Pregnancy support- Vitamin Treatment

L-arginine - updated: 03 November 2008

L-arginine supplementation in patients with gestational hypertension: a pilot study

Hypertens Pregnancy. 2007;26(1):121-30

Facchinetti F, Saade GR, Neri I, Pizzi C, Longo M, Volpe A.

OBJECTIVE: To evaluate the effects of L-arginine (L-Arg) supplementation on clinical outcomes and blood pressure (BP) changes in patients with gestational hypertension. METHODS: Patients with gestational hypertension and proteinuria (n = 28, >300 mg/24 h) and those without proteinuria (n = 46) were randomized in a double-blind design to receive either L-Arg (20g/500 mL intravenously daily, for 5 days followed by 4 g/day orally for 2 weeks) or placebo (PL). The primary outcome variable was time from randomization to delivery (Latency). Automated BP readings were obtained every 2 hours, between 8.00 am and 8.00 pm daily, untill the sixth day after treatment. RESULTS: At inclusion, gestational age and proportions of patients with proteinuria did not differ significantly between the PL and L-Arg group. Latency was significantly longer in the L-Arg group compared with the PL group (19.5 +/- 16.9 vs. 31.7 +/- 25.2 days; p = 0.008). Compared with baseline, both systolic and diastolic BP 6 days after treatment were significantly reduced in the L-Arg group but not in the PL group. The subgroup of patients without proteinuria randomized to the group receiving L-Arg showed a trend to prolong pregnancy, to attenuate the evolution to PE, and to reduce the rate of low birth weight. CONCLUSIONS: The treatment with L-Arg seems promising in prolonging pregnancy and reducing blood pressure, particularly in patients with gestational hypertension and without proteinuria. This benefit should be confirmed in larger studies with the power to evaluate the effectiveness of L-Arg in preventing the development to preeclampsia.

Publication Types:

• randomized in a double-blind design

Effect of L-arginine on blood pressure in pregnancy-induced hypertension: a randomized placebo-controlled trial

J Matern Fetal Neonatal Med. 2006 May;19(5):277-81.

Neri I, Jasonni VM, Gori GF, Blasi I, Facchinetti F.

OBJECTIVE: To evaluate the antihypertensive efficacy of L-arginine (L-Arg) repeated infusions in women affected by gestational hypertension. METHODS: The women were referred to obstetric units in order to assess their clinical conditions and to exclude the presence of severe fetal and/or maternal complications. Inclusion criteria were: maternal age range 16-45 years, diagnosis of gestational hypertension without proteinuria (patients normotensive until the 20th week), and gestational age ranging between 24 and 36 weeks. Each woman was allocated to receive either L-arginine (20 g/500 mL) or placebo treatment through an i.v. line. The infusion was carried out in the morning from 8 a.m. to 10 a.m. and it was repeated for the next four consecutive days. Systolic and diastolic blood pressure values as well as heart rate were recorded with the patient in an upright, seated position at 08:00, 12:00, 16:00 and 20:00 h. RESULTS: Maternal clinical features such as age, height, weight, and gestational age at inclusion were similar between groups. Both systolic and diastolic blood pressures were reduced by treatment, the effect of L-arginine being significantly higher than that of the placebo (systolic values F = 8.59, p < 0.005; diastolic values F = 3.36; p < 0.001). Twenty women assigned to the L-Arg group (32.2%) and 23 to the placebo group (37.7%) were concomitantly treated with antihypertensives before starting the study. Analyzing the subgroup of patients not receiving antihypertensive drugs we found that L-arginine was superior to placebo in lowering systolic (F = 5.42, p < 0.005) and diastolic (F = 2.20, p < 0.005) blood pressure values. CONCLUSIONS: In conclusion, these data support the use of L-Arg as an antihypertensive agent for gestational hypertension especially in view of the other beneficial effects nitric oxide donors display in pregnancy. Further, L-Arg seems well tolerated since in this sample none of the patients reported adverse effects requiring study interruption.

Publication Types:

• randomized placebo-controlled trial

Effects of oral L-arginine on the foetal condition and neonatal outcome in preeclampsia: a preliminary report

Basic Clin Pharmacol Toxicol. 2006 Aug;99(2):146-52

Rytlewski K, Olszanecki R, Lauterbach R, Grzyb A, Basta A. Estimation of the influence of oral supplementation with low dose of L-arginine on biophysical profile, foeto-placental circulation and neonatal outcome in preeclampsia. Randomized, placebo-controlled, double-blind, clinical trial. Oral therapy with 3 g of L-arginine daily or placebo as a supplement to standard therapy. Eighty-three preeclamptic women, randomly assigned to the L-arginine (n=42) or placebo (n=41) groups; [n=30 (L-arginine) and n=31 (placebo) ended the study, respectively]. Foetal gain chances due to ultrasound biometry, biophysical profile, Doppler velocimetry of pulsatility indices of umbilical and middle cerebral arteries, cerebro-placental ratio, as well as differences in duration of pregnancy and clinical data of newborn. L-arginine treatment transitory accelerated foetal gain and improved biophysical profile. Starting from 3rd week of therapy, the umbilical artery pulsatility indices values were significantly lower in L-arginine than in placebo group. Moreover, treatment with L-arginine caused significant increase of middle cerebral artery pulsatility indices and cerebro-placental ratio values. Latency was longer in L-arginine group. Neonates delivered in the L-arginine group revealed higher Apgar score. Supplementary treatment with oral L-arginine seems to be promising in improving foetal well-being and neonatal outcome as well as in prolonging pregnancy complicated with preeclampsia. However, these benefits require confirmation in more-powered, larger studies.

Publication Types:

• Randomized, placebo-controlled, double-blind, clinical trial

Effect and mechanism of L-arginine therapy for fetal growth retardation due to pregnancy-induced hypertension

Nan Fang Yi Ke Da Xue Xue Bao. 2007 Feb;27(2):198-200

Zhang N, Xiong AH, Xiao X, Li LP.

OBJECTIVE: To investigate the therapeutic effect of L-arginine (L-Arg) administration on fetus growth retardation (FGR) due to pregnancy-induced hypertension and explore its mechanism. METHODS: Sixty-eight pregnant women with pregnancy-induced hypertension and FGR were enrolled in this study, and 25 of them were given L-Arg in addition to routine therapy. Umbilical artery flow parameters and serum NO concentrations in maternal and umbilical blood were measured, and the therapeutic effects were evaluated according to neonatal birth weight. RESULTS: L-Arg therapy markedly decreased the systolic/diastolic value, pulse index and resistant index (P=0.000,0), while increased the fast blood velocity rate(P=0.000,0). NO contents in maternal and umbilical blood were 60.45-/+22.68 and 28.45-/+11.35 micromol/L in L-Arg group, respectively, significantly higher than those in routine treatment group (P=0.000,0 and 0.001,7, respectively) but lower than those in the control group (P=0.000,8 and 0.000,0, respectively). The neonatal birth weights were 2.9-/+0.3 kg in L-Arg group, significantly higher than that in routine treatment group (2.7-/+0.3 kg, P=0.006,8) and similar with that of the control group (3012.9-/+295.9 g, P=0.176,2). CONCLUSION: L-Arg promote intrauterine growth of the fetus by increasing NO production and improving the umbilical artery flow in pregnant women with pregnancy-induced hypertension and FGR.

Publication Types:

• Randomized Controlled Trial

Publication Types:

• Review

Publication Types:

• Review