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Rapid target allopurinol concentrations in the hypoxic fetus after maternal administration during labour
  1. J J Kaandorp1,2,
  2. M P H van den Broek3,
  3. M J N L Benders1,
  4. M A Oudijk1,
  5. M M Porath4,
  6. S Bambang Oetomo5,
  7. M G A J Wouters6,
  8. R M Elburg7,8,
  9. M T M Franssen9,
  10. A F Bos10,
  11. B W J Mol11,
  12. G H A Visser1,
  13. F van Bel1,
  14. C M A Rademaker3,
  15. J B Derks1,
  16. for the ALLO-trial Study Group
  1. 1Department of Perinatology, University Medical Centre, Utrecht, The Netherlands
  2. 2Diakonessen Hospital, Utrecht, The Netherlands
  3. 3Department of Clinical Pharmacy, University Medical Centre, Utrecht, The Netherlands
  4. 4Department of Obstetrics, Maxima Medical Centre, Veldhoven, The Netherlands
  5. 5Department of Neonatology, Maxima Medical Centre, Veldhoven, The Netherlands
  6. 6Department of Obstetrics, VU University Medical Centre, Amsterdam, The Netherlands
  7. 7Department of Neonatology, VU University Medical Centre, Amsterdam, The Netherlands
  8. 8Danone Research, Centre for Specialised Nutrition, Wageningen, The Netherlands
  9. 9Department of Obstetrics, University Medical Centre, University of Groningen, Groningen, The Netherlands
  10. 10Department of Neonatology, University of Groningen, University Medical Centre, Groningen, The Netherlands
  11. 11Department of Obstetrics, Amsterdam Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Joepe J Kaandorp, Department of Perinatology, University Medical Centre, PO Box 85090, Utrecht 3508 AB, The Netherlands; J.J.Kaandorp-2{at}umcutrecht.nl

Abstract

Objective Perinatal hypoxia-induced free radical formation is an important cause of hypoxic-ischaemic encephalopathy and subsequent neurodevelopmental disabilities. Allopurinol reduces the formation of free radicals, which potentially limits hypoxia-induced brain damage. We investigated placental transfer and safety of allopurinol after maternal allopurinol treatment during labour to evaluate its potential role as a neuroprotective agent in suspected fetal hypoxia.

Design We used data from a randomised, double-blind multicentre trial comparing maternal allopurinol versus placebo in case of imminent fetal hypoxia (NCT00189007).

Patients We studied 58 women in labour at term, with suspected fetal hypoxia prompting immediate delivery, in the intervention arm of the study.

Setting Delivery rooms of 11 Dutch hospitals.

Intervention 500 mg allopurinol, intravenously to the mother, immediately prior to delivery.

Main outcome measures Drug disposition (maternal plasma concentrations, cord blood concentrations) and drug safety (maternal and fetal adverse events).

Results Within 5 min after the end of maternal allopurinol infusion, target plasma concentrations of allopurinol of ≥2 mg/L were present in cord blood. Of all analysed cord blood samples, 95% (52/55) had a target allopurinol plasma concentration at the moment of delivery. No adverse events were observed in the neonates. Two mothers had a red and/or painful arm during infusion.

Conclusions A dose of 500 mg intravenous allopurinol rapidly crosses the placenta and provides target concentrations in 95% of the fetuses at the moment of delivery, which makes it potentially useful as a neuroprotective agent in perinatology with very little side effects.

Trial registration The study is registered in the Dutch Trial Register (NTR1383) and the Clinical Trials protocol registration system (NCT00189007).

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