ARGIMEP

L-Arginine 1000 mg
®

SUPPLEMENTATION FOR
IMPROVING
MATERNAL AND NEONATAL

OUTCOMES
L-Arginine merupakan asam amino semi-esensial yang berperan sebagai prekursor dalam sintesis molekul
seperti oksida nitrat (NO), ornitin, kreatin, prolin dan poliamina yang memiliki peran penting selama
kehamilan dan perkembangan janin1,3

Kreatin diperlukan untuk perkembangan neurologis janin dan fungsi otot

Prolin diperlukan untuk perkembangan tulang rawan
Poliamina diperlukan untuk implantasi, embriogenesis awal, pertumbuhan janin, dan perkembangan plasenta

L-arg (e,n)NOS (fast, small NO)

iNOS (slow, high NO)
Creatine
+ 1 NADPH
+ 1 O2

Protein
synthesis N-OH-L-arg

+ ½ NADPH
Arginase + 1 O2

Urea L-Citrulline

NO
L-Ornithine

Biosintesis L-Arginine2

Receptor
Malnutrition
Placenta Trophoblast Cell
VEGF NO
Flt-1
eNOS
Dietary Intake PIGF Flt-1 L-arg
L-citrulline
of L-arginine

L-arginine Flt-1
Nitric Oxide
NOS sFlt-1
L-arginine
Demand SDMA
ADMA Ang-1/Ang-2 NO Placental
Tie-2
eNOS Vascular
L-arg
Development
Pregnancy
Renal Inflammation
Excretion DDAH-1

Kebutuhan L-Arginine meningkat selama kehamilan untuk

mendukung pertumbuhan plasenta dan perkembangan janin3
Peranan L-Arginine pada kehamilan

1 Mengurangi risiko preeklampsia untuk wanita dengan riwayat kehamilan yang kurang baik
dan berisiko tinggi mengalami preeklampsia atau dengan preeklampsia4

Intervention Control
Author (Year) Country Population Outcome Start End
Content Content

Camarena Pulido (2016) Mexico High risk of pre-eclampia IUGR, PB, BW L-Arg 3 g/day Placebo 20 weeks -
Gestational hypertension
Dare (2007) Poland and/or IUGR IUGR, IN, RDS, ICH, BW L-Arg 3 g/day Placebo 25-34 weeks -

Neri (2010) Italy Mild chronic hypertension IUGR, PB, NICUA L-Arg 4 g/day Placebo < 16 weeks -

Ropacka (2007) Poland IUGR IUGR, IN, RDS, ICH, BW L-Arg 3 g/day Placebo 24-36 weeks Delivery

Rytlewski (2006) Poland Pre-eclampsia IUGR, BW, BL, GA, AS L-Arg 3 g/day Placebo 27-31 weeks Delivery

Rytlewski (2008) Poland Threatened pre-term labour IUGR, BW, AS L-Arg 3 g/day Placebo 25-34 weeks Delivery

Sieroszewski (2004) Poland IUGR IUGR,GA L-Arg 3 g/day None - -

Singh (2015) India Asymmetrical IUGR RDS, NICUA, BW, GA L-Arg 3 g/day None 30-40 weeks 33 weeks-delivery

Vadillo-Ortega (2011) Mexico High risk of pre-eclampsia PB, AB, CA, BW, BL, GA, AS L-Arg 6.6 g/day + Vitamins Vitamins 14-32 weeks Delivery

Winer (2009) France Vascular IUGR IUGR, AB, CA, BW, GA, AS L-Arg 14 g Placebo 24-32 weeks -

AB abortion; Arg arginine; AS Apgar score; BL birth length; BW birthweight; CA Caesarean section; GA gestational age; ICH intracranial haemorrhage; IN infection;
IUGR, intrauterine growth retardation; NICUA neonatal intensive care unit admission; PB pre-term birth; RDS respiratory distress syndrome.

2 Meningkatkan volume cairan ketuban (Amniotic Fluid Index / AFI) pada oligohidramnion,
mempercepat kenaikan berat janin, dan membantu memperpanjang durasi kehamilan5

AFI AFTER
10
Median AFI(in Cm)

BEFORE
5

0
Peningkatan AFI dengan L-Arginine5)

3
Meningkatkan berat lahir bayi dan memperpanjang usia kehamilan saat
melahirkan janin IUGR (Intrauterine Growth Restriction)6

ARG/PG Inclusion criteria of IUGR Maternal age Gestational age at entry Daily dose and
Studies (or control group) fetuses (Fetal Weight)
Disease of pregnancy (wk, ARG/ PG) supplement type Course of Treatment
(wk, ARG/ PG)

Sieroszewsk 27.1 ± 5.2/

et al. 2004 78/30 Below 10th percentile for GA NA 29.5 ± 7.4 29.5 ± 2.7/31.7 ± 3.6 3 g/d, oral 20 days
29.3 ± 6.7/
Rytlewski et al. 2006 30/31 Below 10th percentile for GA preeclampsia 29.3 ± 3.42/29.1 ± 3.41 3 g/d, oral Until delivery
29.2 ± 5.9

Dear et al. 2007 42/27 Below 10th percentile for GA Gestational hypertension 28 ± 5/28 ± 4 31.09 ± 2.98/29.88 ± 3.22 3 g/d, oral Until delivery
28.7 ± 5.9/ 31.2 ± 3.1/29.7 ± 3.4
Ropacka et al. 2007 24/17 Below 10th percentile for GA NA 28.7 ± 3.8 3 g/d, oral Until delivery

28.2 ± 5.9/
Winer et al. 2009 21/22 Below 3rd percentile for GA Preeclampsia, or other disease 28.0 ± 2.0/27.7 ± 2.1 14 g/d, oral Until delivery
29.3 ± 4.2
25.47 ± 4.3/
Singh et al 2011 30/30 Below 10th percentile for GA NA 33.13 ± 2.9/33.0 ± 2.3 3 g/d, oral 21 days
25.17 ± 4.3

ARG L-Arginine treatment group, PG placebo group, GA gestational age, NA not available
 INFORMASI PRODUK
Komposisi:
Tiap tablet effervescent
L-Arginine 1000 mg

Kemasan:
1 Tube @10 Tablet Effervescent

Nomor Izin Edar:

POM SD225032641

Dosis: 1-3 tablet sehari

IMPROVING MATERNAL
& NEONATAL OUTCOMES
Mengurangi risiko Preeklampsia

BR.ARG/0/03-2023/IS/AS/SSB
Mengurangi risiko Oligohidramnion
Mengurangi risiko Intrauterine Growth
Restriction (IUGR)
Mengurangi risiko Bayi Berat Lahir
Rendah (BBLR)

Referensi :
1. Hsu, Chien N., et.al. Impact of Arginine Nutrition and Metabolism during Pregnancy on Offspring Outcomes (Review). Nutrients, 2019, 1-2
2. Umbrello, M., et.al. The Key Role of Nitric Oxide in Hypoxia: Hypoxic Vasodilation and Energy Supply–Demand Matching (Rev 1). ResearchGate; Mary Ann Liebert, 2012, 65
3. Weckman, Andrea M., et.al. Perspective: L-arginine and L-citrulline Supplementation in Pregnancy: A Potential Strategy to Improve Birth Outcomes
in Low-Resource Settings. Adv Nutr, 2019; 10: 767-768
4. Goto, E. Effects of prenatal oral L-Arginine on birth outcomes: a metaanalysis. Scientific Reports, 2021; 11: 3-4
5. Soni, A., et.al. Role of L Arginine in Oligohydramnios. The Journal of Obstetrics and Gynecology of India, 2016, 281
6. Chen, J., et.al. Effect of L-Arginine and sildenafil citrate on intrauterine growth restriction fetuses. BMC Preganancy and Childbirth, 2016, 2-4