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L-Arginine Treatment for Severe Vascular Fetal Intrauterine Growth Restriction: a Randomized Double Bind Controlled Trial (L Arginine in IUGR)

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ClinicalTrials.gov Identifier: NCT00549575
Recruitment Status : Terminated (terminated)
First Posted : October 26, 2007
Last Update Posted : October 26, 2007
Sponsor:
Information provided by:
Nantes University Hospital

Brief Summary:
Although there is a strong rationale to supplement gravid patients suffering intrauterine growth restriction (IUGR) or preeclampsia with Arginine or other nitric oxide donors, evidence in the literature has been inconclusive. The current study was designed to determine whether oral treatment with L-Arginine, a nitric oxide (NO) donor, would enhance birth weight and/or decrease neonatal morbidity in pregnancies with severe vascular intrauterine growth restriction (IUGR).

Condition or disease Intervention/treatment Phase
Intra Uterine Growth Retardation Drug: L ARG Drug: Placebo Phase 3

Detailed Description:
Patients and Methods: 44 patients with a singleton pregnancy who had been referred for IUGR detected by ultrasonic examination were included. Vascular IUGR was defined by fetal abdominal circumference less than or equal to the third percentile, associated with abnormal uterine Doppler. After double blind randomization, patients received either 14 g/day of L-arginine (90 mL syrup, Veyron France Laboratories), or a placebo. Doppler ultrasound examination of the uterine, umbilical and cerebral circulation, and of ductus venosus was performed prior to inclusion, after 7 days of treatment, and the day before delivery. Ultrasound examination was performed upon randomization, and weekly until birth. Venous blood and urine samples were collected before initiation and after 7 days of treatment, and both maternal and umbilical venous samples were obtained at delivery for nitrate and nitrite (NO2-/ NO3-) determination.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 44 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: L-Arginine Treatment for Severe Vascular Fetal Intrauterine Growth Restriction: a Randomized Double Bind Controlled Trial
Study Start Date : July 2000
Actual Study Completion Date : June 2006

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Experimental: A
Patients received 14 g/day of L-arginine (90 mL syrup, Veyron France Laboratories). Doppler ultrasound examination of the uterine, umbilical and cerebral circulation, and of ductus venous was performed prior to inclusion, after 7 days of treatment, and the day before delivery. Ultrasound examination was performed upon randomization, and weekly until birth. Venous blood and urine samples were collected before initiation and after 7 days of treatment, and both maternal and umbilical venous samples were obtained at delivery for nitrate and nitrite (NO2-/ NO3-) determination.
Drug: L ARG
Patients received 14 g/day of L-arginine (90 mL syrup, Veyron France Laboratories).
Placebo Comparator: B
After double blind randomization, patients received a placebo. Doppler ultrasound examination of the uterine, umbilical and cerebral circulation, and of ductus venous was performed prior to inclusion, after 7 days of treatment, and the day before delivery. Ultrasound examination was performed upon randomization, and weekly until birth. Venous blood and urine samples were collected before initiation and after 7 days of treatment, and both maternal and umbilical venous samples were obtained at delivery for nitrate and nitrite (NO2-/ NO3-) determination.
Drug: Placebo
After double blind randomization, patients received a placebo.



Primary Outcome Measures :
  1. The principal outcome is birth weight at delivery and neonatal morbidity (Crib Score) [ Time Frame: 6 weeks ]

Secondary Outcome Measures :
  1. Secondary outcomes are Maternal and fetal hemodynamic with blood pressure and dopplers upon inclusion, after 7 days of treatment and at delivery [ Time Frame: 6 weeks ]


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Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Multicenter randomized trial.
  • Patients with a singleton pregnancy with IUGR defined by fetal abdominal circumference less than or equal to the third percentile for gestational age, and abnormal uterine Doppler. Uterine Doppler was considered pathologic if Pourcelot's resistance index (S-D/S) was equal to or higher than 0.7, and/or if an obvious notch was present. If the placenta was not median, the side of the pathologic Doppler had to be on the same side as the placenta

Exclusion Criteria:

  • Acute fetal distress
  • Non vascular and non severe IUGR (normal uterine doppler scans and/or abdominal circumference > 3rd percentile)
  • Maternal immune disorder
  • IUGR from an infectious etiology
  • IUGR associated with fetal malformation, multifetal pregnancy, and preeclampsia upon inclusion

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00549575


Locations
France
Chu-Nantes
Nantes, France, 44093
Sponsors and Collaborators
Nantes University Hospital
Investigators
Principal Investigator: Norbert Winer, Doctor CHU Nantes
Study Chair: Dominique Darmaun, Professor CHU Nantes
Study Chair: Philippe Gilard, Doctor University Hospital, Angers
Study Chair: F Goffinet, Professor Paris-Port-Royal

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
ClinicalTrials.gov Identifier: NCT00549575     History of Changes
Other Study ID Numbers: 99/4-A
First Posted: October 26, 2007    Key Record Dates
Last Update Posted: October 26, 2007
Last Verified: October 2007

Keywords provided by Nantes University Hospital:
Severe Intra uterine growth retardation below the third centile with abnormal uterine doppler
Severe growth retardation with pathologic uterine Doppler
L-Arginine
Nitric Oxide Donor

Additional relevant MeSH terms:
Fetal Growth Retardation
Fetal Diseases
Pregnancy Complications
Growth Disorders
Pathologic Processes