Uterine Blood Flow Response to Alpha-Adrenergic Blockade in Nulligravid Women of Reproductive Age

A methodology for examining the association between plasma volume and micronutrient biomarker mass and concentration in healthy eumenorrheic women

Background

Accurate estimation and interpretation of nutritional biomarker concentrations are important in nutritional research, clinical care, and public health surveillance. Plasma volume (PV) may affect the interpretation of plasma biomarkers but is rarely measured. We aimed to examine the association between plasma volume (PV) and micronutrient biomarker concentrations and mass as part of pilot work to develop methods.

Methods

Nine healthy women with regular menstrual cycles provided fasting blood samples to measure micronutrient biomarkers. Indocyanine green was injected, and five timed blood draws were taken from 2 to 5 min to measure PV. Visits were scheduled around menstrual cycle day 2. Retinol, 25-hydroxyvitamin D, riboflavin, alpha-tocopherol, zinc, copper, magnesium, manganese, cobalt, iron, and ferritin concentrations were measured in serum. Total circulating micronutrient biomarker mass was calculated from PV and concentration.

Results

The mean PV was 2067 ±  470 mL. PV correlated positively with concentration of iron (r = 0.87, P = 0.005); other correlations were weaker with p > 0.05. PV and total mass of retinol (r = 0.90), 25(OH)D (r = 0.75), zinc (r = 0.88), copper (r = 0.83), magnesium (r = 0.93), manganese (r = 0.72), and iron (r = 0.92) were strongly correlated (all p < 0.05). PV was positively correlated with circulating micronutrient mass for most biomarkers, implying that concentrations are maintained at different volumes of plasma. Larger studies are needed to further examine these relationships.

Conclusion

Though there appear to be some association between micronutrient biomarker mass and plasma volume, we are unable to draw a firm conclusion about any relationship from these results because of the small sample size. We consider these findings as a preliminary analysis to establish methods for future studies.

Preeclampsia and maternal cardiovascular disease: consequence or predisposition?

Formerly preeclamptic women stand a higher chance of developing cardiovascular disease (CVD) later in life and may experience a shortened life span. This review updates the pathophysiology and definition of this complex disease and highlights the protective role of pregnancy by considering the relationship between pregnancy interval and likelihood of disease recurrence. The evidence for persistent maternal cardiovascular impairment following preeclampsia (PE) is considered, e.g. postpartum changes in CVD occurrence, blood pressure elevation and changes in the renin-angiotensin-aldosterone system). Since maternal endothelial dysfunction is a hallmark of PE, we summarize the evidence for reduced flow-mediated dilation in women with previous PE, and consider the utility and shortcomings of this clinical measure. In addition to viewing postpartum changes as a consequence of this disease, we consider the alternative view that PE might be the manifestation of a maternal phenotype that already has some predisposition to or is in the earlier stages of CVD; in this case, some of the postpartum residual deficits (or their antecedents) may have already been present prior to pregnancy. Finally, we consider the use of novel biomarkers for predicting or detecting PE prior to the appearance of clinical symptoms.

Large conductance Ca2+-activated K+ channels modulate uterine α1-adrenergic sensitivity in ovine pregnancy

The uteroplacental vasculature is refractory to α-adrenergic stimulation, and large conductance Ca(2+)-activated K(+) channels (BK(Ca)) may contribute. We examined the effects of uterine artery (UA) BK(Ca) inhibition with tetraethylammonium (TEA) on hemodynamic responses to phenylephrine (PE) at 101 to 117 days and 135 to 147 days of ovine gestation, obtaining dose responses for mean arterial pressure (MAP), heart rate (HR), and uteroplacental blood flow (UPBF) and vascular resistance (UPVR) before and during UA TEA infusions. The UA α(1)-adrenergic receptors (α1-ARs) were assessed. The PE increased MAP and UPVR and decreased HR and UPBF dose dependently at both gestations (P < .001, analysis of variance). The %▵MAP was less at 135 to 147 days before and during TEA infusions (P ≤ .008); however, responses during TEA were greater (P ≤ .002). The PE increased %▵UPVR>>%▵MAP, thus %▵UPBF fell. The TEA enhanced PE-mediated increases in %▵UPVR at 135 to 147 days (P ≤ .03). The UA α(1)-AR expression was unchanged in pregnancy. Uterine vascular responses to PE exceed systemic vascular responses throughout pregnancy and are attenuated by BK(Ca) activation, suggesting BK(Ca) protect UPBF.

Differential sensitivity to angiotensin II and norepinephrine in human uterine arteries

BACKGROUND

During pregnancy, uteroplacental responses to norepinephrine (NE) exceed systemic responses. In contrast, uteroplacental responses to angiotensin II (ANG II) are less than systemic. The explanation for these differences in uteroplacental sensitivity remain unclear but may reflect type 2 ANG II receptor (AT(2)R) predominance in uterine artery (UA) vascular smooth muscle (VSM).

OBJECTIVE

The objective of the study was to examine VSM sensitivity to KCl, NE, and ANG II in UA from nonpregnant (NP) and pregnant (P) women and determine VSM ANG II receptor subtype expression.

METHODS

Responses to KCl, NE, and ANG II were examined in endothelium-denuded UA rings from NP (n = 28) and P (n = 13; 34-40 wk gestation) women, and ANG II receptor subtype, α(1)-receptor and contractile proteins were measured.

RESULTS

KCl and NE dose dependently contracted UA (P < 0.001), P exceeding NP 2-fold or greater; but α(1)-receptor expression was unchanged. ANG II did not elicit dose effects in NP or P UA; however, P responses exceeded NP approximately 2-fold (P < 0.001) and were approximately 2.5-fold less than NE (P < 0.001). AT(2)R and AT(1)R expression were similar (P > 0.1) in VSM from NP and term P women. AT(1)R blockade abolished ANG II contractions (P < 0.001); AT(2)R blockade did not enhance ANG II sensitivity in UA with or without endothelium. Actin contents increased approximately 2-fold in term UA.

CONCLUSIONS

Sensitivity to α-stimulation exceeds ANG II in NP and P UA, explaining the differential uteroplacental sensitivity in pregnancy. Because AT(2)R predominate in UA VSM throughout reproduction, this contributes to the inherent refractoriness to ANG II in the uterine vasculature. The increase in UA contractile proteins at term P suggests remodeling, explaining the enhanced contractility seen.

Defining the differential sensitivity to norepinephrine and angiotensin II in the ovine uterine vasculature

The intact ovine uterine vascular bed (UVB) is sensitive to α-agonists and refractory to angiotensin II (ANG II) during pregnancy; the converse occurs in the systemic circulation. The mechanism(s) responsible for these differences in uterine sensitivity are unclear and may reflect predominance of nonconstricting AT(2) receptors (AT(2)R) in uterine vascular smooth muscle (UVSM). The contribution of the placental vasculature also is unclear. Third generation and precaruncular/placental arteries from nonpregnant (n = 16) and term pregnant (n = 23) sheep were used to study contraction responses to KCl, norepinephrine (NE), and ANG II (with/without ATR specific inhibitors) and determine UVSM ATR subtype expression and contractile protein content. KCl and NE increased third generation and precaruncular/placental UVSM contractions in a dose- and pregnancy-dependent manner (P ≤ 0.001). ANG II only elicited modest contractions in third generation pregnant UVSM (P = 0.04) and none in precaruncular/placental UVSM. Moreover, compared with KCl and NE, ANG II contractions were diminished ≥ 5-fold. Whereas KCl and ANG II contracted third generation>>precaruncular/placental UVSM, NE-induced contractions were similar throughout the UVB. However, each agonist increased third generation contractions ≥ 2-fold at term, paralleling increased actin/myosin and cellular protein content (P ≤ 0.01). UVSM AT(1)R and AT(2)R expression was similar throughout the UVB and unchanged during pregnancy (P > 0.1). AT(1)R inhibition blocked ANG II-mediated contractions; AT(2)R blockade, however, did not enhance contractions. AT(2)R predominate throughout the UVB of nonpregnant and pregnant sheep, contributing to an inherent refractoriness to ANG II. In contrast, NE elicits enhanced contractility throughout the ovine UVB that exceeds ANG II and increases further at term pregnancy.

HAEMODYNAMIC CONTRIBUTIONS TO THE PATHOGENESIS OF PREECLAMPSIA AND ECLAMPSIA

Current hypotheses regarding the origins of preeclampsia have focused on the “Two stage model”. This model suggests that the primary steps in the pathophysiologic sequence of preeclampsia are initiated by abnormal placentation including the classic finding of abnormal trophoblast invasion of maternal decidual spiral arteries. The second stage of the sequence includes the elaboration of a single or multiple substances from these disordered placentas which contribute to the generalized maternal systemic illness, eventually manifesting as endothelial injury, hypertension and proteinuria. Recent studies have focused on the role of pro and anti-angiogenic peptides as potential placentally derived aetiologic agents in this pathophysiologic sequence, although other placental products have been highlighted in recent research. Despite the fact that this modeling of preeclampsia has widespread support significant limitations to this hypothesis can be identified.

Maternal psychological distress, prenatal cortisol, and fetal weight

OBJECTIVE

The objective of this study was to examine the effects of maternal psychological distress on estimated fetal weight during midgestation and explore the maternal hypothalamic-pituitary axis and sympathoadrenal dysregulation as potential risk factors for these effects.

METHODS

Fetal ultrasound biometry measurements and maternal sociodemographic characteristics, emotional distress symptoms, and first morning urine samples were collected during a clinical ultrasound examination for a cross-sectional sample of 98 women who were between 16 and 29 weeks pregnant. Fetal weight was estimated from ultrasound biometry measurements; maternal emotional distress was assessed using the daily hassles (stress), Center for Epidemiologic Studies-Depression (depression), and State-Trait Anxiety Inventory (anxiety) scales; and urine samples were assayed for cortisol and norepinephrine levels.

RESULTS

Correlation analyses revealed that both maternal psychological (daily hassles, depression, and anxiety) and biochemical (cortisol and norepinephrine) variables were negatively related to fetal biometry measurements and estimated fetal weight. A structural equation model further revealed that when the independent variance of maternal sociodemographic, psychological distress, and biochemistry measures were accounted for, prenatal cortisol was the only significant predictor of fetal weight.

CONCLUSIONS

Women exhibiting psychological distress during pregnancy exhibit elevated cortisol levels during midgestation that are in turn related to lower fetal weight.

The Effect of Herbal Medicine Toki-shakuyaku-san on Blood Pressure in an Nω-Nitro-L-Arginine Methyl Ester-Induced Pre-eclampsia Rat Model During Pregnancy and the Postpartum Period

The chronic inhibition of nitric oxide (NO) synthesis with N(omega)-nitro-L-arginine methyl ester (L-NAME) in pregnant rats induces a pre-eclampsia-like syndrome, including hypertension. We have previously reported the beneficial effects of Toki-shakuyaku-san (TS) in this model. In the present study we demonstrated the anti-hypertensive effect of TS in pre-eclampsia produced by prolonged L-NAME-infusion during the postpartum period. Analysis of blood sex steroids suggested that the level of progesterone differs between the TS-effective (gestational day 19 and postpartum day 7) and TS-ineffective (postpartum day 1) periods. Co-administration of TS and progesterone inhibited L-NAME-induced hypertension on postpartum day 1. Furthermore, the anti-hypertensive effect of TS on postpartum day 6 disappeared in the presence of a co-administered progesterone antagonist mifepristone. These data suggest that a certain level of progesterone may be an indispensable prerequisite for an anti-hypertensive effect of TS. Finally, the effects of TS are apparently unrelated to blood levels of NO, calcitonin gene-related peptide, and endothelin-1, which have been reported to modulate systolic blood pressure in the L-NAME-induced pre-eclampsia model. Thus, the use of TS may provide a new therapeutic strategy for pre-eclampsia, although elucidation of the mechanism of action of TS would be necessary to optimize treatment protocols.