<br>观点：妊娠期补充 L-精氨酸和 L-瓜氨酸：改善资源匮乏地区出生结果的潜在策略,Advances in Nutrition

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观点：妊娠期补充 L-精氨酸和 L-瓜氨酸：改善资源匮乏地区出生结果的潜在策略
Advances in Nutrition ( IF 8.0 ) Pub Date : 2023-01-11 , DOI: 10.1093/advances/nmz015
Andrea M Weckman _{1,

2} , Chloe R McDonald ₂ , Jo-Anna B Baxter _{3,

4} , Wafaie W Fawzi ₅ , Andrea L Conroy ₂ , Kevin C Kain _{1,

2,

6}

Affiliation

现有数据支持这样的假设：L-精氨酸或 L-瓜氨酸补充剂适合在资源有限的环境中实施，并将增强胎盘血管发育并改善出生结局。在资源有限的环境中，不良出生结局（包括胎儿生长受限、早产和低出生体重）的发生率异常高。早产引起的并发症现已成为全球 <5 岁儿童死亡的主要原因。尽管不良出生结果给全球健康带来负担，但目前几乎没有有效的干预措施，迫切需要新的策略，特别是在资源匮乏的地区。 L-精氨酸是妊娠期必需的营养氨基酸，也是一氧化氮的直接前体。在怀孕期间，胎盘和胚胎的生长增加了对 L-精氨酸的需求，这可能超过从 L-瓜氨酸合成 L-精氨酸的内源性，因此需要增加饮食摄入量。在许多资源匮乏的地区，由于普遍的蛋白质营养不良以及孕产妇感染（特别是疟疾）导致内源性 L-精氨酸耗尽，妊娠期 L-精氨酸的膳食摄入量不足。在这里，我们研究了 L-精氨酸-一氧化氮生物合成途径在妊娠中的作用，包括胎盘血管发育和胎儿生长。我们回顾了 L-精氨酸生物利用度改变与妊娠结局之间关系的证据，以及妊娠期精氨酸补充策略。现有在资源丰富的环境中补充 L-精氨酸的研究表明，可以改善母体和胎儿的血流动力学，预防先兆子痫，并改善出生结局，包括增加出生体重和延长妊娠时间。精氨酸补充研究现在需要扩展到资源匮乏地区的孕妇，特别是那些有疟疾风险的孕妇。

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Perspective: L-arginine and L-citrulline Supplementation in Pregnancy: A Potential Strategy to Improve Birth Outcomes in Low-Resource Settings

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.

更新日期：2023-01-11

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