The following is a summary of “Effect of pentaerythritol tetranitrate (PETN) on the development of fetal growth restriction in pregnancies with impaired uteroplacental perfusion at midgestation—a randomized trial,” published in the JANUARY 2023 issue of Obstetrics and Gynecology by Groten, et al.

Abnormal uteroplacental blood flow and impaired placentation are both strongly linked to fetal growth restriction. Strong vasodilators that safeguard the endothelium are nitric oxide donors like pentaerythritol tetranitrate. In a recent randomized controlled pilot study, researchers found that giving pentaerythritol tetranitrate to pregnant women at risk—identified by poor uterine perfusion at midgestation—reduced the chance of fetal growth restriction or perinatal mortality by 38% relative. The findings of the single-center investigation led to the idea that pentaerythritol tetranitrate, used as a supplementary prophylaxis, would impact pregnancies with impaired placental function. In a multicenter trial, the study set out to determine whether nitric oxide donor pentaerythritol tetranitrate decreases fetal growth restriction and perinatal death in expecting mothers who have impaired placental perfusion at midgestation.

Two parallel groups of pregnant women who presented with a mean uterine artery pulsatility index >95th percentile at 19+0 to 22+6 weeks of gestation were randomly assigned to receive 50-mg Pentalong or a placebo twice daily in this multicenter, randomized, double-blind, placebo-controlled experiment. According to their medical histories, participants were divided into high- or low-risk groups before randomization was carried out block-wise with a set block length stratified by center and risk group. The composite outcome of perinatal mortality or the emergence of prenatal growth restriction served as the primary effectiveness endpoint. The newborn and maternal outcome measures served as secondary endpoints.

The study involved 317 individuals between August 2017 and March 2020, of which 307 underwent analysis. In the pentaerythritol tetranitrate group, the cumulative incidence of the main outcome was 41.1%, while it was 45.5% in the placebo group (unadjusted relative risk, 0.90; 95% CI, 0.69-1.17; adjusted relative risk, 0.90; 95% CI, 0.69-1.17; P=.43). Preterm birth (adjusted relative risk, 0.73; 95% CI, 0.56-0.94; P=.01) and pregnancy-induced hypertension (unadjusted relative risk, 0.65; 95% CI, 0.46–0.93; adjusted relative risk, 0.65; 95% CI, 0.46–0.92; P=0.01) were lowered secondary outcomes.

In pregnant women with impaired uterine perfusion at midgestation, the study was unable to demonstrate a connection between pentaerythritol tetranitrate and the onset of fetal growth restriction and perinatal death. In these pregnancies, pentaerythritol tetranitrate significantly decreased secondary outcome parameters like the frequency of preterm birth and pregnancy-induced hypertension.

Reference: ajog.org/article/S0002-9378(22)00583-X/fulltext