Administration of the nitric oxide synthase (NOS) inhibitor, AP-nitro-L-arginine methyl ester (L-NAME) during pregnancy has been shown to compromise fetal growth. This study was designed to determine whether aminoguanidine, a predominate inhibitor of inducible NOS, affects fetal outcome. In addition, we extended the prenatal administration of L-NAME into the postnatal period (14 d) to determine whether neonatal growth and maturation were also affected. L-NAME, but not aminoguanidine, compromises fetal and placental growth. When compared with control 14-d-old pups, postnatal L-NAMEcompromised neonatal growth, whether it was given directly (intraperitoneally) (39.7 ± 1.1 versus 24.1 ± 1.0 g) or indirectly (38.6 ± 0.5 versus 22.2 ± 1.2 g) via maternal breast milk. Neonatal growth retardation was asymmetric, with brain sparing, suggesting a nutritional origin. L-NAME administration resulted in growth retardation that extended into adulthood, without evidence of catch-up growth. Treated neonates displayed the hallmarks of hypertrophic pyloric stenosis. Significant increases in stomach weight/pup weight (9.9 ± 0.3 versus 8.2 ± 0.4 X 10 3 ) and stomach volume/pup weight (12.0 ± 0.6 versus 9.4 ± 0.6 mL/100 g) with a concomitant Endogenous NO produced from L-arginine by NOS (1), is an important regulator in a number of physiologic proce sse s. Se veral different isoforms of NOS exist; the con stitutive isoforms regul ate v ascular tone (1), neurotransmission (2), and platelet aggregation (3), w hereas the ind ucible for m appears to have its primary effect s on inflammation (4, 5) and host defense (6). A number of exog enous NOS inhibitors have been identified including the structural an alog of L-arginine, I.-NA ME, w hich inhibits both co nstitutive and inducible NOS isoforms , wi th pr eference for the constitut ive isoform (7,8 Supported in parI by National Institutes of Health Granl ROI HD31885 (to MJ.S.M.) and American Heart Association, Louisiana Chapter (to M.R.P.). decrease in small intestine weight/length (2.10 ± 0.08 versus 3.18 ± 0.13 g/100 em) was noted in treated versus control pups (p < 0.05). Muscularis hypertrophy at the pyloric sphincter in the L-NAME-treated pups was noted by histology. Blood pressure was elevated in the L-NAME-treated pups (93 ± 6 versus 60 ± 5 mm Hg in control pups, p < 0.05). These findings are consistent with inhibition of neuronal and endothelial NOS activity. We conclude that NO, formed via the constitutive isoforms of NOS, is a critical determinant of fetal and neonatal growth and maturation. (Pediatr Res 38: 768-774, 1995) Abbreviations NO, nitric oxide NOS, nitric oxide synthase cNOS, constitutive nitric oxide synthase iNOS, inducible nitric oxide synthase L-NAME, AP-nitro-L-arginine methyl ester HPS , hypertrophic pyloric stenosis VIP , vasoactive intestinal polypeptide nidine, although not a i-arginine anal og, predominately inhibits the indu cible NOS isoform (9) .NO fo rma tion is up-regul ated in pregn ancy (10). Th e uteroplacental unit via both co nst itutive and ind...