title: Rapid target allopurinol concentrations in the hypoxic fetus after maternal administration during labour.
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.
  
  
  METHODS
  We used data from a randomised, double-blind multicentre trial comparing maternal allopurinol versus placebo in case of imminent fetal hypoxia (NCT00189007).
  
  
  METHODS
  We studied 58 women in labour at term, with suspected fetal hypoxia prompting immediate delivery, in the intervention arm of the study.
  
  
  METHODS
  Delivery rooms of 11 Dutch hospitals.
  
  
  METHODS
  500 mg allopurinol, intravenously to the mother, immediately prior to delivery.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  The study is registered in the Dutch Trial Register (NTR1383) and the Clinical Trials protocol registration system (NCT00189007).
authors.affiliation: Department of Perinatology, University Medical Centre, , Utrecht, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kaandorp
authors.forename: M P H
authors.initials: MP
authors.lastname: van den Broek
authors.forename: M J N L
authors.initials: MJ
authors.lastname: Benders
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
authors.forename: M M
authors.initials: MM
authors.lastname: Porath
authors.forename: S
authors.initials: S
authors.lastname: Bambang Oetomo
authors.forename: M G A J
authors.initials: MG
authors.lastname: Wouters
authors.forename: Ruurd
authors.initials: R
authors.lastname: van Elburg
authors.forename: M T M
authors.initials: MT
authors.lastname: Franssen
authors.forename: A F
authors.initials: AF
authors.lastname: Bos
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: G H A
authors.initials: GH
authors.lastname: Visser
authors.forename: F
authors.initials: F
authors.lastname: van Bel
authors.forename: C M A
authors.initials: CM
authors.lastname: Rademaker
authors.forename: J B
authors.initials: JB
authors.lastname: Derks
mesh_terms: D000328:Adult; D000493:Allopurinol / Q000494:pharmacology* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005311:Fetal Hypoxia / Q000188:drug therapy* / Q000517:prevention & control; D005333:Fetus / Q000187:drug effects / Q000378:metabolism; D016166:Free Radical Scavengers / Q000494:pharmacology / Q000627:therapeutic use; D005609:Free Radicals / Q000009:adverse effects; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000517:prevention & control*; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000097:blood* / Q000187:drug effects; D008431:Maternal-Fetal Exchange / Q000187:drug effects*; D018696:Neuroprotective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D010920:Placenta / Q000187:drug effects / Q000378:metabolism; D011247:Pregnancy
chemical_list: D016166:Free Radical Scavengers; D005609:Free Radicals; D018696:Neuroprotective Agents; D000493:Allopurinol