Clinical experience of L-arginine use for preconception care in women with fetal loss syndrome and a history of low-risk thrombophilia

Endothelial dysfunction during pregnancy is associated with an imbalance between the production of vasodilatory, angioprotective, and antiproliferative factors on one hand, and vasoconstrictive, prothrombotic, and proliferative factors on the other. These disturbances may contribute to reproductive losses, the prevention of which is a critical challenge in modern obstetrics.The objective: to substantiate the necessity and evaluate the effectiveness of L-arginine administration for preconception preparation in women with recurrent pregnancy loss syndrome and a history of low-risk thrombophilias.Materials and methods. A prospective controlled clinical study was conducted involving 80 women with recurrent pregnancy loss syndrome and a history of low-risk thrombophilias. The participants were divided into two groups of 40 patients each. The control group underwent standard preconception preparation for patients with hemostasiological disorders and recurrent pregnancy loss syndrome, while women in the main group additionally received L-arginine supplements. To identify endothelial dysfunction in the first trimester of pregnancy, endothelial-dependent vasodilation of blood vessels, the structure and incidence of pregnancy and childbirth complications were assessed. Statistical data analysis was performed using the IBM SPSS Statistics software package (version 20).Results. The use of L-arginine during preconception preparation in women with low-risk thrombophilias and a history of recurrent pregnancy loss was associated with a reduced incidence of gestational endothelial dysfunction in the first trimester (odds ratio (OR) 0.33; 95% confidence interval (CI) [0.11–0.97]), placental dysfunction (OR 0.14; 95% CI [0.04–0.45]), fetal growth restriction (OR 0.13; 95% CI [0.04–0.45]), and de novo hypertensive disorders (OR 0.21; 95% CI [0.05–0.84]).Conclusions. The proposed strategy for managing the preconception period and early gestation in women with recurrent pregnancy loss syndrome and low-risk thrombophilias in their medical history effectively reduced the risk of gestational endothelial dysfunction and placental-associated pregnancy complications.