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ORIGINAL ARTICLE
The role of L-arginine in the prevention and treatment of
pre-eclampsia: a systematic review of randomised trials
T Dorniak-Wall1, RM Grivell1,2, GA Dekker1,3, W Hague1,2 and JM Dodd1,2
Pre-eclampsia is a significant health issue in pregnancy, complicating between 2–8% of pregnancies. L-arginine is an important
mediator of vasodilation with a potential preventative role in pregnancy related hypertensive diseases. We aimed to systematically
review randomised trials in the literature assessing the role of L-arginine in prevention and treatment of pre-eclampsia. We searched
the Cochrane Controlled Trials Register, PUBMED, and the Australian and International Clinical Trials Registry, to identify
randomised trials involving pregnant women where L-arginine was administered for pre-eclampsia to improve maternal and infant
health outcomes. We identified eight randomised trials, seven of which were included. The methodological quality was fair, with a
combined sample size of 884 women. For women at risk of pre-eclampsia, L-arginine was associated with a reduction in pre-
eclampsia (RR: 0.34, 95% CI: 0.21–0.55), when compared with placebo and a reduction in risk of preterm birth (RR: 0.48 and 95% CI:
0.28 to 0.81). For women with established hypertensive disease, L-arginine was associated with a reduction in pre-eclampsia (RR:
0.21; 95% CI: 0.05–0.98). L-arginine may have a role in the prevention and/or treatment of pre-eclampsia. Further well-designed and
adequately powered trials are warranted, both in women at risk of pre-eclampsia and in women with established disease.
Journal of Human Hypertension (2014) 28, 230–235; doi:10.1038/jhh.2013.100; published online 31 October 2013
Keywords: pregnancy; L-arginine; pre-eclampsia; hypertensive disease
1
The University of Adelaide, Robinson Institute and Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia; 2The Women’s and Children’s Hospital,
Department of Perinatal Medicine, North Adelaide, South Australia, Australia and 3The Lyell McEwin Hospital, Department of Obstetrics & Gynaecology, Elizabeth, South Australia,
Australia. Correspondence: Dr RM Grivell, The University of Adelaide, Robinson Institute and Discipline of Obstetrics & Gynaecology, Women’s and Children’s Hospital, 77 King
William Road, North Adelaide, South Australia 5006, Australia.
E-mail: rosalie.grivell@adelaide.edu.au
Received 15 July 2013; accepted 9 September 2013; published online 31 October 2013