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Published on: June 29, 2013
L-Arginine treatment for severe vascular fetal intrauterine growth restriction: a randomized double-bind controlled
Norbert Winer1, Bernard Branger, Elie Azria
1Department of Perinatality, Obstetrics and Neonatology, Centre Hospitalier Universitaire, Nantes, France.
Insights
Oral L-arginine supplementation did not improve birth weight or reduce neonatal morbidity in infants with severe intrauterine growth restriction (IUGR). This study found no significant benefits for L-arginine in managing severe vascular growth restriction.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Severe intrauterine growth restriction (IUGR) in infants is linked to increased neonatal mortality, morbidity, and long-term chronic disease risks.
- L-arginine, a nitric oxide precursor, is investigated for its potential role in placental vascular function and vasodilation.
Purpose of the Study:
- To evaluate the efficacy of oral L-arginine supplementation in pregnant patients with severe IUGR.
- To determine if L-arginine enhances birth weight and/or decreases neonatal morbidity in affected infants.
Main Methods:
- A double-blind, randomized, placebo-controlled trial involving 44 singleton pregnancies diagnosed with severe IUGR via ultrasound.
- Vascular IUGR was defined by abdominal circumference at or below the 3rd percentile with abnormal uterine Doppler.
- Patients received either 14 g/day of L-arginine or a placebo.
Main Results:
- No significant differences were observed between the L-arginine and placebo groups regarding birth weight.
- Maternal and neonatal characteristics, including the Clinical Risk Index for Babies (CRIB) score, were similar between groups.
- There were no significant differences in duration of ventilatory support or time to full enteral feeding.
Conclusions:
- L-arginine supplementation is not an effective treatment for severe vascular intrauterine growth restriction.
- This multicenter, randomized trial provides evidence against the use of L-arginine for this condition.
Background & Aims:
Infants born with severe IUGR are exposed to higher neonatal mortality and morbidity rates, as compared with appropriate-for-gestational-age. They are exposed to a higher risk of developing chronic disease such as hypertension, coronary artery disease, obesity, and type 2 diabetes in adulthood. L-Arginine is a precursor of nitric oxide (NO) and may play a role in placental vascular mediation or local vasodilatation.
Objective:
The current study was designed to determine whether oral supplementation of gravid patients suffering from severe intrauterine growth restriction (IUGR) with L-arginine, would enhance birth weight and/or decrease neonatal morbidity.
Patients And Methods:
Forty-four patients with a singleton pregnancy who had been referred for IUGR detected by ultrasonic examination were included. Vascular IUGR was defined by fetal abdominal circumference less than or equal to the 3rd percentile, associated with abnormal uterine Doppler. After double-blind randomization, patients received either 14 g/day of L-arginine, or a placebo.
Results:
The characteristics of the two groups of patients (IUGR with L-arginine vs IUGR with placebo) were similar upon randomization. There was no significant difference between the two groups concerning birth weight (1042+/-476 vs. 1068+/-452 g). At delivery, maternal and neonatal characteristics were similar in the two groups. There was no difference in the Clinical Risk Index for Babies (CRIB) score, the duration of ventilatory assistance, nor the delay between birth and full enteral feeding between the two groups.
Conclusion:
In this study which is, at the best of our knowledge, the first double-bind, multicenter, randomized trial in this condition, L-arginine is not an effective treatment for severe vascular growth restriction.
