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Bakrania BA, Spradley FT, Drummond HA, LaMarca B, Ryan MJ, Granger JP. Preeclampsia: Linking Placental Ischemia with Maternal Endothelial and Vascular Dysfunction. Compr Physiol 2020; 11:1315-1349. [PMID: 33295016 PMCID: PMC7959189 DOI: 10.1002/cphy.c200008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Preeclampsia (PE), a hypertensive disorder, occurs in 3% to 8% of pregnancies in the United States and affects over 200,000 women and newborns per year. The United States has seen a 25% increase in the incidence of PE, largely owing to increases in risk factors, including obesity and cardiovascular disease. Although the etiology of PE is not clear, it is believed that impaired spiral artery remodeling of the placenta reduces perfusion, leading to placental ischemia. Subsequently, the ischemic placenta releases antiangiogenic and pro-inflammatory factors, such as cytokines, reactive oxygen species, and the angiotensin II type 1 receptor autoantibody (AT1-AA), among others, into the maternal circulation. These factors cause widespread endothelial activation, upregulation of the endothelin system, and vasoconstriction. In turn, these changes affect the function of multiple organ systems including the kidneys, brain, liver, and heart. Despite extensive research into the pathophysiology of PE, the only treatment option remains early delivery of the baby and importantly, the placenta. While premature delivery is effective in ameliorating immediate risk to the mother, mounting evidence suggests that PE increases risk of cardiovascular disease later in life for both mother and baby. Notably, these women are at increased risk of hypertension, heart disease, and stroke, while offspring are at risk of obesity, hypertension, and neurological disease, among other complications, later in life. This article aims to discuss the current understanding of the diagnosis and pathophysiology of PE, as well as associated organ damage, maternal and fetal outcomes, and potential therapeutic avenues. © 2021 American Physiological Society. Compr Physiol 11:1315-1349, 2021.
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Affiliation(s)
- Bhavisha A. Bakrania
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Frank T. Spradley
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Heather A. Drummond
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Babbette LaMarca
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael J. Ryan
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Joey P. Granger
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Moors S, Staaks KJJ, Westerhuis MEMH, Dekker LRC, Verdurmen KMJ, Oei SG, van Laar JOEH. Heart rate variability in hypertensive pregnancy disorders: A systematic review. Pregnancy Hypertens 2020; 20:56-68. [PMID: 32179490 DOI: 10.1016/j.preghy.2020.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertensive pregnancy disorders (HPD) are associated with dysfunction of the autonomic nervous system. Cardiac autonomic functions can be assessed by heart rate variability (HRV) measurements. OBJECTIVE To study whether HRV detects differences in the function of the autonomic nervous system between pregnant women with HPD compared to normotensive pregnant women and between women with a history of a pregnancy complicated by HPD compared to women with a history of an uncomplicated pregnancy. METHODS A systematic search was performed in Medline, EMBASE, and CENTRAL to identify studies comparing HRV between pregnant women with HPD or women with a history of HPD to women with (a history of) normotensive pregnancies. RESULTS The search identified 523 articles of which 24 were included in this review, including 850 women with (a history of) HPD and 1205 normotensive controls. The included studies showed a large heterogenicity. A decrease in overall HRV was found in preeclampsia (PE), compared to normotensive pregnant controls. A trend is seen towards increased low frequency/high frequency-ratio in women with PE compared to normotensive pregnant controls. CONCLUSION Our systematic review supports the hypothesis a sympathetic overdrive is found in HPD which is associated with a parasympathetic withdrawal. However, the included studies in our review showed a large diversity in the methods applied and their results.
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Affiliation(s)
- S Moors
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - K J J Staaks
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M E M H Westerhuis
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - L R C Dekker
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K M J Verdurmen
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Kasim HH, Masri MA, Noh NA, Mokhtar A, Mokhtar RH. Clinical implications of blood pressure variability (BPV) in pregnancies: a review. Horm Mol Biol Clin Investig 2019; 39:/j/hmbci.ahead-of-print/hmbci-2018-0060/hmbci-2018-0060.xml. [PMID: 30712023 DOI: 10.1515/hmbci-2018-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022]
Abstract
Background Hypertension disorder in pregnancy (HDP) is the second most common contributor to maternal morbidity and mortality worldwide. Blood pressure variability (BPV), with the assistance of ambulatory blood pressure monitoring (ABPM), measures blood pressure readings in pregnant women and has the potential to predict the occurrence of pregnancy-induced hypertension (PIH) or preeclampsia (PE) before any symptoms develop. Methodology Studies involving ABPM among pregnant women were identified using electronic databases such as PubMed, Scopus, Google Scholar, ScienceDirect, Medscape, Ovid and ProQuest. These electronic databases were assessed from 1990 to 2018. Keywords used to search for literatures included a combination of BPV matched with pregnancy, pregnant women and HDP, gestational hypertension and/or PE. Results Out of 21,526 articles identified, a total of 10 studies met the criteria. Seven articles used the spectral analysis method while another two articles used a combination of spectral analysis, time domain and a non-linear method for BPV analysis. The final article described BPV as vagal baroreflex. Four articles agreed that high frequency (HF) BPV was mainly dominant from the second trimester until 4 days postpartum in HDP patients. This reflects the dominant features of parasympathetic activities among these patients. Two articles that used time domain also agreed that standard deviation (SD) BPV increased in PE patients. Conclusions In pregnancy, BPV has a strong impact on the knowledge understanding of the disease in clinical fields, allows a superior ability to predict PIH and PE in mid-pregnancy and offers potential value for addressing hypertension in pregnancy.
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Affiliation(s)
- Hanis Hidayu Kasim
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia, Phone: +603-4289 2400, Fax : +603-4289 2477
| | - Maizatul Azma Masri
- Obstetrics and Gynaecology, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Nor Azila Noh
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Azlina Mokhtar
- Surgical Based Discipline, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Rafidah Hanim Mokhtar
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia, Phone: +603-4289 2400, Fax : +603-4289 2477
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Bhaskar L, Kharya C, Deepak KK, Kochupillai V. Assessment of Cardiac Autonomic Tone Following Long Sudarshan Kriya Yoga in Art of Living Practitioners. J Altern Complement Med 2017; 23:705-712. [PMID: 28691853 DOI: 10.1089/acm.2016.0391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The breathing processes are known to modulate cardiac autonomic tone and improve psychological status. We investigated cardiac autonomic tone following long Sudarshan Kriya Yoga (SKY) using heart rate variability (HRV) and skin conductance level (SCL). METHODS Thirty healthy volunteers (age 28.3 ± 8.4 years; 23 M: 7 F) participated in the study. Electrocardiogram (ECG) and SCL were recorded for 5 min each, before and after long SKY. Long SKY is a combination of pranayama and cyclic rhythmic breathing and is performed by following the guided audio instructions. HRV analysis was used for the assessment of cardiac autonomic tone. Time and frequency domain parameters of HRV were calculated by using RR interval of ECG. SCL was acquired using Galvanic skin response (GSR) amplifier of PowerLab in microSeimens (μS). RESULTS Time domain parameters of HRV, including mean RR interval (p = 0.000), respiratory sinus arrhythmia (RSA) (p = 0.037), standard deviation of all NN intervals (SDNN) (p = 0.013), NN50 count divided by the total number of all NN intervals (pNN50) (p = 0.004), and square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) (p = 0.002) increased, and mean heart rate decreased (p = 0.000) following long SKY. In frequency domain analysis, power of low-frequency (LF) component (p = 0.010) and LF/HF ratio (p = 0.008) decreased significantly, whereas power of high frequency (HF) significantly increased (p = 0.010). SCL decreased following long SKY, although it did not attain statistical significance. CONCLUSIONS The results suggest that long SKY induces significant oscillations in cardiac autonomic tone. Parasympathetic activity increases and sympathetic activity decreases and sympathovagal balance improves following long SKY. Decrease in sympathetic activity is also demonstrated by decrease in conductance although it did not reach statistical significance. From this study it can be concluded that long SKY has a beneficial effect on cardiac autonomic tone, and psychophysiological relaxation. It may serve as a tool to improve HRV, which is the marker of cardiovascular health.
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Affiliation(s)
- Lakshmi Bhaskar
- 1 Sri Sri Institute of Advanced Research , Ved Vignan Maha Vidya Peeth, Bengaluru, India
| | - Chhaya Kharya
- 1 Sri Sri Institute of Advanced Research , Ved Vignan Maha Vidya Peeth, Bengaluru, India
| | - K K Deepak
- 2 Department of Physiology, All India Institute of Medical Sciences , New Delhi, India
| | - Vinod Kochupillai
- 1 Sri Sri Institute of Advanced Research , Ved Vignan Maha Vidya Peeth, Bengaluru, India
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Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia. Clin Sci (Lond) 2017; 130:1417-34. [PMID: 27389588 DOI: 10.1042/cs20160108] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/13/2016] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE) is a form of gestational hypertension that complicates ∼5% of pregnancies worldwide. Over 70% of the fatal cases of PE are attributed to cerebral oedema, intracranial haemorrhage and eclampsia. The aetiology of PE originates from abnormal remodelling of the maternal spiral arteries, creating an ischaemic placenta that releases factors that drive the pathophysiology. An initial neurological outcome of PE is the absence of the autonomically regulated cardiovascular adaptations to pregnancy. PE patients exhibit sympathetic overactivation, in comparison with both normotensive pregnant and hypertensive non-pregnant females. Moreover, PE diminishes baroreceptor reflex sensitivity (BRS) beyond that observed in healthy pregnancy. The absence of the cardiovascular adaptations to pregnancy, combined with sympathovagal imbalance and a blunted BRS leads to life-threatening neurological outcomes. Behaviourally, the increased incidences of maternal depression, anxiety and post-traumatic stress disorder (PTSD) in PE are correlated to low fetal birth weight, intrauterine growth restriction (IUGR) and premature birth. This review addresses these neurological consequences of PE that present in the gravid female both during and after the index pregnancy.
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Rash JA, Thomas JC, Campbell TS, Letourneau N, Granger DA, Giesbrecht GF. Developmental origins of infant stress reactivity profiles: A multi-system approach. Dev Psychobiol 2016; 58:578-99. [DOI: 10.1002/dev.21403] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Joshua A. Rash
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Jenna C. Thomas
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Tavis S. Campbell
- Department of Psychology; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Nicole Letourneau
- Faculty of Nursing and Cumming School of Medicine (Pediatrics and Psychiatry); University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
| | - Douglas A. Granger
- Institute for Interdisciplinary Saliva Bioscience Research; Arizona State University; Tempe AZ 85287
- Bloomberg School of Public Health and School of Medicine; The John Hopkins University School of Nursing; Baltimore MD 21205
| | - Gerald F. Giesbrecht
- Alberta Children's Hospital Research Institute; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
- Department of Pediatrics, Cumming School of Medicine; University of Calgary; 2500 University Drive N.W. Calgary AB T2N 1N4 Canada
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Reduced Heart Rate Variability and Altered Cardiac Conduction after Pre-Eclampsia. PLoS One 2015; 10:e0138664. [PMID: 26407294 PMCID: PMC4583376 DOI: 10.1371/journal.pone.0138664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/01/2015] [Indexed: 11/19/2022] Open
Abstract
Pre-eclampsia is a hypertensive disorder of pregnancy that is associated with elevated maternal risk for cardiovascular disease. The aims of this study were to determine the effect of normal pregnancy on postpartum parameters of the electrocardiogram, and furthermore to determine how a history of pre-eclampsia may affect these parameters. Ten-minute high-resolution (1000 Hz) orthogonal Holter electrocardiogram (ECG) recordings were used to measure heart rate variability (HRV). Signal-averaged P-wave and QRS complex durations were determined. Participants included non-pregnant controls, normotensive parous controls and women with a recent history of PE. While reductions in HRV induced by uncomplicated pregnancy returned to non-pregnant levels by 6–8 months postpartum HRV remained reduced in women with a history of PE compared to control groups. In addition, P-Wave and QRS complex durations were prolonged in PE subjects at 6–8 months postpartum compared to control groups. Only QRS duration was independent of differences in blood pressure. These results suggest increased sympathetic cardiac activity, and delayed myocardial conduction in women after PE; alterations consistent with cardiac remodeling and increased risk for arrhythmia. In examining the association between PE and cardiovascular disease, identification of ECG abnormalities soon after pregnancy in women with a history of PE highlights a unique opportunity for early identification and screening in this population before other risk factors become apparent.
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Ntusi NBA, Badri M, Gumedze F, Sliwa K, Mayosi BM. Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy. PLoS One 2015; 10:e0133466. [PMID: 26252951 PMCID: PMC4529210 DOI: 10.1371/journal.pone.0133466] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/28/2015] [Indexed: 01/26/2023] Open
Abstract
Aims There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM), as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP) (i.e., peripartum cardiac failure associated with any form of hypertension) and PPCM have similar or different clinical features and outcome. Methods and Results We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features) and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years) and PPCM (n = 30; age 31.5 ± 7.5 years). The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001). PPCM was more significantly associated with the following features than HHFP (p<0.05): twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05) to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05). There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005) during follow-up. Conclusion There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.
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Affiliation(s)
- Ntobeko B. A. Ntusi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Motasim Badri
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Freedom Gumedze
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Bongani M. Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- * E-mail:
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Tomsin K, Mesens T, Molenberghs G, Gyselaers W. Impedance cardiography in uncomplicated pregnancy and pre-eclampsia: A reliability study. J OBSTET GYNAECOL 2012; 32:630-4. [DOI: 10.3109/01443615.2012.673036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pal GK, Shyma P, Habeebullah S, Pal P, Nanda N, Shyjus P. Vagal withdrawal and sympathetic overactivity contribute to the genesis of early-onset pregnancy-induced hypertension. Int J Hypertens 2011; 2011:361417. [PMID: 21629868 PMCID: PMC3095942 DOI: 10.4061/2011/361417] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/31/2010] [Accepted: 02/10/2011] [Indexed: 12/04/2022] Open
Abstract
Objective. In this study, we have assessed sympathovagal imbalance (SVI) by spectral analysis of heart rate variability (HRV) that contributes to the genesis of early-onset PIH.
Methods. Body mass index (BMI), basal heart rate (BHR), blood pressure (BP) and HRV indices such as LFnu, HFnu, LF-HF ratio, mean RR, SDNN and RMSSD were assessed in normal pregnant women (Control group) and pregnant women having risk factors for PIH (Study group) at all the trimesters pregnancy. Retrospectively, those who did not develop PIH (Study group I) were separated from those who developed PIH (Study group II). Study group II was subdivided into early-onset and late-onset PIH. Sympathovagal balance (LF-HF ratio) was correlated with BMI, BHR and BP.
Results. LF-HF ratio was significantly high in study group II compared to study group I and control group, and in early-onset PIH group compared to the late-onset category at all the trimesters of pregnancy, which was significantly correlated with BHR and BP. Alteration in HFnu in early-onset category was more prominent than the alteration in LFnu.
Conclusion. Though the SVI in PIH is contributed by both sympathetic overactivity and vagal withdrawal, especially in early-onset type, SVI is mainly due to vagal inhibition.
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Affiliation(s)
- G K Pal
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605 006, India
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Heiskanen N, Saarelainen H, Kärkkäinen H, Valtonen P, Lyyra-Laitinen T, Laitinen T, Vanninen E, Heinonen S. Cardiovascular autonomic responses to head-up tilt in gestational hypertension and normal pregnancy. Blood Press 2010; 20:84-91. [DOI: 10.3109/08037051.2010.532313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nonna Heiskanen
- Department of Obsteterics and Gynecology, Kuopio University Hospital, University of Kuopio, Kuopio, Finland
| | - Heli Saarelainen
- Department of Obsteterics and Gynecology, Kuopio University Hospital, University of Kuopio, Kuopio, Finland
| | - Henna Kärkkäinen
- Department of Obsteterics and Gynecology, Kuopio University Hospital, University of Kuopio, Kuopio, Finland
| | - Pirjo Valtonen
- Department of Clinical Chemistry, Kuopio University Hospital, University of Kuopio, Finland
| | - Tiina Lyyra-Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Kuopio, Finland
| | - Esko Vanninen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Kuopio, Finland
| | - Seppo Heinonen
- Department of Obsteterics and Gynecology, Kuopio University Hospital, University of Kuopio, Kuopio, Finland
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Pal GK, Shyma P, Habeebullah S, Shyjus P, Pal P. Spectral analysis of heart rate variability for early prediction of pregnancy-induced hypertension. Clin Exp Hypertens 2010; 31:330-41. [PMID: 19811361 DOI: 10.1080/10641960802621333] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The early prediction of pregnancy-induced hypertension (PIH), a common morbid disorder of pregnancy is unsatisfactory. Therefore, in the present study we have investigated the role of spectral analysis of heart rate variability (HRV) in the early prediction of PIH. Spectral analysis of HRV was performed in three groups of subjects (Group I: normal pregnant women; Group II: pregnant women with risk factors, but did not develop PIH; Group III: pregnant women with risk factors and developed PIH). It was observed that the LF-HF ratio, the most sensitive indicator of sympathovagal balance, was significantly high (p < 0.01) since early pregnancy in group III compared to other groups, which was significantly correlated with heart rate and blood pressure. It was suggested that the predictive knowledge of sympathovagal imbalance should be utilized in designing the prevention and management of PIH.
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Affiliation(s)
- G K Pal
- Department of Physiology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry - 605 006, India.
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Metsaars WP, Ganzevoort W, Karemaker JM, Rang S, Wolf H. Increased Sympathetic Activity Present in Early Hypertensive Pregnancy is Not Lowered by Plasma Volume Expansion. Hypertens Pregnancy 2009; 25:143-57. [PMID: 17065036 DOI: 10.1080/10641950600912927] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate whether sympathetic activity is increased in early-onset hypertensive pregnancy and whether this can be influenced by management with plasma volume expansion. METHODS The study group consisted of 74 subjects, of which 37 had early-onset hypertensive disorders of pregnancy (preeclampsia or gestational hypertension with fetal growth restriction), who were included at 24 to 34 weeks in a randomized controlled trial of management with (n = 18) or without (n = 19) plasma volume expansion. Heart rate and blood pressure variabilities, LF/HF ratio for heart rate, baroreflex sensitivity, and phase difference at low frequency (LF approximately 0.1 Hz) were calculated by spectral analysis from continuous heart rate and blood pressure recordings of the finger pulse wave (Portaprestrade mark, TNO). Measurements were performed at inclusion, after 20 to 40 hours and after 65 to 100 hours. The control group consisted of 29 women with a normal pregnancy and 8 women who had late-onset preeclampsia after 34 weeks. Controls were measured at 32 weeks. All controls had a normal blood pressures at that time. RESULTS LF variability of heart rate and blood pressure were significantly higher and baroreflex sensitivity was significantly lower in early-onset patients compared with normal controls. A significant trend towards higher LF variability of blood pressure and lower baroreflex sensitivity was found from normal controls to late-onset controls to early-onset patients. Parameters of sympathetic activity were not influenced by plasma volume expansion. CONCLUSION Sympathetic activity was increased in early-onset hypertensive pregnancy. However, this was not affected by management with plasma volume expansion, suggesting that hypovolaemia in preeclampsia is a secondary phenomenon.
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Affiliation(s)
- Wieneke P Metsaars
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
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Jerath R, Barnes VA, Fadel HE. Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction. Med Hypotheses 2009; 73:163-6. [PMID: 19364630 DOI: 10.1016/j.mehy.2009.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 03/03/2009] [Accepted: 03/07/2009] [Indexed: 10/20/2022]
Abstract
High blood pressure is an important component of pre-eclampsia. The underlying mechanism of development of hypertension in pre-eclampsia is complicated and still remains obscure. Several theories have been advanced including endothelial dysfunction, uteroplacental insufficiency leading to generalized vasoconstriction, increased cardiac output, and sympathetic hyperactivity. Increased blood flow and pressure are thought to lead to capillary dilatation, which damages end-organ sites, leading to hypertension, proteinuria and edema. Additional theories have been put forward based on epidemiological research, implicating immunological and genetic factors. None of these theories have been substantiated. Based on a review of literature this paper postulates that the initiating event for the development of pre-eclampsia is intermittent hypoxia associated with irregular breathing during sleep, hypoapnea, apnea, inadequate respiratory excursions during the waking hours and inadequate cardiopulmonary synchronization (abnormal sympatho-vagal balance).
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Affiliation(s)
- Ravinder Jerath
- Augusta Women's Center, Obstetrics and Gynecology, Suites 6 and 7, 2100 Central Avenue, Augusta, GA 30904, USA.
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15
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Brown CA, Lee CT, Hains SMJ, Kisilevsky BS. Maternal Heart Rate Variability and Fetal Behavior in Hypertensive and Normotensive Pregnancies. Biol Res Nurs 2008; 10:134-44. [DOI: 10.1177/1099800408322942] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relation between maternal heart rate variability (HRV) and fetal behavior was examined in hypertensive and normotensive pregnant women. A total of 40 mother—fetal pairs (n = 20 normotensive mothers; n = 20 hypertensive mothers) at 33—41 weeks' gestation were observed using a standardized procedure lasting approximately 50 min. It included the following measurements: maternal beat-by-beat arterial blood pressure and HRV; spontaneous fetal heart rate (HR), body and breathing movements; and an estimate of amniotic fluid volume. The women in the hypertensive group had higher average body mass index (BMI) (33.7 vs. 28.8 kg/m2) than the normotensive group. In the normotensive group, there was no association between maternal HRV and fetal gestational age, HR, body or breathing movements. In the hypertensive group, maternal HRV measures of low-frequency, high-frequency, and total power were associated with fetal gestational age; also, there was an association between maternal autonomic modulation of HR and fetal spontaneous HR. These findings suggest that the maternal autonomic system influences fetal cardiac function in pregnancies complicated by hypertension.
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Affiliation(s)
- C. Ann Brown
- Queen's University School of Nursing, Kingston, Ontario,
| | - Charlotte T. Lee
- Queen's University School of Nursing, Kingston, Ontario, University of Toronto, Ontario, Canada
| | | | - Barbara S. Kisilevsky
- Queen's University School of Nursing, Kingston, Ontario, Kingston General Hospital, Kingston, Ontario
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16
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Hatch M, Berkowitz G, Janevic T, Sloan R, Lapinski R, James T, Barth WH. Race, cardiovascular reactivity, and preterm delivery among active-duty military women. Epidemiology 2006; 17:178-82. [PMID: 16477258 DOI: 10.1097/01.ede.0000199528.28234.73] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rates of preterm delivery in the United States are higher in black women compared with whites. In this study, we examined cardiovascular reactivity and risk of preterm delivery among black and white military women. METHODS We recruited a total of 500 black and white active-duty military women from the prenatal clinic at a large military installation, interviewing them early in pregnancy and again at 28 weeks of gestation. A subgroup of women underwent a computerized stress test to determine cardiovascular reactivity assessed as increases in heart rate and blood pressure compared with measurements taken before the stress test. RESULTS Despite a relatively low overall risk of preterm delivery (8.2%), we found the same 2-fold racial disparity reported in other populations (hazard ratio for preterm delivery in black women vs whites = 2.30; 95% confidence interval = 1.24-4.27). The disparity is present in all military ranks and is largest for medically indicated preterm deliveries. Among the 313 subjects who participated in the computerized stress testing, blacks exhibited more cardiac reactivity than whites. In black subjects only, a 1-mm increase in diastolic blood pressure reactivity was associated with 1.1 a day earlier delivery (-0.17 weeks). A similar trend was seen with heart rate. CONCLUSIONS Autonomic dysfunction after exposure to stressors may play a role in the timing of delivery among black women.
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Affiliation(s)
- Maureen Hatch
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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17
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Faber R, Baumert M, Stepan H, Wessel N, Voss A, Walther T. Baroreflex sensitivity, heart rate, and blood pressure variability in hypertensive pregnancy disorders. J Hum Hypertens 2005; 18:707-12. [PMID: 15116143 DOI: 10.1038/sj.jhh.1001730] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypertensive pregnancy disorders are a leading cause of perinatal and maternal morbidity and mortality. Heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) are relevant predictors of cardiovascular risk in humans. The aim of the study was to evaluate whether HRV, BPV, and BRS differ between distinct hypertensive pregnancy disorders. Continuous heart rate and blood pressure recordings were performed in 80 healthy pregnant women as controls (CON), 19 with chronic hypertension (CH), 18 with pregnancy-induced hypertension (PIH), and 44 with pre-eclampsia (PE). The data were assessed by time and frequency domain analysis, nonlinear dynamics, and BRS. BPV is markedly altered in all three groups with hypertensive disorders compared to healthy pregnancies, whereby changes were most pronounced in PE patients. Interestingly, this increase in PE patients did not lead to elevated spontaneous baroreflex events, while BPV changes in both the other hypertensive groups were paralleled by alterations in baroreflex parameters. The HRV is unaltered in CH and PE but significantly impaired in PIH. We conclude that parameters of the HRV, BPV, and BRS differ between various hypertensive pregnancy disorders. Thus, distinct clinical manifestations of hypertension in pregnancy have different pathophysiological, regulatory, and compensatory mechanisms.
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Affiliation(s)
- R Faber
- Department of Obstetrics and Gynecology, University of Leipzig, Germany.
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18
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Antonazzo P, Cetin I, Tarricone D, Lombardi F, Pardi G. Cardiac autonomic modulation in normal, high-risk, and in vitro fertilization pregnancies during the first trimester. Am J Obstet Gynecol 2004; 190:199-205. [PMID: 14749660 DOI: 10.1016/s0002-9378(03)00896-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to test the adaptation of autonomic modulation of heart rate in high-risk or in vitro fertilization (IVF) pregnancies during the first trimester. STUDY DESIGN Thirty-three pregnant women were studied between 6.0 and 12.5 weeks of gestation and were divided into three groups: normal (n=17), high-risk (n=7), and IVF pregnancies (n=9), together with 9 nonpregnant women of comparable age. All subjects underwent a short-term continuous electrocardiographic recording to measure short-term heart rate variability (HRV). RESULTS Average values of mean R-R interval, total power, and low-frequency (LF) component were similar in nonpregnant and normally pregnant women. The high-frequency (HF) component was only slightly increased in normal pregnant women but no difference was observed in LF/HF ratio. High-risk and IVF pregnancies were characterized by a significant increase in LF component in comparison to normal pregnancies. In pregnancies that had obstetric complications, signs of abnormal autonomic modulation of the sinus node were particularly evident. CONCLUSION Short-term analysis of HRV in high-risk and IVF pregnancies was significantly different from that observed in normal pregnancies. These differences were more significant in those pregnancies later complicated by an adverse outcome, suggesting an early origin of these pathologic conditions.
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Affiliation(s)
- Patrizio Antonazzo
- Unit of Obstetrics and Gynecology, Department of Medicine, Surgery and Dentistry, San Paolo Hospital, University of Milano, Milan, Italy
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19
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Rang S, Wolf H, Montfrans GA, Karemaker JM. Non-invasive assessment of autonomic cardiovascular control in normal human pregnancy and pregnancy- associated hypertensive disorders: a review. J Hypertens 2002; 20:2111-9. [PMID: 12409941 DOI: 10.1097/00004872-200211000-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pre-eclampsia is a major complication of pregnancy. Although the disorder usually becomes apparent only in the third trimester of pregnancy, evidence is available that underlying pathophysiological abnormalities are already present early in pregnancy. The association between alterations in autonomic cardiovascular control and the development of hypertension in pregnancy has been investigated for some time. Non-invasive methods are especially of interest, since they have the advantage of minimal risk for the mother and the conceptus and enable repeated measurements during pregnancy. If non-invasive tests for autonomic cardiovascular control could demonstrate the increased sympathetic activity, as observed by microneurography than this method is a candidate for early identification of pre-eclampsia. Therefore, the literature on non-invasive testing of autonomic cardiovascular control in normal pregnancies and pre-eclampsia was summarized. DATA IDENTIFICATION AND SELECTION Medline was searched and 36 articles on autonomic cardiovascular control in human pregnancy by non-invasive test methods were reviewed. For each test method, data of different studies were summarized to evaluate if the method could discriminate between healthy pregnancy and pre-eclampsia. CONCLUSION Although small differences have been observed between normal pregnancy and pre-eclampsia in individual studies using non-invasive methods, the consistency in the available data is insufficient to discriminate between normal pregnancy and pre-eclampsia. The failure to demonstrate the increased sympathetic activity, as observed by direct microneurography, might be due to methodological factors of the non-invasive studies. Alternatively, sympathetic activity to resistance vessels in skeletal muscle may not be a proper reflection of autonomic cardiovascular control in pregnancy. Well-designed longitudinal research could be useful to test these suppositions.
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Affiliation(s)
- Saskia Rang
- Department of Obstetrics and Gynecology, Internal Medicine and Physiology, Academic Medical Center, Amsterdam, The Netherlands.
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20
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Abstract
Pre-eclampsia is more than pregnancy induced hypertension. The emerging view described in this presentation is that pre-eclampsia is secondary to the interactions of reduced placental perfusion with diverse maternal factors that alter endothelial function. The maternal contribution is from factors that antedate pregnancy and are influenced by the usual metabolic adaptations of pregnancy. The endothelium and other targets for the effects of these interactions are more sensitive to insults during pregnancy because of activation of the inflammatory cascade as a normal part of pregnancy. At least part of the response to reduced placental perfusion may be a fetal adaptive response to attempt to overcome the reduced delivery of nutrients. A reasonable convergence point for the interaction is at the level of oxidative stress. This hypothesis has both encouraging and discouraging corollaries. The diversity of maternal factors argues that there will be no single gene to explain the disorder and no single 'magic bullet' to treat the disorder. However, it is encouraging that the recognition of maternal predisposition to the disorder directs therapy to prevent pre-eclampsia at a specific target in subsets of women. Finally, the suggestion that some of the maternal alterations are due to fetal adaptive responses encourages careful choices of agents and meticulous infant follow up in well planned clinical trials.
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Affiliation(s)
- J M Roberts
- Magee-Womens Research Institute and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213-3180, USA.
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21
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Greenwood JP, Scott EM, Stoker JB, Walker JJ, Mary DA. Sympathetic neural mechanisms in normal and hypertensive pregnancy in humans. Circulation 2001; 104:2200-4. [PMID: 11684631 DOI: 10.1161/hc4301.098253] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Direct recordings from peripheral sympathetic nerves have shown an increased sympathetic drive in pregnancy-induced hypertension (PIH) and preeclampsia (PE). It is unknown whether sympathetic drive is altered in normal pregnancy, when arterial blood pressure can be normal or relatively low. The aim of this study was to measure and compare peripheral sympathetic discharge, its vasoconstrictor effect and its baroreceptor control, during pregnancy and postpartum in women with normal pregnancy (NP) and PIH and in normotensive nonpregnant (NN) women. METHODS AND RESULTS Twenty-one women with NP, 18 women with PIH, and 21 NN women had muscle sympathetic nerve activity assessed from multiunit discharges (MSNA) and from single units with defined vasoconstrictor properties (s-MSNA). The s-MSNA in NP (38+/-6.6 impulses/100 beats) was greater (P<0.05) than in NN women (19+/-1.8 impulses/100 beats) despite similar age and body weight but less than in PIH women (P<0.001) (146+/-23.5 impulses/100 beats). MSNA followed a similar trend. Cardiac baroreceptor reflex sensitivity (BRS) was impaired in NP and PIH women relative to NN. After delivery, sympathetic activity decreased to values similar to those obtained in NN, and there was an increase in BRS. In women with NP, the decrease in sympathetic output occurred despite an insignificant change in blood pressure. CONCLUSIONS Central sympathetic output was increased in women with normal pregnancy and was even greater in the hypertensive pregnant group. The findings suggest that the moderate sympathetic hyperactivity during the latter months of normal pregnancy may help to return the arterial pressure to nonpregnant levels, although when the increase in activity is excessive, hypertension may ensue.
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Affiliation(s)
- J P Greenwood
- Department of Cardiology, St James's University Hospital, Leeds, UK.
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22
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Voss A, Malberg H, Schumann A, Wessel N, Walther T, Stepan H, Faber R. Baroreflex sensitivity, heart rate, and blood pressure variability in normal pregnancy. Am J Hypertens 2000; 13:1218-25. [PMID: 11078183 DOI: 10.1016/s0895-7061(00)01199-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Heart rate variability is a relevant predictor of cardiovascular risk in humans. However, to use heart and blood pressure (BP) variability or baroreflex sensitivity as markers for hypertensive pregnancy disorders, it is first necessary to describe these parameters in normal pregnancy. To accommodate the complexities of autonomic cardiovascular control we added parameter domains of nonlinear dynamics to conventional linear methods of time and frequency domains. The BP of 27 women with normal pregnancy and 14 nonpregnant women were monitored at a high resolution (200 Hz sampling frequency) using a Portapres for 30 min. The pregnant women were divided into groups of 32 or less or greater than 32 weeks of gestation. Pregnant and nonpregnant women were classified into subclasses of maternal age of less than 28 or 28 or more years. Except for two single parameter domains, we found no significant differences in heart rate and BP variability for pregnant women with different gestational age or different maternal age. Moreover, no significant differences in spontaneous baroreflex sensitivity could be found between pregnant women regardless of either their age or gestational age. In contrast, all measures of nonlinear dynamics of heart rate variability as well as all parameter domains of spontaneous baroreflex sensitivity showed significant changes between pregnant and nonpregnant women, whereas BP variability did not differ between those groups. This complex assessment of autonomic cardiovascular regulation has shown that the parameters tested are stable in the second half of normal pregnancy, and might have the potential to be excellent indicators of pathophysiologic conditions.
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Affiliation(s)
- A Voss
- University of Applied Sciences, Jena, Germany
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