Effect of early L-arginine therapy on intrauterine growth restriction in preeclampsia. A randomized controlled trial in Latin-American women
Julio E Valdivia-Silva a, Keisy López-Molina b, Rodney Macedo b
a
Oncoinmunología y Biología Vascular. Facultad de Medicina. Universidad
Nacional San Agustín. Arequipa. Perú. Departamento de Inmunología.
Instituto de Investigaciones Biomédicas. México DF. México.
b Oncoinmunología y Biología Vascular. Facultad de Medicina. Universidad Nacional San Agustín. Arequipa. Perú.
Abstract
Objective: To assess the benefit of
early L-arginine administration in preeclampsia on the relative risk to
fetal growth. Patients and methods: One-hundred women with preeclampsia
were randomized to receive either L-arginine or placebo until the day
of delivery. To evaluate the relative risk of intrauterine growth
restriction (IUGR) and the effect of L-arginine on this process, 96 live
singleton infants of women with preeclampsia (50 with treatment and 46
without treatment) were compared; these infants were also compared with a
further 50 control infants of healthy women. Gestational age-related
birth weight was compared using standard growth curves. Infants smaller
than the 10th percentile were classified as IUGR. The Mann-Witney
U-test, ANOVA, and chi-square test were used to evaluate statistically
significant differences (P<.05) between the groups. Results: No
significant differences were found between the groups with preeclampsia
before randomization. Preeclampsia was associated with a 21% reduction
in birth weight. The risk of IUGR was five times higher in infants born
after preeclampsia without L-arginine therapy than in control
pregnancies (RR = 5.0; 95%IC: 1.5-16.2) and was two times higher in
infants born after preeclampsia with L-arginine therapy (RR = 2.0; 95%
CI: 1.9-7.6). The fetal biophysical profile and Apgar score were
significantly more favorable in the L-arginine group (P<.05).
Conclusion: Fetal growth markedly improves with early L-arginine therapy
in women with preeclampsia.
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