Editorials

Can a dietary supplement prevent pre-eclampsia?

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2777 (Published 19 May 2011) Cite this as: BMJ 2011;342:d2777
  1. Liam Smeeth, professor of clinical epidemiology1,
  2. David Williams, obstetric physician2
  1. 1Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  2. 2Institute for Women’s Health, University College London Hospital, London, UK
  1. liam.smeeth{at}lshtm.ac.uk

L-arginine with vitamins show promise, but there are good grounds for caution

Pre-eclampsia is a pregnancy syndrome that is defined as the gestational onset of hypertension and proteinuria; it affects 2-8% of first time pregnant mothers and has a marked international variation.1 The highest incidence of maternal mortality as a result of pre-eclampsia is in Latin America and the Caribbean, where it accounts for a quarter of maternal deaths.2 Most of these maternal deaths are caused by uncontrolled hypertension and multi-organ failure. A simple, cheap, and safe intervention to prevent pre-eclampsia would have a major impact on global health. In the linked randomised trial (doi:10.1136/bmj.d2901), Vadillo-Ortega and colleagues assess whether supplementation during pregnancy with L-arginine (the substrate for synthesis of the vasodilatory gas, nitric oxide) and antioxidant vitamins in a medical food reduces pre-eclampsia in a high risk population.3

Despite its simple definition, pre-eclampsia is a complex syndrome with multiple causes that can present with a variety of clinical features. For this reason, a single treatment is unlikely to be effective in all women at risk. As our understanding of pre-eclampsia improves, new therapeutic options emerge. Over the past 20 years, low dose aspirin and calcium supplements have had partial success in preventing …

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