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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
University of Manchester
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Gestational Hypertension focused on measuring Pregnancy, hypertension, nitrate, beetroot juice

Eligibility Criteria

16 Years - 45 Years (Child, Adult)FemaleAccepts Healthy Volunteers

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

    First Posted
    April 23, 2019
    Last Updated
    April 26, 2019
    Sponsor
    University of Manchester
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    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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