Effect of L-arginine and sildenafil citrate on intrauterine growth restriction fetuses: a meta-analysis

Abstract

BackgroundIntrauterine growth restriction (IUGR) is associated with perinatal morbidity and mortality. Several clinical trials have reported L-arginine and sildenafil citrate had effect on intrauterine growth restriction fetuses. A meta-analysis of available randomized controlled trials (RCTs) was conducted to investigate the effects of L-arginine and sildenafil citrate on major clinical outcomes of IUGR fetuses.MethodsSystematically searched Medline, Embase, the Cochrane Library, and Clinical Trials, references of retrieved articles, and conference proceedings from 1960 to 2015. We included randomized controlled trials assessing the effects of L-arginine and sildenafil citrate on IUGR. Outcomes analyzed were the birth weight, gestational age at labor, Apgar score at 1and 5 min, the ratio of NRDS, the ratio of ICH and neonatal death, etc.ResultsTen trials were included. Nine trials (576 patients) compared L-arginine with either placebo or no intervention. In the L-arginine treatment groups of the L-arginine trials, there was a significant increase in fetal birth weight (SMD 0.41, 95 % CI [0.24,0.58]), gestational age (SMD 0.30, 95 % CI [0.07,0.54]); L-arginine treatment group have a significant reduction in the ratio of neonatal respiratory distress syndrome (P = 0.009), intracranial hemorrhage of fetuses (P = 0.002), but the number of included studies and people on these outcomes are small. As only one trial (41 patients) compared sildenafil citrate with placebo, it was too small for reliable conclusions about possible differential effects could be drawn.ConclusionsThe results of this meta-analysis showed that L-arginine increased birth weight and prolonged gestational age at labor of IUGR fetuses. However, further large-scale RCTs are needed to adequately assess the effect of L-arginine and Sildenafil citrate on clinical outcomes, because the number of study may be small.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1009-6) contains supplementary material, which is available to authorized users.

Endothelial dysfunction in individuals born after fetal growth restriction: cardiovascular and renal consequences and preventive approaches

“…74 More recently, the combined results of 10 small trials showed that L-Arg supplementation can increase the body weight and gestational age at birth of IUGR fetuses. 208 However, this study contrasts with others that reported no benefit of L-Arg therapy. 209,210 Such differences could be explained by the different route of administration (oral or intravenous).…”

Sildenafil Administration in Early Onset Intrauterine Growth Restriction

“…18 Another review reports improvement in Doppler after administration of 25mg sildenafil twice a day vaginally with treatment being stopped at 36weeks gestation and a healthy child was delivered. [19][20][21] In both of our cases, IUGR was due to utero-placental insufficiency since other causes were excluded, although, in the second case there was also an element of pre-eclampsia which is commonly associated with IUGR and can worsen the prognosis. Interestingly, in the first case where there was improvement in the Doppler readings, and emergency C-section was done for foetal distress and the infant died shortly after birth due to complications arising as a result of his prematurity.…”

Effects of dietary L‐arginine supplementation to early pregnant mares on conceptus diameter—Preliminary findings

“…Administration of arginine to women with an IUGR foetus reduced placental apoptosis and improved foetal growth and development. Arginine treatment also decreased the incidence of small for gestational age newborns (Chen, Gong, Chen, Luo, & Xiuquan, ; Shen & Hua, ). In addition, maternal plasma arginine concentrations were lower in pregnancies with foetal growth restriction and arginine concentration in amniotic fluid from gestational weeks 13 to 15 was positively correlated with birth weight and length and head circumference of the human neonate (Bjørke‐Jenssen, Ueland, & Bjørke‐Monsen, ).…”