The features of the prevention of preeclampsia in pregnant women with gestational endotheliopathy in the first trimester

Abstract

Low-dose aspirin (ASA) has been used during pregnancy, most commonly to prevent or delay the onset of preeclampsia. The Ukrainian National clinical guideline (2022) recommending daily 100-150mg from 12 weeks of gestation and continued until 35-36 weeks for women with highest risk development of preeclampsia. Most of the entheliotropic drugs are either not recommended during pregnancy due to a lack of reliable data about the absence of teratogenic and embryotoxic effects (resveratrol, meldonium), or are only undergoing clinical trials (statins proton pump inhibitors, metformin), or raise concerns about a possible link between prenatal exposure and neonatal death from pulmonary hypertension (sildenafil). In addition, all of the above drugs have a stimulating effect on the endothelium, which leads to the production of NO, but also to endothelial depletion. Therefore, it is very important to use a NO precursor from which the endothelium can synthesize the necessary substances. Thus, there is a need for a class of endothelioprotective agents that not only stimulate the endothelium to produce NO but also supply the substrate. The only substance that is a substrate for NO synthesis is L-arginine.