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However, whether L\u2010arginine can prevent or only treat pre\u2010eclampsia, and thus the target population and timing of initiation, remains unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the effects of L\u2010arginine and L\u2010citrulline (precursor of L\u2010arginine) on the prevention and treatment of pre\u2010eclampsia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search Strategy<\/jats:title><jats:p>MEDLINE, Embase, CINAHL, Global Index Medicus and the Cochrane Library were searched through 7 February 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criteria<\/jats:title><jats:p>Trials administering L\u2010arginine or L\u2010citrulline to pregnant women, with the comparison group receiving placebo or standard care, were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection and Analysis<\/jats:title><jats:p>Meta\u2010analyses were conducted separately for prevention or treatment trials, using random\u2010effects models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>Twenty randomised controlled trials (RCTs) (2028 women) and three non\u2010randomised trials (189 women) were included. The risk of bias was \u2018high\u2019 in eight RCTs and showed \u2018some concerns\u2019 in 12. In prevention trials, L\u2010arginine was associated with a reduced risk of pre\u2010eclampsia (relative risk [RR] 0.52; 95% confidence interval [CI], 0.35, 0.78; low\u2010certainty evidence, four trials) and severe pre\u2010eclampsia (RR 0.23; 95% CI, 0.09, 0.55; low\u2010certainty evidence, three trials). In treatment trials, L\u2010arginine may reduce mean systolic blood pressure (MD \u22125.64\u2009mmHg; 95% CI, \u221210.66, \u22120.62; very low\u2010certainty evidence, three trials) and fetal growth restriction (RR 0.46; 95% CI, 0.26, 0.81; low\u2010certainty evidence, two trials). Only one study (36 women) examined L\u2010citrulline and reported no effect on pre\u2010eclampsia or blood pressure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>L\u2010arginine may be promising for pre\u2010eclampsia prevention and treatment, but findings should be interpreted cautiously. More trials are needed to determine the optimal dose and time to commence supplementation and support clinical decision\u2010making.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.18070","type":"journal-article","created":{"date-parts":[[2025,1,12]],"date-time":"2025-01-12T23:39:14Z","timestamp":1736725154000},"page":"698-708","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["L\u2010Arginine and L\u2010Citrulline for Prevention and Treatment of Pre\u2010Eclampsia: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-3702","authenticated-orcid":false,"given":"Maureen","family":"Makama","sequence":"first","affiliation":[{"name":"Women's, Children's and Adolescents' Health Program Burnet Institute  Melbourne Australia"},{"name":"Health and Social Care Unit, School of Public Health and Preventive Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1182-6679","authenticated-orcid":false,"given":"Annie R. 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