Role of the Oral Microbiome in Blood Pressure Regulation in Pregnancy
Primary Purpose
Gestational Hypertension
Status
Unknown status
Phase
Early Phase 1
Locations
Study Type
Interventional
Intervention
Beetroot juice
Sponsored by
About this trial
This is an interventional basic science trial for Gestational Hypertension focused on measuring Pregnancy, hypertension, nitrate, beetroot juice
Eligibility Criteria
Inclusion Criteria:
- Normotensive or hypertensive women (hypertension as systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg OR on anti-hypertensive medication)
- For pregnant women, between 20-28 weeks gestation
Exclusion Criteria:
- Multi-fetal pregnancy (for pregnant women)
- Age under 16, or over 45 years of age
- Lacking ability to consent
- Pre-existing diabetes (Type 1/Type 2)
- Previous history of pre-term FGR (delivery before 32 weeks with FGR)
- Current tobacco smoker
- Body Mass Index greater than or equal to 40 or less than or equal to 18
- Use of any of the following drugs in the last 6 months: systemic antibiotics, antifungals, antivirals or antiparasitics (intravenous, intramuscular, or oral)
- Large doses of commercial probiotics (greater than or equal to 108 cfu or organisms per day) including tablets, capsules, lozenges, chewing gum or powders (ordinary dietary components such as yoghurts do not apply)
- Evidence of oral disease, assessed on screening proforma (current conditions of: oral candidiasis (thrush); Dental caries (tooth decay); Halitosis; Oral ulcerations/mouth ulcers; Wisdom tooth pain; Chronic dry mouth)
- Allergy to beetroot juice or lemon juice (both contained within the juice shot)
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm Type
Experimental
Experimental
Experimental
Experimental
Arm Label
Normotensive pregnant women
Hypertensive pregnant women
Normotensive non-pregnant women
Hypertensive non-pregnant women
Arm Description
Normotensive pregnant women
Hypertensive pregnant women
Normotensive non-pregnant women
Hypertensive non-pregnant women
Outcomes
Primary Outcome Measures
Quantity of oral nitrate reducing bacterial species
Assessment of oral bacterial profile using next-generation sequencing (bacterial 16S rRNA sequencing)
Oral bacterial nitrate reductase activity
Assessment of oral nitrate reductase activity, measured using enzyme assay
Difference between groups in nitrate/nitrite concentrations before and after dietary nitrate dose
Measurement of plasma and salivary nitrate and nitrite concentrations, using high-performance liquid chromatography (HPLC)
Secondary Outcome Measures
Difference between groups in blood pressure response to dietary nitrate dose
Change in blood pressure
Full Information
NCT ID
NCT03930693
First Posted
April 23, 2019
Last Updated
April 26, 2019
Sponsor
University of Manchester
1. Study Identification
Unique Protocol Identification Number
NCT03930693
Brief Title
Role of the Oral Microbiome in Blood Pressure Regulation in Pregnancy
Official Title
Investigation of the Oral Microbiome in Pregnancy - do Differences in Oral Bacterial Profiles and Nitrate Metabolism Contribute to Blood Pressure Regulation in Pregnant Women?
Study Type
Interventional
2. Study Status
Record Verification Date
April 2019
Overall Recruitment Status
Unknown status
Study Start Date
May 2019 (Anticipated)
Primary Completion Date
December 2020 (Anticipated)
Study Completion Date
June 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Manchester
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
High blood pressure in pregnancy is associated with poor outcomes for both mum and baby, increasing the risk of pregnancy complications including pre-eclampsia, fetal growth restriction and preterm birth. The development of new blood pressure lowering interventions suitable for use in pregnancy is a key research priority.
Inorganic nitrate is a compound found in certain types of food, particularly green leafy vegetables and beetroot. Nitrate provides an important source of nitric oxide (NO), a molecule involved in keeping blood vessels healthy and regulating blood pressure. Supplementation with nitrate in the diet, using interventions such as beetroot juice, has been shown to reduce blood pressure and improve blood vessel function.
In order for dietary nitrate to have these beneficial effects, it needs to be converted in the body to nitrite, via bacteria that live in the mouth (oral bacteria). Differences in oral bacteria, and how they metabolise nitrate, are thought to influence blood pressure regulation and potentially response to dietary nitrate supplementation.
This study aims to understand (1) whether pregnant women with high blood pressure have a different composition of oral bacteria compared to healthy pregnant women and women who are not pregnant, and (2) how differences in oral bacteria affect blood pressure responses to a dose of dietary nitrate (in the form of beetroot juice).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gestational Hypertension
Keywords
Pregnancy, hypertension, nitrate, beetroot juice
7. Study Design
Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
160 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Normotensive pregnant women
Arm Type
Experimental
Arm Description
Normotensive pregnant women
Arm Title
Hypertensive pregnant women
Arm Type
Experimental
Arm Description
Hypertensive pregnant women
Arm Title
Normotensive non-pregnant women
Arm Type
Experimental
Arm Description
Normotensive non-pregnant women
Arm Title
Hypertensive non-pregnant women
Arm Type
Experimental
Arm Description
Hypertensive non-pregnant women
Intervention Type
Dietary Supplement
Intervention Name(s)
Beetroot juice
Intervention Description
Beetroot juice shot (70mL containing 400mg inorganic nitrate)
Primary Outcome Measure Information:
Title
Quantity of oral nitrate reducing bacterial species
Description
Assessment of oral bacterial profile using next-generation sequencing (bacterial 16S rRNA sequencing)
Time Frame
Baseline
Title
Oral bacterial nitrate reductase activity
Description
Assessment of oral nitrate reductase activity, measured using enzyme assay
Time Frame
Baseline
Title
Difference between groups in nitrate/nitrite concentrations before and after dietary nitrate dose
Description
Measurement of plasma and salivary nitrate and nitrite concentrations, using high-performance liquid chromatography (HPLC)
Time Frame
Baseline to 2.5 hour post-nitrate dose
Secondary Outcome Measure Information:
Title
Difference between groups in blood pressure response to dietary nitrate dose
Description
Change in blood pressure
Time Frame
Baseline to 2.5 hour post-nitrate dose
Other Pre-specified Outcome Measures:
Title
Correlation between salivary nitrate reductase activities and the change in salivary/plasma nitrite concentrations post-nitrate dose
Description
Change in nitrite vs. baseline nitrate reductase activity
Time Frame
Baseline to 2.5 hour post-nitrate dose
Title
Correlation between changes in plasma nitrite concentrations and blood pressure lowering post-nitrate dose
Description
Change in plasma nitrite vs. change in blood pressure
Time Frame
Baseline to 2.5 hour post-nitrate dose
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Normotensive or hypertensive women (hypertension as systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg OR on anti-hypertensive medication)
For pregnant women, between 20-28 weeks gestation
Exclusion Criteria:
Multi-fetal pregnancy (for pregnant women)
Age under 16, or over 45 years of age
Lacking ability to consent
Pre-existing diabetes (Type 1/Type 2)
Previous history of pre-term FGR (delivery before 32 weeks with FGR)
Current tobacco smoker
Body Mass Index greater than or equal to 40 or less than or equal to 18
Use of any of the following drugs in the last 6 months: systemic antibiotics, antifungals, antivirals or antiparasitics (intravenous, intramuscular, or oral)
Large doses of commercial probiotics (greater than or equal to 108 cfu or organisms per day) including tablets, capsules, lozenges, chewing gum or powders (ordinary dietary components such as yoghurts do not apply)
Evidence of oral disease, assessed on screening proforma (current conditions of: oral candidiasis (thrush); Dental caries (tooth decay); Halitosis; Oral ulcerations/mouth ulcers; Wisdom tooth pain; Chronic dry mouth)
Allergy to beetroot juice or lemon juice (both contained within the juice shot)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Elizabeth Cottrell, PhD
Phone
+44 (0) 161 701 6957
Email
elizabeth.cottrell@manchester.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jenny Myers, BM, PhD
Organizational Affiliation
Manchester University NHS Foundation Trust
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
No
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Role of the Oral Microbiome in Blood Pressure Regulation in Pregnancy
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