Heda Ayush, Deshwali Akanksha, Heda Sakshi, Priyadarshi Mayank
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Eur J Obstet Gynecol Reprod Biol X. 2024 Oct 28;24:100350. doi: 10.1016/j.eurox.2024.100350. eCollection 2024 Dec.
Fetal Growth Restriction (FGR), often due to placental insufficiency, poses significant risks to perinatal outcomes. This review evaluates the efficacy of pentaerythritol tetranitrate (PETN), a nitric oxide donor, in preventing FGR.
A systematic review and meta-analysis was conducted by searching PubMed, Embase, and CENTRAL up to July 2024. The inclusion criteria focused on randomized controlled trials comparing PETN to placebo in FGR prevention. Key outcomes were incidences of FGR, perinatal mortality, neonatal mortality, and intrauterine fetal demise (IUFD). Other outcomes were classified as maternal, fetal, neonatal and safety outcomes. We used Cochrane RoB 2.0 tool to assess risk of bias, and GRADE criteria for evidence quality.
Two eligible studies encompassing 417 pregnant women at risk of FGR were included. PETN did not significantly reduce incidence of FGR (RR 0.83, 95 % CI 0.66-1.04, 2 trials, 417 participants, low certainty) or perinatal mortality (RR 0.64, 95 % CI 0.26-1.58, 2 trials, 417 participants, very low certainty) compared to placebo. None of the studies reported neonatal mortality or IUFD. However, PETN treatment was associated with a reduction in preterm birth (RR 0.74, 95 % CI 0.58-0.93, 2 trials, 417 participants, moderate certainty). Other outcomes were similar between the groups.
While PETN does not significantly impact FGR rates or perinatal mortality, it is associated with a reduction in preterm birth, suggesting potential benefits in high-risk pregnancies. Larger trials are necessary to substantiate these findings and clarify the role of PETN in FGR prevention.
胎儿生长受限（FGR）通常由于胎盘功能不全，对围产期结局构成重大风险。本综述评估一氧化氮供体季戊四醇四硝酸酯（PETN）预防FGR的疗效。
通过检索截至2024年7月的PubMed、Embase和CENTRAL进行系统综述和荟萃分析。纳入标准集中于比较PETN与安慰剂预防FGR的随机对照试验。主要结局为FGR发生率、围产期死亡率、新生儿死亡率和宫内胎儿死亡（IUFD）。其他结局分为母体、胎儿、新生儿和安全性结局。我们使用Cochrane RoB 2.0工具评估偏倚风险，并使用GRADE标准评估证据质量。
纳入两项符合条件的研究，共417名有FGR风险的孕妇。与安慰剂相比，PETN并未显著降低FGR发生率（RR 0.83，95%CI 0.66 - 1.04，2项试验，417名参与者，低确定性）或围产期死亡率（RR 0.64，95%CI 0.26 - 1.58，2项试验，417名参与者，极低确定性）。没有研究报告新生儿死亡率或IUFD。然而，PETN治疗与早产减少相关（RR 0.74，95%CI 0.58 - 0.93，2项试验，417名参与者，中等确定性）。两组间其他结局相似。
虽然PETN对FGR发生率或围产期死亡率没有显著影响，但它与早产减少相关，提示在高危妊娠中可能有益。需要更大规模的试验来证实这些发现并阐明PETN在预防FGR中的作用。
