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Han YC, Laketic K, Hornaday KK, Slater DM, Mu C, Tough SC, Shearer J. Maternal Acylcarnitine Disruption as a Potential Predictor of Preterm Birth in Primigravida: A Preliminary Investigation. Nutrients 2024; 16:595. [PMID: 38474728 DOI: 10.3390/nu16050595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
Preterm birth, defined as any birth before 37 weeks of completed gestation, poses adverse health risks to both mothers and infants. Despite preterm birth being associated with several risk factors, its relationship to maternal metabolism remains unclear, especially in first-time mothers. Aims of the present study were to identify maternal metabolic disruptions associated with preterm birth and to evaluate their predictive potentials. Blood was collected, and the serum harvested from the mothers of 24 preterm and 42 term births at 28-32 weeks gestation (onset of the 3rd trimester). Serum samples were assayed by untargeted metabolomic analyses via liquid chromatography/mass spectrometry (QTOF-LC/MS). Metabolites were annotated by inputting the observed mass-to-charge ratio into the Human Metabolome Database (HMDB). Analysis of 181 identified metabolites by PLS-DA modeling using SIMCA (v17) showed reasonable separation between the two groups (CV-ANOVA, p = 0.02). Further statistical analysis revealed lower serum levels of various acyl carnitines and amino acid metabolites in preterm mothers. Butenylcarnitine (C4:1), a short-chain acylcarnitine, was found to be the most predictive of preterm birth (AUROC = 0.73, [CI] 0.60-0.86). These observations, in conjuncture with past literature, reveal disruptions in fatty acid oxidation and energy metabolism in preterm primigravida. While these findings require validation, they reflect altered metabolic pathways that may be predictive of preterm delivery in primigravida.
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Affiliation(s)
- Ying-Chieh Han
- Department of Biomedical Engineering, Faculty of Engineering, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Katarina Laketic
- Department of Biomedical Engineering, Faculty of Engineering, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Kylie K Hornaday
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Donna M Slater
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Chunlong Mu
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Suzanne C Tough
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Department of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Jane Shearer
- Department of Biomedical Engineering, Faculty of Engineering, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
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Menichini D, Feliciello L, Neri I, Facchinetti F. L-Arginine supplementation in pregnancy: a systematic review of maternal and fetal outcomes. J Matern Fetal Neonatal Med 2023; 36:2217465. [PMID: 37258415 DOI: 10.1080/14767058.2023.2217465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/08/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Daniela Menichini
- Obstetrics Unit, Mother-Infant Department, University Hospital Policlinico of Modena, Modena, Italy
- Department of Biomedical, International Doctorate School in Clinical and Experimental Medicine, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lia Feliciello
- Obstetrics Unit, Mother-Infant Department, University Hospital Policlinico of Modena, Modena, Italy
| | - Isabella Neri
- Obstetrics Unit, Mother-Infant Department, University Hospital Policlinico of Modena, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics Unit, Mother-Infant Department, University Hospital Policlinico of Modena, Modena, Italy
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Biochemical and molecular-physiological aspects of the nitric oxide action in the utera. UKRAINIAN BIOCHEMICAL JOURNAL 2021. [DOI: 10.15407/ubj93.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Goto E. Effects of prenatal oral L-arginine on birth outcomes: a meta-analysis. Sci Rep 2021; 11:22748. [PMID: 34815460 PMCID: PMC8610968 DOI: 10.1038/s41598-021-02182-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
Adverse birth outcomes are associated with elevated mortality and morbidity rates throughout life. This meta-analysis of randomised controlled trials examined whether prenatal oral L-arginine has effects on birth outcomes. A total of 45 overall good quality studies were extracted from 10 finally eligible articles. In comparison to controls, providing oral L-arginine to women with a history of poor pregnancy outcomes significantly reduced risks of intrauterine growth retardation neonates, pre-term birth and respiratory distress syndrome (n = 7, 3 and 3, respectively) and significantly increased birthweight and gestational age (n = 8 and 5, respectively) L-Arginine significantly increased Apgar score in women at high risk of pre-eclampsia or with pre-eclampsia or gestational or mild chronic hypertension in comparison to controls (n = 4). L-Arginine showed no significant effect on any other outcome examined (n = 2). The quality of evidence was at least medium or high. Consequently, oral L-arginine may be at least moderately recommended for women with a history of poor pregnancy outcomes and at high risk of pre-eclampsia or with pre-eclampsia or gestational or mild chronic hypertension. However, further studies are required to provide stronger conclusions, partly due to small study effects.
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Affiliation(s)
- Eita Goto
- Department of Medicine and Public Health, Nagoya Medical Science Research Institute, 1-118 Kamenoi, Meitou-ku, Nagoya, 465-0094, Japan.
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Monari F, Menichini D, Pignatti L, Basile L, Facchinetti F, Neri I. Effect of L-Arginine supplementation in pregnant women with chronic hypertension and previous placenta vascular disorders receiving Aspirin prophylaxis: a randomized control trial. Minerva Obstet Gynecol 2021; 73:782-789. [PMID: 33978350 DOI: 10.23736/s2724-606x.21.04827-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the study is to evaluate the effects of supplementation with Arginine (L-Arg) 3g, (together with Magnesium (Mg) 350 mg and Salicilate (Sal) 100 mg) on maternal blood pressure (BP), uterine artery doppler PI and neonatal outcomes in women with high-risk pregnancy for chronic hypertension (CH) and other previous placenta vascular disorders (PVD) already treated with low dose of aspirin (LDA), as recommended by guidelines. METHODS We enrolled women affected by CH and other previous PVD referred to the High-Risk Clinic of the Mother-Infant Department of the University of Modena and Reggio Emilia from September 2017 to June 2019. The study design was a controlled, randomized trial of oral supplementation of L-Arg 3g (together with Mg 350 mg and Sal extract 100 mg) + LDA 100 mg/die versus only LDA 100 mg/die. Inclusion criteria were: singleton pregnancy; diagnosis of chronic hypertension, previous preeclampsia < 34 weeks, previous intrauterine growth restriction (IUGR) < 10° centile or previous stillbirth (SB) related to placenta vascular disorders; gestational age < 14 weeks. Each woman was enrolled between 12-14 weeks gestation and underwent 24-h ambulatory BP monitoring with an automatic device (SpaceLab 92710, Critikon, WA), repeated at 18-20th and 24-26th weeks. Moreover Uterine artery Doppler ultrasound evaluation including PI were performed at 18-20 weeks gestation and repeated at 24-26th weeks. Pregnancy outcomes data were collected in a password protected database. RESULTS Seventy-nine women agreed to participate in the study. No significant differences between the demographic characteristics in the two groups at enrollment (Group LDA + L-Arg: 30 patients versus Group LDA: 49 patient) were found. In the LDA-L-Arg group there isn't the significant increase in both systolic (127.22 ± 12.02 and 132.75 ± 7.51 mmHg, p=0.002) and diastolic (75.85 ± 8.53 and 83.63 ± 6.05 mmHg, p=0.0000) BP values at 24-26 weeks reveled in the LDA group. The value of the Uterine Artery Doppler median PI > 95° centile at 24-26 weeks show a significant reduction in the LDA+L-Arg group respect the LDA group (7 women, 23.3% vs 21 women, 42.9%; p=0.04). A significantly lower percentage of women received new antihypertensive drugs in the LDA+ L-Arg group than the LDA group (6.7% vs 24.5%) (p= 0.02). There was neither statistically significant difference in perinatal outcomes between 2 groups, except for trend of significance. CONCLUSIONS Although we found only trends of improvements of perinatal outcomes in LDA+LArg group, considering the promising results on BP values, uterine artery PI and the low need to start a new antihypertensive treatment, thus the resulting impact in reducing pregnancy medicalization, number of maternal-fetal well-being monitoring visits and the need of induction of labour, we believe that further studies should be performed to enlarge our observation and clarify the role of L-Arg 3g supplementation as a protective integration in high-risk pregnancies already in prophylaxis with LDA.
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Affiliation(s)
- Francesca Monari
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy -
| | - Daniela Menichini
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Laura Basile
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy
| | - Isabella Neri
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy
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Bouya S, Rezaie Keikhaie L, Hosseini S, Rezaie Keikhaie K. The effect of yoga on uterine artery Doppler indices, maternal and fetal complications in pregnant women: A quasi-experimental study. J Ayurveda Integr Med 2021; 12:70-74. [PMID: 32950349 PMCID: PMC8039333 DOI: 10.1016/j.jaim.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Today, the effect of yoga has been examined on various physical and psychological dimensions of pregnant women. However, there are still sparse studies on the effect of yoga on the uterine artery indices as well as maternal and fetal complications. OBJECTIVE The aim was to determine the effect of yoga on uterine artery Doppler indices, maternal and fetal Complications. MATERIALS AND METHODS This quasi-experiential study was conducted, on 100 pregnant women. The participants were assigned to yoga and control groups. In the yoga group, the participants exercised yoga for 1 h. On the other hand, the control group received routine care. RESULTS The results showed that in the yoga group, the functional indices of the uterine artery (S/D, PI, RI, and DN) improved more significantly compared to the control (p = 0.01). The results also showed that in the yoga group, maternal complications (diabetes and preeclampsia), as well as fetal complications (SAG, IUGR), were significantly lower compared to the control (p = 0.01). CONCLUSION This study revealed the positive effects of yoga on improving fetal development indices and reducing maternal and fetal complications following pregnancy. It can be used as a Complementary therapy alongside other treatments for mothers.
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Affiliation(s)
- Salehoddin Bouya
- Internal Medicine and Nephrology, Clinical Immunology Research Center, Ali-ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Iran
| | - Leli Rezaie Keikhaie
- Department of Infectious Disease, School of Medicine, Zabol University of Medical Science, Zabol, Iran
| | - SaraSadat Hosseini
- Medical-Surgical Nursing, Department of Nursing, Neyshabur University of Medical Science, Neyshabur, Iran
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Prenatal Amino Acid Supplementation to Improve Fetal Growth: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12092535. [PMID: 32825593 PMCID: PMC7551332 DOI: 10.3390/nu12092535] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
Aberrant fetal growth remains a leading cause of perinatal morbidity and mortality and is associated with a risk of developing non-communicable diseases later in life. We performed a systematic review and meta-analysis combining human and animal studies to assess whether prenatal amino acid (AA) supplementation could be a promising approach to promote healthy fetal growth. PubMed, Embase, and Cochrane libraries were searched to identify studies orally supplementing the following AA groups during gestation: (1) arginine family, (2) branched chain (BCAA), and (3) methyl donors. The primary outcome was fetal/birth weight. Twenty-two human and 89 animal studies were included in the systematic review. The arginine family and, especially, arginine itself were studied the most. Our meta-analysis showed beneficial effects of arginine and (N-Carbamyl) glutamate (NCG) but not aspartic acid and citrulline on fetal/birth weight. However, no effects were reported when an isonitrogenous control diet was included. BCAA and methyl donor supplementation did not affect fetal/birth weight. Arginine family supplementation, in particular arginine and NCG, improves fetal growth in complicated pregnancies. BCAA and methyl donor supplementation do not seem to be as promising in targeting fetal growth. Well-controlled research in complicated pregnancies is needed before ruling out AA supplements or preferring arginine above other AAs.
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Indexes of nitric oxide system in experimental antiphospholipid syndrome. UKRAINIAN BIOCHEMICAL JOURNAL 2020. [DOI: 10.15407/ubj92.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Weckman AM, McDonald CR, Baxter JAB, Fawzi WW, Conroy AL, Kain KC. Perspective: L-arginine and L-citrulline Supplementation in Pregnancy: A Potential Strategy to Improve Birth Outcomes in Low-Resource Settings. Adv Nutr 2019; 10:765-777. [PMID: 31075164 PMCID: PMC6743852 DOI: 10.1093/advances/nmz015] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/19/2018] [Accepted: 01/28/2019] [Indexed: 12/22/2022] Open
Abstract
The available data support the hypothesis that L-arginine or L-citrulline supplementation would be suitable for implementation in resource-constrained settings and will enhance placental vascular development and improve birth outcomes. In resource-constrained settings, the rates of adverse birth outcomes, including fetal growth restriction, preterm birth, and low birth weight, are disproportionately high. Complications resulting from preterm birth are now the leading cause of mortality in children <5 y of age worldwide. Despite the global health burden of adverse birth outcomes, few effective interventions are currently available and new strategies are urgently needed, especially for low-resource settings. L-arginine is a nutritionally essential amino acid in pregnancy and an immediate precursor of nitric oxide. During pregnancy, placental and embryonic growth increases the demand for L-arginine, which can exceed endogenous synthesis of L-arginine from L-citrulline, necessitating increased dietary intake. In many low-resource settings, dietary intake of L-arginine in pregnancy is inadequate owing to widespread protein malnutrition and depletion of endogenous L-arginine due to maternal infections, in particular malaria. Here we examine the role of the L-arginine-nitric oxide biosynthetic pathway in pregnancy including placental vascular development and fetal growth. We review the evidence for the relations between altered L-arginine bioavailability and pregnancy outcomes, and strategies for arginine supplementation in pregnancy. Existing studies of L-arginine supplementation in pregnancy in high-resource settings have shown improved maternal and fetal hemodynamics, prevention of pre-eclampsia, and improved birth outcomes including higher birth weight and longer gestation. Arginine supplementation studies now need to be extended to pregnant women in low-resource settings, especially those at risk of malaria.
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Affiliation(s)
- Andrea M Weckman
- Laboratory Medicine and Pathobiology
- Sandra A Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Chloe R McDonald
- Sandra A Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Jo-Anna B Baxter
- Department of Nutritional Sciences
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA
| | - Andrea L Conroy
- Sandra A Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Kevin C Kain
- Laboratory Medicine and Pathobiology
- Sandra A Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
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Impact of Arginine Nutrition and Metabolism during Pregnancy on Offspring Outcomes. Nutrients 2019; 11:nu11071452. [PMID: 31252534 PMCID: PMC6682918 DOI: 10.3390/nu11071452] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022] Open
Abstract
By serving as a precursor for the synthesis of nitric oxide, polyamines, and other molecules with biological importance, arginine plays a key role in pregnancy and fetal development. Arginine supplementation is a potential therapy for treating many human diseases. An impaired arginine metabolic pathway during gestation might produce long-term morphological or functional changes in the offspring, namely, developmental programming to increase vulnerability to developing a variety of non-communicable diseases (NCDs) in later life. In contrast, reprogramming is a strategy that shifts therapeutic interventions from adulthood to early-life, in order to reverse the programming processes, which might counterbalance the rising epidemic of NCDs. This review presented the role of arginine synthesis and metabolism in pregnancy. We also provided evidence for the links between an impaired arginine metabolic pathway and the pathogenesis of compromised pregnancy and fetal programming. This was followed by reprogramming strategies targeting the arginine metabolic pathway, to prevent the developmental programming of NCDs. Despite emerging evidence from experimental studies showing that targeting the arginine metabolic pathway has promise as a reprogramming strategy in pregnancy to prevent NCDs in the offspring, these results need further clinical application.
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Immunometabolism, pregnancy, and nutrition. Semin Immunopathol 2017; 40:157-174. [PMID: 29071391 DOI: 10.1007/s00281-017-0660-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022]
Abstract
The emerging field of immunometabolism has substantially progressed over the last years and provided pivotal insights into distinct metabolic regulators and reprogramming pathways of immune cell populations in various immunological settings. However, insights into immunometabolic reprogramming in the context of reproduction are still enigmatic. During pregnancy, the maternal immune system needs to actively adapt to the presence of the fetal antigens, i.e., by functional modifications of distinct innate immune cell subsets, the generation of regulatory T cells, and the suppression of an anti-fetal effector T cell response. Considering that metabolic pathways have been shown to affect the functional role of such immune cells in a number of settings, we here review the potential role of immunometabolism with regard to the molecular and cellular mechanisms necessary for successful reproduction. Since immunometabolism holds the potential for a therapeutic approach to alter the course of immune diseases, we further highlight how a targeted metabolic reprogramming of immune cells may be triggered by maternal anthropometric or nutritional aspects.
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Darling AM, McDonald CR, Urassa WS, Kain KC, Mwiru RS, Fawzi WW. Maternal Dietary L-Arginine and Adverse Birth Outcomes in Dar es Salaam, Tanzania. Am J Epidemiol 2017; 186:603-611. [PMID: 28911008 DOI: 10.1093/aje/kwx080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/06/2016] [Indexed: 12/22/2022] Open
Abstract
The amino acid arginine is a physiological precursor to nitric oxide, which is a key mediator of embryonic survival, fetal growth, and pregnancy maintenance. We evaluated the association between consumption of the amino acid arginine and the rate of adverse birth outcomes using data from a double-blind, randomized, placebo-controlled micronutrient supplementation trial among pregnant women in Dar es Salaam, Tanzania (2001-2004). Dietary intakes of arginine were assessed using repeated 24-hour recalls that were administered throughout pregnancy. Participants (n = 7,591) were monitored by research midwives throughout follow-up to assess pregnancy outcomes. Cubic-restricted splines and multivariable log-Poisson regression with empirical standard errors were used to estimate the continuous and categorical associations between arginine intake and adverse birth outcomes. Compared with women within the lowest quintile of arginine intake, those within the highest quintile had 0.79 times the risk of preterm birth before 37 weeks (95% confidence interval: 0.63, 1.00; P = 0.03). The continuous associations of arginine intake with preterm birth before 37 weeks and with preterm birth before 34 weeks were characterized by an initial rapid decrease in risk with increasing intake (P for nonlinearity < 0.01). Arginine intake was not associated with fetal loss or giving birth to infants who were born small for their gestational ages. This data suggest that the association between dietary arginine intake and preterm birth warrants further investigation.
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Bairagi S, Quinn K, Crane A, Ashley R, Borowicz P, Caton J, Redden R, Grazul-Bilska A, Reynolds L. Maternal environment and placental vascularization in small ruminants. Theriogenology 2016; 86:288-305. [DOI: 10.1016/j.theriogenology.2016.04.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/21/2016] [Accepted: 03/23/2016] [Indexed: 02/05/2023]
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Bednov A, Espinoza J, Betancourt A, Vedernikov Y, Belfort M, Yallampalli C. l-arginine prevents hypoxia-induced vasoconstriction in dual-perfused human placental cotyledons. Placenta 2015; 36:1254-9. [DOI: 10.1016/j.placenta.2015.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/20/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
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Effects of yoga on utero-fetal-placental circulation in high-risk pregnancy: a randomized controlled trial. Adv Prev Med 2015; 2015:373041. [PMID: 25688304 PMCID: PMC4320907 DOI: 10.1155/2015/373041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 01/10/2023] Open
Abstract
Introduction. Impaired placentation and inadequate trophoblast invasion have been associated with the etiology of many pregnancy complications and have been correlated with the first trimester uterine artery resistance. Previous studies have shown the benefits of yoga in improving pregnancy outcomes and those of yogic visualization in revitalizing the human tissues. Methods. 59 high-risk pregnant women were randomized into yoga (n = 27) and control (n = 32) groups. The yoga group received standard care plus yoga sessions (1 hour/day, 3 times/week), from 12th to 28th week of gestation. The control group received standard care plus conventional antenatal exercises (walking). Measurements were assessed at 12th, 20th, and 28th weeks of gestation. Results. RM-ANOVA showed significantly higher values in the yoga group (28th week) for biparietal diameter (P = 0.001), head circumference (P = 0.002), femur length (P = 0.005), and estimated fetal weight (P = 0.019). The resistance index in the right uterine artery (P = 0.01), umbilical artery (P = 0.011), and fetal middle cerebral artery (P = 0.048) showed significantly lower impedance in the yoga group. Conclusion. The results of this first randomized study of yoga in high-risk pregnancy suggest that guided yogic practices and visualization can improve the intrauterine fetal growth and the utero-fetal-placental circulation.
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Abstract
BACKGROUND A number of tocolytics have been advocated for the treatment of threatened preterm labour in order to delay birth. The rationale is that a delay in birth may be associated with improved neonatal morbidity or mortality. Nitric oxide donors, such as nitroglycerin, have been used to relax the uterus. This review addresses their efficacy, adverse effects and influence on neonatal outcome. OBJECTIVES To determine whether nitric oxide donors administered in threatened preterm labour are associated with a delay in birth, adverse effects or improved neonatal outcome. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013). SELECTION CRITERIA Randomised controlled trials of nitric oxide donors administered for tocolysis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS Twelve trials, including a total of 1227 women at risk of preterm labour, contributed data to this updated review. The methodological quality of trials was mixed; trials comparing nitric oxide donors with other types of tocolytics were not blinded and this may have had an impact on findings.Three studies compared nitric oxide donors (glyceryl trinitrate (GTN)) with placebo. There was no significant evidence that nitric oxide donors prolonged pregnancy beyond 48 hours (average risk ratio (RR) 1.19, 95% confidence interval (CI) 0.74 to 1.90, two studies, 186 women), and although for most adverse effects there was no significant difference between groups, women in the active treatment group in one study were at higher risk of experiencing a headache. For infant outcomes there was no significant evidence that nitric oxide donors reduced the risk of neonatal death or serious morbidity (stillbirth RR 0.36, 95% CI 0.01 to 8.59, one study, 153 infants; neonatal death RR 0.43, 95% CI 0.06 to 2.89, two studies, 186 infants). One study, using a composite outcome, reported a reduced risk of serious adverse outcomes for infants in the GTN group which approached statistical significance (RR 0.29, 95% CI 0.08 to 1.00, 153 infants). Overall, these studies were underpowered to identify differences between groups for most outcomes.When nitric oxide donors were compared with other tocolytic drugs there was no significant evidence that nitric oxide donors performed better than other tocolytics (betamimetics, magnesium sulphate, a calcium channel blocker or a combination of tocolytics) in terms of pregnancy prolongation, although nitric oxide donors appeared to be associated with a reduction in most adverse effects, apart from headache. There was no significant difference between groups for infant morbidity or mortality outcomes. AUTHORS' CONCLUSIONS There is currently insufficient evidence to support the routine administration of nitric oxide donors in the treatment of threatened preterm labour.
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Affiliation(s)
- Kirsten Duckitt
- Campbell River and District General Hospital375 ‐ 2nd AvenueCampbell RiverBritish ColumbiaCanadaV9W 3V1
| | - Steve Thornton
- University of Exeter Medical School and Peninsula College of Medicine and DentistryBarrack RoadExeterUKEX2 5DW
| | - Oliver P O'Donovan
- South Devon Healthcare TrustDepartment of Obstetrics and GynaecologyMaternity Unit, Torbay HospitalTorquayDevonUKTQ2 7AA
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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17
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens 2014; 4:105-45. [PMID: 26104418 DOI: 10.1016/j.preghy.2014.01.003] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/17/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation and treatment of the hypertensive disorders of pregnancy (HDP). EVIDENCE The literature reviewed included the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines from 2008 and their reference lists, and an update from 2006. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT) and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2006 and March 2012. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care and GRADE.
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Affiliation(s)
| | - Anouk Pels
- Academic Medical Centre, Amsterdam, The Netherlands
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18
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Neri I, Monari F, Sgarbi L, Berardi A, Masellis G, Facchinetti F. L-arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications. J Matern Fetal Neonatal Med 2010; 23:1456-60. [PMID: 20958228 DOI: 10.3109/14767051003677962] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate L-arginine (L-Arg) supplementation in pregnant women with chronic hypertension and its effects on blood pressure (BP) and maternal and neonatal complications. METHODS We enrolled 80 women affected by mild chronic hypertension referred to the High Risk Clinic of the Mother-Infant Department of the University of Modena and Reggio Emilia. Each woman after obtaining oral consent was randomized to receive oral L-Arg versus placebo and thereafter submitted to 24-h ambulatory BP monitoring. The primary outcome was BP change after 10-12 weeks of treatment. Secondary outcomes were as follows: percentage of women on antihypertensive treatment at delivery, maternal, and fetal outcome. RESULTS The BP changes after 10-12 weeks of treatment did not differ between groups. A lower percentage of women received antihypertensive drugs in the L-Arg group than the placebo group. The incidence of superimposed preeclampsia indicated delivery before the 34th weeks and certain neonatal complications tended to be higher in the placebo group. CONCLUSIONS L-Arg supplementation in pregnant women with mild chronic hypertension does not significantly affect overall BP but is associated with less need for antihypertensive medications and a trend toward fewer maternal and neonatal complications. The results of the study were limited by the small sample size and by the exclusion of women with severe chronic hypertension. In our policy, these patients needed many hypertensive drugs and were normally managed by the cardiologist. Nevertheless, considering the promising results on maternal and fetal outcome, we believe that further studies should be performed to confirm such data and to clarify the role of L-Arg as a protective supplement in high-risk pregnancy.
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Affiliation(s)
- Isabella Neri
- Mother Infant Department, University of Modena and Reggio Emilia, Italy.
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19
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Wu G, Bazer FW, Davis TA, Kim SW, Li P, Marc Rhoads J, Carey Satterfield M, Smith SB, Spencer TE, Yin Y. Arginine metabolism and nutrition in growth, health and disease. Amino Acids 2008; 37:153-68. [PMID: 19030957 DOI: 10.1007/s00726-008-0210-y] [Citation(s) in RCA: 818] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 11/05/2008] [Indexed: 12/11/2022]
Abstract
L-Arginine (Arg) is synthesised from glutamine, glutamate, and proline via the intestinal-renal axis in humans and most other mammals (including pigs, sheep and rats). Arg degradation occurs via multiple pathways that are initiated by arginase, nitric-oxide synthase, Arg:glycine amidinotransferase, and Arg decarboxylase. These pathways produce nitric oxide, polyamines, proline, glutamate, creatine, and agmatine with each having enormous biological importance. Arg is also required for the detoxification of ammonia, which is an extremely toxic substance for the central nervous system. There is compelling evidence that Arg regulates interorgan metabolism of energy substrates and the function of multiple organs. The results of both experimental and clinical studies indicate that Arg is a nutritionally essential amino acid (AA) for spermatogenesis, embryonic survival, fetal and neonatal growth, as well as maintenance of vascular tone and hemodynamics. Moreover, a growing body of evidence clearly indicates that dietary supplementation or intravenous administration of Arg is beneficial in improving reproductive, cardiovascular, pulmonary, renal, gastrointestinal, liver and immune functions, as well as facilitating wound healing, enhancing insulin sensitivity, and maintaining tissue integrity. Additionally, Arg or L-citrulline may provide novel and effective therapies for obesity, diabetes, and the metabolic syndrome. The effect of Arg in treating many developmental and health problems is unique among AAs, and offers great promise for improved health and wellbeing of humans and animals.
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Affiliation(s)
- Guoyao Wu
- Department of Animal Science, Texas A&M University, College Station, TX 77843, USA.
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20
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Abstract
BACKGROUND A number of tocolytics have been advocated for the treatment of threatened preterm labour in order to delay delivery. The rationale is that a delay in delivery may be associated with improved neonatal morbidity or mortality. Nitric oxide donors, such as nitroglycerin, have been used to relax the uterus. This review addresses their efficacy, side effects and influence on neonatal outcome. OBJECTIVES To determine whether nitric oxide donors administered in threatened preterm labour are associated with a delay in delivery, adverse side effects or improved neonatal outcome. SEARCH STRATEGY A comprehensive search of the Cochrane Pregnancy and Childbirth Group trials register (March 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002) was undertaken. SELECTION CRITERIA Randomised controlled trials of nitric oxide donors administered for tocolysis. DATA COLLECTION AND ANALYSIS Trial quality assessment and data extraction were done independently by two reviewers. MAIN RESULTS Five randomised controlled trials (466 women) were included. Nitroglycerine was the NO donor used in all these trials. Nitric oxide donors did not delay delivery nor improve neonatal outcome when compared with placebo, no treatment or alternative tocolytics such as ritodrine, albuterol and magnesium sulphate. There was, however, a reduction in number of deliveries less than 37 weeks when compared with alternative tocolytics but the numbers of deliveries before 32 and 34 weeks were not influenced. Side effects (other than headache) were reduced in women who received nitric oxide donors rather than other tocolytics. However, women were significantly more likely to experience headache when NO donors had been used. REVIEWER'S CONCLUSIONS There is currently insufficient evidence to support the routine administration of nitric oxide donors in the treatment of threatened preterm labour.
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Affiliation(s)
- K Duckitt
- Nuffield Department of Obstetrics and Gynaecology, Level 3, Women's Centre, John Radcliffe Hospital, Headington, Oxford, UK, OX3 9DU.
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