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We enrolled pregnant women between 14 and32 weeks of gestation at high risk of pre-eclampsiawho were receiving prenatal care at the InstitutoNacional de Perinatologia Isidro Espinosa de losReyes in Mexico City between January 2001 andDecember 2005. We included patients at increasedrisk of pre-eclampsia, which we defined as either a per-sonal history of pre-eclampsia or pre-eclampsia in afirst degree relative. Eligible participants agreed tohave their prenatal care and delivery at the institutionand provide informed consent. We excluded patientswith multiple gestation, known major fetal anomalies(as defined by ultrasound studies by the fetal medicinedepartment), diabetes mellitus or gestational diabetes,pre-existing hypertension, pre-existing renal disease,collagen vascular disease, cancer or strong family his-tory of cancer in first degree relatives, and pre-existingmaternal disease needing drug treatment. Weexcluded women with type 2 diabetes, cancer, or astrong family history of cancer because the angiogenicactions of vascular endothelial growth factor arethought to be mediated, in part, by nitric oxide.32Allwomen were screened for gestational diabetes at week14 and again at week 24 of gestation, according to theinstitutional protocol. We decided in advance that if awoman was diagnosed as having gestational diabetesafter randomisation she would discontinue taking barsbecause of the aforementioned safety concerns. How-ever,weincludedsuchwomeninthedataanalysis.Weexcluded patients with autoimmune disease becauseperoxynitrites have been implicated in the pathogen-esis of tissue damage in autoimmune disease.
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