{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T01:32:16Z","timestamp":1769736736739,"version":"3.49.0"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Severe early\u2010onset fetal growth restriction (FGR) causes stillbirth, neonatal death and neurodevelopmental impairment. Poor maternal spiral artery remodelling maintains vasoactive responsiveness but is susceptible to treatment with sildenafil, a phosphodiesterase type\u20095 (PDE5) inhibitor, which may improve perinatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Superiority, double\u2010blind randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A total of 20 UK fetal medicine units.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Pregnancies affected by FGR, defined as an abdominal circumference below the tenth centile with absent end\u2010diastolic flow in the umbilical artery between 22<jats:sup>+0<\/jats:sup> and 29<jats:sup>+6<\/jats:sup>\u2009weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Treatment with sildenafil (25\u2009mg three times\/day) or placebo until delivery or 32\u2009weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>All infants alive at hospital discharge were assessed for cardiovascular function and cognitive, speech\/language and neuromotor impairment at 2\u2009years of age. The primary outcome was survival without cerebral palsy or neurosensory impairment, or a Bayley\u2010III composite score of &gt;85.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 135 women were randomised between November 2014 and July 2016 (70 to sildenafil and 65 to placebo). We previously published that there was no improvement in time to delivery or perinatal outcomes with sildenafil. In all, 75 babies (55.5%) were discharged alive, with 61 infants eligible for follow\u2010up (32 sildenafil and 29 placebo). One infant died (placebo), three mothers declined and ten mothers were uncontactable. There was no difference in neurodevelopment or blood pressure following treatment with sildenafil. Infants who received sildenafil had a larger head circumference at 2\u2009years of age (median difference 49.2\u2009cm, IQR\u200946.4\u201350.3, vs 47.2\u2009cm, 95%\u2009CI 44.7\u201348.9\u2009cm).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sildenafil therapy did not prolong pregnancy or improve perinatal outcomes and did not improve infant neurodevelopment in FGR survivors. Therefore, sildenafil should not be prescribed for this condition.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17888","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T09:26:32Z","timestamp":1719307592000},"page":"1673-1683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neurodevelopmental outcomes at 2\u2009years in children who received sildenafil therapy in\u2009utero: The <scp>STRIDER randomised controlled trial<\/scp>"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3396-7464","authenticated-orcid":false,"given":"Andrew","family":"Sharp","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health University of Liverpool  Liverpool UK"},{"name":"Liverpool Women's Hospital NHS Foundation Trust  Liverpool 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