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Meta-Analysis
. 2023 Jun 2;23(1):409.
doi: 10.1186/s12884-023-05747-7.

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

Yenlik Rakhanova  1 , Wassim Y Almawi  2   3 , Gulzhanat Aimagambetova  4 , Dieter Riethmacher  1
Affiliations
Meta-Analysis

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

Yenlik Rakhanova et al. BMC Pregnancy Childbirth. .

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).

Keywords: IUGR; Low birthweight; Phosphodiesterase-5 inhibitor; Pregnancy outcomes; Sildenafil citrate.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow-chart of study selection process
Fig. 2
Fig. 2
The risk of bias assessment using the RoB 2. A The risk of bias assessment for each trial. B Percentage distribution of individual risk of bias among studies
Fig. 3
Fig. 3
Forest plot for sildenafil citrate versus placebo. A Neonatal weight at delivery. B Gestational age at delivery. C Stillbirth rate. D Neonatal death. E Neonatal ICU admission rate
See this image and copyright information in PMC

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