin). Patients will not beexcluded if the drug is discontinued (at least one week) prior to randomization.

13. Participating in another intervention study that influences the primary outcome inthis study

14. Plan to deliver in a non-network site

15. Participation in this trial in a previous pregnancy. Patients who were screened in aprevious pregnancy, but not randomized, do not have to be excluded.