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Effectiveness of nitric oxide agents in preventing the early onset of pre-eclampsia and possible modification of metabolic factors in high-risk pregnanciesPre-eclampsia is a pregnancy-specific condition which affects at least 2 - 8% of pregnancies and is the major cause of foetal growth restriction, small gestational age and increased rate of preterm birth from induced labour and caesarean section. The rate of early-onset of pre-eclampsia raises serious concern; and the most affected population are nulliparous women, women with chronic hypertension, multiple pregnancies and those with chronic diseases. Increasing the bioavailability of nitric oxide (NO) in the endothelial system through the timely administration of NO agents could minimise the metabolic precursors of pre-eclampsia which may be a cost-effective intervention in preventing the complications related to the ailment. While the effectiveness and safety of suggested interventions for the prevention of pre-eclampsia on maternal and neonatal health is being deliberated, evidence on the role of NO in the pathogenesis of preeclampsia is well recognised. Nitric oxide agents have been proven to be effective in preventing complications from pre-eclampsia; however, there is limited evidence on NO agents in preventing its early onset in high risk pregnancies. Previous studies on pre-eclampsia prevention with NO agents lacks the criteria required to achieve optimum effects; and the benefit of administering NO agents before 20 weeks’ gestation is yet to be established.