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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2023

Open Access 01-12-2023 | Sildenafil | Research

The effects of sildenafil citrate on intrauterine growth restriction: a systematic review and meta-analysis

Authors: Yenlik Rakhanova, Wassim Y. Almawi, Gulzhanat Aimagambetova, Dieter Riethmacher

Published in: BMC Pregnancy and Childbirth | Issue 1/2023

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Abstract

Background

An increase in vascular resistance of uterine vessels is associated with intrauterine growth restriction (IUGR). Sildenafil citrate, a phosphodiesterase-5 inhibitor that stabilizes cyclic guanosine monophosphate (cGMP) and increases nitric oxide levels, improves placental perfusion by dilation of spiral arteries and is beneficial in managing IUGR. This study aims to determine the effectiveness of sildenafil citrate in improving perinatal outcomes in IUGR pregnancies.

Methods

Meta-analysis was performed on data extracted from all studies specific to sildenafil citrate in IUGR management, searching relevant articles on PubMed, Medline, Google Scholar, Embase, and Cochrane databases. Publications identified by the manual search, based on references in reviews, were also included. Dichotomous results were presented as risk ratio (95% confidence interval), while continuous results were expressed as mean difference (MD); samples represented by the random effects model.

Results

Nine trials were included where the sildenafil citrate effect was compared with a placebo or no intervention. A significant increase in birth weight [SMD (95% CI), 0.69 (0.31, 1.07)] was seen in IUGR pregnancies managed with sildenafil. However, gestational age (SMD (95% CI), 0.44 (-0.05, 0.94], fetal death rate [RR (95% CI), 0.56 (0.17, 1.79)] in IUGR pregnancies was not changed by sildenafil. Neonatal death [RR (95% CI), 0.93 (0.47, 1.86)] and neonatal intensive care unit (NICU) admissions [RR (95% CI), 0.76 (0.50, 1.17)] were not significantly different between sildenafil and control groups.

Conclusion

Sildenafil citrate increases birth weight and prolonged pregnancies but did not affect stillbirth rate, neonatal death, and NICU admission.

Trial registration

The study was registered in PROSPERO on September 18, 2021 (CRD42021271992).
Appendix
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Metadata
Title
The effects of sildenafil citrate on intrauterine growth restriction: a systematic review and meta-analysis
Authors
Yenlik Rakhanova
Wassim Y. Almawi
Gulzhanat Aimagambetova
Dieter Riethmacher
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2023
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-023-05747-7

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