Can a dietary supplement prevent pre-eclampsia?

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 …