L-Arginine supplementation in pregnancy: a systematic review of maternal and fetal outcomes.

2023-05-31
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 36(1)
- Daniela Menichini
- Lia Feliciello
- Isabella Neri
- Fabio Facchinetti

PubMed: 37258415
DOI: 10.1080/14767058.2023.2217465

Study Design

Type: Systematic Review
Methods: systematic review of the literature utilizing PubMed for studies published from inception to September 2022; included human and animal studies where L-Arg was supplemented pre-conceptionally or during pregnancy, by either oral or intravenous route

Background/aim of the study

L-Arginine (L-Arg)/Nitric Oxide (NO) system is involved in the pathophysiology of relevant Obstetric conditions. This review aims at summarizing the effects of L-Arg supplementation in pregnancy looking at safety and efficacy.

Methods

We conducted a systematic review of the literature utilizing PubMed for studies published from inception to September 2022. The search included human and animal studies where L-Arg was supplemented pre-conceptionally or during pregnancy, by either oral or intravenous route. The main perinatal outcomes were focused.

Results

Among 1028 publications, 51 studies were eligible for inclusion, 25 were performed in women, and the remnant in animals. Compared to controls/placebo, the supplementation with L-Arg reduced the development of pre-eclampsia (four studies), decreased blood pressure, and reduced the need for antihypertensive drugs in women with Hypertensive Disorders of Pregnancy (HDP, eight studies). In women carrying growth retarded fetuses, L-Arg improved fetoplacental circulation, birth weight and neonatal outcomes (five studies), while in the case of threatened preterm birth, L-Arg reduced uterine contractions (two studies). In several animal species, L-Arg supplementation in pregnancy improved reproductive performance by increasing the litter number and size. Moreover, in pre-eclamptic and metabolic syndrome experimental models, maternal hypertension and fetal growth were improved.

Conclusion

L-Arg displays biological activities in pregnancies complicated by HDP and growth restriction, both in women and animal models. L-Arg administration is safe and could be a candidate as an intervention beneficial to maternal and fetal outcomes, at least in moderate clinical disorders.

Research Insights

L-Arginine→Improved Birth Weight
L-Arg improved fetoplacental circulation, birth weight and neonatal outcomes
Effect
Beneficial
Effect size
Moderate
L-Arginine→Improved Fetoplacental Circulation
L-Arg improved fetoplacental circulation, birth weight and neonatal outcomes
Effect
Beneficial
Effect size
Moderate
L-Arginine→Improved Neonatal Health Outcomes
L-Arg improved fetoplacental circulation, birth weight and neonatal outcomes
Effect
Beneficial
Effect size
Moderate
L-Arginine→Reduced Blood Pressure
decreased blood pressure, and reduced the need for antihypertensive drugs in women with Hypertensive Disorders of Pregnancy
Effect
Beneficial
Effect size
Moderate
L-Arginine→Reduced Need for Antihypertensive Drug
reduced the need for antihypertensive drugs in women with Hypertensive Disorders of Pregnancy
Effect
Beneficial
Effect size
Moderate
L-Arginine→Reduced Pre-Eclampsia Development
the supplementation with L-Arg reduced the development of pre-eclampsia (four studies)
Effect
Beneficial
Effect size
Moderate
L-Arginine→Reduced Uterine Contraction
in the case of threatened preterm birth, L-Arg reduced uterine contractions
Effect
Beneficial
Effect size
Small

Adverse Events Reported

L-Arginine→Overall tolerability
L-Arg administration is safe
Finding
Reported