医学
宫内生长受限
子痫前期
胎龄
荟萃分析
产科
小于胎龄
相对风险
怀孕
随机对照试验
精氨酸
出生体重
胎儿
胎儿生长
内科学
置信区间
生物化学
化学
遗传学
氨基酸
生物
作者
Lianbin Xu,Xinhui Wang,Chaochen Wang,Wenyuan Li,Hongyun Liu
标识
DOI:10.1016/j.clnu.2022.05.014
摘要
Previous research established that the availability of l-arginine affects placental vascular development and fetal growth. However, practical details associated with the effects of l-arginine supplementation on the neonatal outcomes of hypertensive disorder (HD) and intrauterine growth restriction (IUGR) pregnancies are limited.The PubMed, ScienceDirect, and Web of Science databases were searched for peer-reviewed literature published by September 30, 2021 to investigate the operational details of l-arginine supplementation in improving neonatal outcomes in complicated pregnancies. Standardized mean difference (SMD) and weighted mean difference (WMD) of continuous variables, as well as the risk ratio (RR) for categorical variables were pooled by random-effects models.The results indicated that l-arginine supplementation increased the plasma nitric oxide (NO) concentrations in IUGR pregnancies (SMD: 0.71; 95% CI: 0.45, 0.97; I2 = 0%), but decreased the risk of preeclampsia in HD mothers (RR: 0.49; 95% CI: 0.31, 0.76; I2 = 0%). Administration with l-arginine elevated birth weights both in hypertensive and IUGR pregnant women, with WMDs of 194.70 g (95% CI: 58.21, 331.20; I2 = 44.2%) and 134.00 g (95% CI: 43.53, 224.46; I2 = 42.4%), respectively. However, the intervention had no effect on gestational age except in HD pregnancies (WMD: 7.05 d; 95% CI: 3.16, 10.95; I2 = 36.5%). l-arginine administration during pregnancy significantly reduced the small for gestational age (SGA) risk of fetus both in HD (RR: 0.51; 95% CI: 0.31, 0.83; I2 = 0.0%) and IUGR mothers (RR: 0.46; 95% CI: 0.25, 0.88; I2 = 0.0%). Subgroup analyses revealed that l-arginine supplementation at <4 g/d dosage or for ≥1-month duration or in the third trimester had a greater effect on birth weights in HD women without proteinuria, but a higher l-arginine dosage was more beneficial for extending gestational age and reducing the risk of SGA in older pregnancies. Additionally, intravenous infusion of l-arginine, but not oral administration, significantly increased birth weight in IUGR pregnancies with elevated NO concentrations, although the recommended amount should be confined to <4 g/d.These findings provide practical guidelines for l-arginine supplementation to improve the birth outcomes of complicated pregnancies.CRD42021246290 (https://www.crd.york.ac.uk/PROSPERO).
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