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Lučovnik M, Lackner HK, Žebeljan I, Moertl MG, Dinevski IV, Mahlmann A, Dinevski D. Effect of Prenatal Yoga versus Moderate-Intensity Walking on Cardiorespiratory Adaptation to Acute Psychological Stress: Insights from Non-Invasive Beat-to-Beat Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:1596. [PMID: 38475131 PMCID: PMC10934350 DOI: 10.3390/s24051596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
We recently reported enhanced parasympathetic activation at rest throughout pregnancy associated with regular yoga practice. The present study presents a secondary analysis of data collected within a prospective cohort study of 33 pregnant women practicing yoga once weekly throughout pregnancy and 36 controls not involved in formal pregnancy exercise programs. The objective was to assess the impact of prenatal yoga on the autonomic nervous system stress response. Healthy pregnant women with singleton pregnancies were recruited in the first trimester. There was no significant difference in the maternal body mass index (BMI) between the yoga group and the controls (24.06 ± 3.55 vs. 23.74 ± 3.43 kg/m2, p = 0.693). Women practicing yoga were older (28.6 ± 3.9 vs. 31.3 ± 3.5 years, p = 0.005) and more often nulliparous (26 (79%) vs. 18 (50%), p = 0.001). We studied heart rate variability (HRV) parameters in the time domain (SDNN, standard deviation of regular R-R intervals, and RMSSD, square root of mean squared differences of successive R-R intervals) and frequency domain (ln(LF/HF), natural logarithm of low-frequency to high-frequency power), as well as synchronization indices of heart rate, blood pressure and respiration during and immediately following acute psychological stress of a standardized mental challenge test. Measurements were performed once per trimester before and after yoga or a 30 min moderate-intensity walk. Statistical comparison was performed using three-way analyses of variance (p < 0.05 significant). Time domain HRV parameters during and following mental challenge in the yoga group were significantly higher compared to the controls regardless of the trimester (F = 7.22, p = 0.009 for SDNN and F = 9.57, p = 0.003 for RMSSD, respectively). We observed no significant differences in the yoga group vs. the controls in terms of ln(LF/HF) and synchronization indices. Regular prenatal yoga practice was associated with a significantly reduced sympathetic response to mental challenge and quicker recovery after acute psychological stress. These effects persisted throughout pregnancy with regular practice.
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Affiliation(s)
- Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Helmut K. Lackner
- Otto Loewi Research Center, Division of Physiology and Pathophysiology, Medical University of Graz, 8036 Graz, Austria
| | - Ivan Žebeljan
- Department for Women’s Health, Health Center Lenart, 2230 Lenart v Slovenskih Goricah, Slovenia;
| | - Manfred G. Moertl
- Department of Philosophy, Alpen-Adria University Klagenfurt, 9020 Klagenfurt, Austria;
| | | | - Adrian Mahlmann
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany;
- Centre for Vascular Medicine, Clinic of Angiology, St.-Josefs-Hospital, Katholische Krankenhaus Hagen gem. GmbH, 58097 Hagen, Germany
| | - Dejan Dinevski
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia;
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Brislane Á, Davenport MH, Steinback CD. The sympathetic nervous system in healthy and hypertensive pregnancies: physiology or pathology? Exp Physiol 2023; 108:1238-1244. [PMID: 36459575 PMCID: PMC10988427 DOI: 10.1113/ep089665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/18/2022] [Indexed: 09/30/2023]
Abstract
NEW FINDINGS What is the topic of this review? Sympathoexcitation in both healthy and hypertensive pregnancies, and concurrent adaptations along the neurovascular cascade. What advances does it highlight? Known and plausible adaptations along the neurovascular cascade which may offset elevated MSNA in normotensive pregnancy while also highlighting knowledge gaps regarding understudied pathways. ABSTRACT The progression from conception through to the postpartum period represents an extraordinary period of physiological adaptation in the mother to support the growth and development of the fetus. Healthy, normotensive human pregnancies are associated with striking increases in both plasma volume and sympathetic nerve activity, yet normal or reduced blood pressure; it represents a unique period of apparent healthy sympathetic hyperactivity. However, how this normal blood pressure is achieved in the face of sympathoexcitation, and the mechanisms responsible for this increased activity are unclear. Importantly, sympathetic activation has been implicated in hypertensive pregnancy disorders - the leading causes of maternal-fetal morbidity and mortality in the developed world. An understudied link between pregnancy and the development of maternal hypertension may lie in the sympathetic nervous system regulation of blood pressure. This brief review presents the latest data on sympathoexcitation in both healthy and hypertensive pregnancies, and concurrent adaptations along the neurovascular cascade.
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Affiliation(s)
- Áine Brislane
- Program for Pregnancy & Postpartum HealthNeurovascular Health Lab, Faculty of Kinesiology, Sport, and RecreationWomen and Children's Health Research InstituteAlberta Diabetes InstituteUniversity of AlbertaAlbertaCanada
| | - Margie H. Davenport
- Program for Pregnancy & Postpartum HealthNeurovascular Health Lab, Faculty of Kinesiology, Sport, and RecreationWomen and Children's Health Research InstituteAlberta Diabetes InstituteUniversity of AlbertaAlbertaCanada
| | - Craig D. Steinback
- Program for Pregnancy & Postpartum HealthNeurovascular Health Lab, Faculty of Kinesiology, Sport, and RecreationWomen and Children's Health Research InstituteAlberta Diabetes InstituteUniversity of AlbertaAlbertaCanada
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Greenwall KM, Brislane Á, Matenchuk BA, Sivak A, Davenport MH, Steinback CD. Muscle sympathetic nerve activity during pregnancy: A systematic review and meta-analysis. Physiol Rep 2023; 11:e15626. [PMID: 36905144 PMCID: PMC10006587 DOI: 10.14814/phy2.15626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
We conducted a systematic review and meta-analysis to quantify the impact of healthy and complex pregnancy on muscle sympathetic nerve activity (MSNA) at rest, and in response to stress. Structured searches of electronic databases were performed until February 23, 2022. All study designs (except reviews) were included: population (pregnant individuals); exposures (healthy and complicated pregnancy with direct measures of MSNA); comparator (individuals who were not pregnant, or with uncomplicated pregnancy); and outcomes (MSNA, BP, and heart rate). Twenty-seven studies (N = 807) were included. MSNA burst frequency was higher in pregnancy (n = 201) versus non-pregnant controls (n = 194) (Mean Differences [MD], MD: 10.6 bursts/min; 95% CI: 7.2, 14.0; I2 = 72%). Accounting for the normative increase in heart rate with gestation, burst incidence was also higher during pregnancy (Pregnant N = 189, non-pregnant N = 173; MD: 11 bpm; 95% CI: 8, 13 bpm; I2 = 47%; p < 0.0001). Meta-regression analyses confirmed that although sympathetic burst frequency and incidence are augmented during pregnancy, this was not significantly associated with gestational age. Compared to uncomplicated pregnancy, individuals with obesity, obstructive sleep apnea, and gestational hypertension exhibited sympathetic hyperactivity, while individuals with gestational diabetes mellitus or preeclampsia did not. Uncomplicated pregnancies exhibited a lesser response to head-up tilt, but an exaggerated sympathetic responsiveness to cold pressor stress compared to non-pregnant individuals. MSNA is higher in pregnant individuals and further increased with some, but not all pregnancy complications. PROSPERO registration number: CRD42022311590.
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Affiliation(s)
- Kelly M. Greenwall
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes InstituteUniversity of Alberta, and the University of Alberta LibrariesEdmontonAlbertaCanada
| | - Áine Brislane
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes InstituteUniversity of Alberta, and the University of Alberta LibrariesEdmontonAlbertaCanada
| | - Brittany A. Matenchuk
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes InstituteUniversity of Alberta, and the University of Alberta LibrariesEdmontonAlbertaCanada
| | - Allison Sivak
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes InstituteUniversity of Alberta, and the University of Alberta LibrariesEdmontonAlbertaCanada
| | - Margie H. Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes InstituteUniversity of Alberta, and the University of Alberta LibrariesEdmontonAlbertaCanada
| | - Craig D. Steinback
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes InstituteUniversity of Alberta, and the University of Alberta LibrariesEdmontonAlbertaCanada
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Ford E, Bozin M, Shedda S, McCormick J, Skandarajah A, Cade T. Risk factors for acute colonic pseudo-obstruction after caesarean section: A retrospective case-control study. Aust N Z J Obstet Gynaecol 2023; 63:86-92. [PMID: 35815382 DOI: 10.1111/ajo.13583] [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: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pregnancy and caesarean section are known to predispose to the development of acute colonic pseudo-obstruction (ACPO), a rare form of functional ileus of the distal large bowel. Pathogenesis of ACPO is likely influenced by pregnancy and childbirth and subsequent changes to hormonal, autonomic and metabolic physiology. Identifying pregnancy risk factors will assist with early identification, as the insidious onset postpartum often leads to delayed diagnosis and bowel ischaemia, perforation and sepsis. AIMS To establish pregnancy risk factors associated with the development of ACPO after caesarean section. MATERIALS AND METHODS A retrospective case-control study included 19 121 women undergoing caesarean between 1 January 2008 and 31 December 2016 at a tertiary referral hospital. Twenty-three cases of computerised tomography (CT)-diagnosed ACPO post-caesarean were identified from hospital medical records and imaging databases. Controls were matched for gestational and maternal age within one week of delivery with a ratio of 1:3. RESULTS The incidence of ACPO was one in 800 caesarean sections. ACPO was significantly more likely to occur in women who had been administered opioid analgesia in labour (odds ratio (OR) 4.67, P = 0.04), and a trend for increased estimated blood loss (OR 1.01, P = 0.01). There was no increased risk associated with emergency or elective caesarean classification, previous abdominal surgery, type of anaesthesia, duration of labour, oxytocin augmentation, intrapartum fever, hypertensive disorders, diabetes in pregnancy, antepartum haemorrhage, multiple gestation, fetal presentation or birthweight. CONCLUSIONS Risk factors for developing ACPO post-caesarean include opioid analgesia in labour and a trend for increased blood loss.
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Affiliation(s)
- Elisa Ford
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Michael Bozin
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Susan Shedda
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jacob McCormick
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of Specialist General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Cade
- Department of Maternity Services, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Christifano DN, Chollet-Hinton L, Mathis NB, Gajewski BJ, Carlson SE, Colombo J, Gustafson KM. DHA Supplementation During Pregnancy Enhances Maternal Vagally Mediated Cardiac Autonomic Control in Humans. J Nutr 2023; 152:2708-2715. [PMID: 35953431 PMCID: PMC9839999 DOI: 10.1093/jn/nxac178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND DHA is an essential omega-3 (ω-3; n-3) fatty acid that has well-established benefits for the fetus. DHA also has the potential to influence the health of the mother, but this area is understudied. OBJECTIVES The objective of this secondary analysis was to determine if DHA was related to maternal heart rate (HR) and heart rate variability (HRV) metrics in a large cohort of pregnant women. METHODS In the parent trial (1R01HD086001) eligible participants (≥18 y old, English speaking, carrying a singleton pregnancy, 12-20 wk of gestation) were randomly assigned to consume 200 mg/d or 800 mg/d DHA for the duration of their pregnancy (n = 300). Weight, blood pressure, and magnetocardiograms (MCGs) were collected at 32 wk and 36 wk of gestation (n = 221). Measures of HR and HRV in time-, frequency-, and nonlinear-domains were determined from the isolated maternal MCG. Treatment group and timepoint were examined as predictors in association with HR and HRV metrics using random-intercept mixed-effects ANOVA unadjusted and adjusted models accounting for weight and dietary DHA intake. RESULTS Women receiving the higher dose of DHA (800 mg/d) during pregnancy had lower HR, lower sympathetic index, higher vagally mediated HRV indices, and greater HRV complexity when compared with the women who received the lower dose (200 mg/d; all P < 0.05). All the dose relations remained significant even after controlling for the effect of time, maternal weight, and dietary DHA intake. CONCLUSIONS DHA supplementation increases vagal tone in pregnant women. Longitudinal studies examining the potential link between DHA, enhanced vagal tone, and reported reduction in early preterm birth are warranted.
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Affiliation(s)
- Danielle N Christifano
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lynn Chollet-Hinton
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nicole B Mathis
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Byron J Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - John Colombo
- Department of Psychology, Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
| | - Kathleen M Gustafson
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Issotina Zibrila A, Wang Z, Sangaré-Oumar MM, Zeng M, Liu X, Wang X, Zeng Z, Kang YM, Liu J. Role of blood-borne factors in sympathoexcitation-mediated hypertension: Potential neurally mediated hypertension in preeclampsia. Life Sci 2022; 320:121351. [PMID: 36592790 DOI: 10.1016/j.lfs.2022.121351] [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: 09/29/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
Hypertension remains a threat for society due to its unknown causes, preventing proper management, for the growing number of patients, for its state as a high-risk factor for stroke, cardiac and renal complication and as cause of disability. Data from clinical and animal researches have suggested the important role of many soluble factors in the pathophysiology of hypertension through their neuro-stimulating effects. Central targets of these factors are of molecular, cellular and structural nature. Preeclampsia (PE) is characterized by high level of soluble factors with strong pro-hypertensive activity and includes immune factors such as proinflammatory cytokines (PICs). The potential neural effect of those factors in PE is still poorly understood. Shedding light into the potential central effect of the soluble factors in PE may advance our current comprehension of the pathophysiology of hypertension in PE, which will contribute to better management of the disease. In this paper, we summarized existing data in respect of hypothesis of this review, that is, the existence of the neural component in the pathophysiology of the hypertension in PE. Future studies would address this hypothesis to broaden our understanding of the pathophysiology of hypertension in PE.
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Affiliation(s)
- Abdoulaye Issotina Zibrila
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, Shaanxi, PR China; Department of Animal Physiology, Faculty of science and Technology, University of Abomey-Calavi, 06 BP 2584 Cotonou, Benin
| | - Zheng Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, PR China
| | - Machioud Maxime Sangaré-Oumar
- Department of Animal Physiology, Faculty of science and Technology, University of Abomey-Calavi, 06 BP 2584 Cotonou, Benin
| | - Ming Zeng
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, Shaanxi, PR China
| | - Xiaoxu Liu
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, Shaanxi, PR China
| | - Xiaomin Wang
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, Shaanxi, PR China
| | - Zhaoshu Zeng
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, Shaanxi, PR China
| | - Yu-Ming Kang
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, Shaanxi, PR China.
| | - Jinjun Liu
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, Shaanxi, PR China.
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Sharifiheris Z, Rahmani A, Axelin A, Rasouli M, Bender M. Heart rate variability and pregnancy complications: Systematic Review (Preprint). Interact J Med Res 2022. [DOI: 10.2196/44430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Sharifiheris Z, Rahmani A, Onwuka J, Bender M. The Utilization of Heart Rate Variability for Autonomic Nervous System Assessment in Healthy Pregnant Women: Systematic Review. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e36791. [PMID: 38935943 PMCID: PMC11135217 DOI: 10.2196/36791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/20/2022] [Accepted: 11/03/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND The autonomic nervous system (ANS) plays a central role in pregnancy-induced adaptations, and failure in the required adaptations is associated with adverse neonatal and maternal outcomes. Mapping maternal ANS function in healthy pregnancy may help to understand ANS function. OBJECTIVE This study aimed to systematically review studies on the use of heart rate variability (HRV) monitoring to measure ANS function during pregnancy and determine whether specific HRV patterns representing normal ANS function have been identified during pregnancy. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to guide the systematic review. The CINAHL, PubMed, SCOPUS, and Web of Science databases were searched to comprehensively identify articles without a time span limitation. Studies were included if they assessed HRV in healthy pregnant individuals at least once during pregnancy or labor, with or without a comparison group (eg, complicated pregnancy). Quality assessment of the included literature was performed using the National Heart, Lung, and Blood Institute (NHLBI) tool. A narrative synthesis approach was used for data extraction and analysis, as the articles were heterogenous in scope, approaches, methods, and variables assessed, which precluded traditional meta-analysis approaches being used. RESULTS After full screening, 8 studies met the inclusion criteria. In 88% (7/8) of the studies, HRV was measured using electrocardiogram and operationalized in 3 different ways: linear frequency domain (FD), linear time domain (TD), and nonlinear methods. FD was measured in all (8/8), TD in 75% (6/8), and nonlinear methods in 25% (2/8) of the studies. The assessment duration varied from 5 minutes to 24 hours. TD indexes and most of the FD indexes decreased from the first to the third trimesters in the majority (5/7, 71%) of the studies. Of the FD indexes, low frequency (LF [nu]) and the LF/high frequency (HF) ratio showed an ascending trend from early to late pregnancy, indicating an increase in sympathetic activity toward the end of the pregnancy. CONCLUSIONS We identified 3 HRV operationalization methods along with potentially indicative HRV patterns. However, we found no justification for the selection of measurement tools, measurement time frames, and operationalization methods, which threaten the generalizability and reliability of pattern findings. More research is needed to determine the criteria and methods for determining HRV patterns corresponding to ANS functioning in healthy pregnant persons.
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Affiliation(s)
| | - Amir Rahmani
- University of California, Irvine, Irvine, CA, United States
| | - Joseph Onwuka
- University of California, Irvine, Irvine, CA, United States
| | - Miriam Bender
- University of California, Irvine, Irvine, CA, United States
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Cardiovascular Function in Different Phases of the Menstrual Cycle in Healthy Women of Reproductive Age. J Clin Med 2022; 11:jcm11195861. [PMID: 36233728 PMCID: PMC9572726 DOI: 10.3390/jcm11195861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Sex hormones influence the cardiovascular (CV) function in women. However, it is uncertain whether their physiological variation related to the regular menstrual cycle affects the CV system. We studied changes in the hemodynamic profile and body’s water content and their relation to sex hormone concentration in healthy women during the menstrual cycle. Material and methods: Forty-five adult women were examined during the early follicular, late follicular, and mid-luteal phases of the same menstrual cycle. The hemodynamic profile was estimated non-invasively by cardiac impedance while water content was estimated by total body impedance. Results were compared with repeated measures ANOVA with post-test, if applicable. Results: There were no significant changes in most hemodynamic and water content parameters between the menstrual cycle phases in healthy women. Left ventricular ejection time differed significantly among phases of the menstrual cycle, with shorter values in the mid-luteal phase (308.4 vs. 313.52 ms, p < 0.05) compared to the late follicular phase. However, the clinical relevance of such small differences is negligible. Conclusions: Changes in sex hormones during the physiological menstrual cycle appear to have no considerable effect on healthy women’s hemodynamic function and water accumulation.
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Suzuki Y, Matsubara K, Watanabe K, Tanaka K, Yamamoto T, Nohira T, Mimura K, Suzuki H, Hamada F, Makino S, Koide K, Nishizawa H, Naruse K, Mikami Y, Kawabata I, Yoshimatsu J, Suzuki K, Saito S. A multicenter prospective study of home blood pressure measurement (HBPM) during pregnancy in Japanese women. Hypertens Res 2022; 45:1563-1574. [PMID: 35974173 DOI: 10.1038/s41440-022-00992-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
Abstract
In the near future, hypertensive disorders of pregnancy (HDP) have been diagnosed by home blood pressure monitoring (HBPM) instead of clinic BP monitoring. A multicenter study of HBPM was performed in pregnant Japanese women in the non-high risk group for HDP. Participants were women (n = 218), uncomplicated pregnancy who self-measured and recorded their HBP daily. Twelve women developed HDP. HBP was appropriate (100 mmHg in systole and 63 mmHg in diastole), bottoming out at 17 to 21 weeks of gestation. It increased after 24 weeks of gestation and returned to non-pregnant levels by 4 weeks of postpartum. The upper limit of normal HBP was defined as the mean value +3 SD for systolic and mean +2 SD for diastolic with reference to the criteria for non-pregnant women. Using the polynomial equation, the hypertensive cut-off of systolic HBP was 125 mmHg at 15 weeks and 132 mmHg at 30 weeks of gestation, while it for diastolic HBP was 79 mmHg at 15 weeks and 81 mmHg at 30 weeks of gestation. Systolic HBP in women who developed HDP was higher after 24 weeks of gestation, and diastolic HBP was higher during most of the pregnancy compared to normal pregnancy. When the variability of individual HBP in women developed HDP compared to normal pregnant women was examined using the coefficient of variation (CV), the CV was lower in HDP before the onset of HDP. HBPM can be used not only for HDP determination, but also for early detection of HDP.
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Affiliation(s)
- Yoshikatsu Suzuki
- Department of Obstetrics and Gynecology, Fukiage Maternity Clinic, Nagoya, Japan.
| | - Keiichi Matsubara
- Department of Obstetrics and Gynecology, Ehime University School of Medicine, Toon, Japan
| | - Kazushi Watanabe
- Department of Obstetrics and Gynecology, Perinatal and Neonatal Medical Center, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kanji Tanaka
- Perinatal Medical Center, Hirosaki University Hospital, Hirosaki, Japan
| | - Tamao Yamamoto
- Department of Obstetrics and Gynecology, Fukiage Maternity Clinic, Nagoya, Japan
| | - Tomoyoshi Nohira
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotuke, Japan
| | - Fumiaki Hamada
- Department of Perinatology and Gynecology, Kochi Prefectural Hata Kenmin Hospital, Sukumo, Japan
| | - Shintarou Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Keiko Koide
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Haruki Nishizawa
- Department of Obstetrics and Gynecology, Fujita Health University, Toyoake, Japan
| | - Katsuhiko Naruse
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Yukiko Mikami
- Department of Obstetrics and Gynecology, Saitama Medical University, Kawagoe, Japan
| | - Ikuno Kawabata
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Jun Yoshimatsu
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
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Neethling E, Heggie JE. Considerations in Critical Care and Anesthetic Management of Adult Patients Living with Fontan Circulation. Can J Cardiol 2022; 38:1100-1110. [PMID: 35490923 DOI: 10.1016/j.cjca.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/02/2022] Open
Abstract
The Fontan procedure is a staged palliation for various complex congenital cardiac lesions, including tricuspid atresia (TA), pulmonary atresia (PA), hypoplastic left heart syndrome (HLHS), and double inlet left ventricle (DILV), all of which involve a functional single-ventricle physiology. The complexity of the patients' original anatomy combined with the anatomical and physiological consequences of the Fontan circulation creates challenges. Teens and adults living with Fontan palliation will need perioperative support for non-cardiac surgery, peripartum management for labor and delivery, interventions related to their structural heart disease, electrophysiology procedures, pacemakers, cardioversions, cardiac surgery, transplant, and advanced mechanical support. This review focuses on the anesthetic and ICU management of these patients during their perioperative journey, with an emphasis on the continuity of pre-intervention planning, referral pathways, and post-intervention intensive care unit (ICU) management. Requests for recipes and doses of medications are frequent; however, as in normal anesthesia and ICU practice, the method of anesthesia and dosing are dependent on the presenting medical/surgical conditions and the underlying anatomy and physiological reserve. A patient with Fontan palliation in their early 20s attending school full-time with a cavopulmonary connection is likely to have more reserve than a patient in their late 40s with an atrio- pulmonary (AP) Fontan at home waiting for a heart transplant. Each case will require an anesthetic and critical care plan tailored to their situation. The critical care environment is a natural extension of the anesthetic management of a patient, with complex considerations for a patient with Fontan palliation.
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Affiliation(s)
| | - Jane E Heggie
- Toronto General Hospital, University Health Network, Toronto.
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12
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Grant AD, Erickson EN. Birth, love, and fear: Physiological networks from pregnancy to parenthood. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100138. [PMID: 35757173 PMCID: PMC9227990 DOI: 10.1016/j.cpnec.2022.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
Pregnancy and childbirth are among the most dramatic physiological and emotional transformations of a lifetime. Despite their central importance to human survival, many gaps remain in our understanding of the temporal progression of and mechanisms underlying the transition to new parenthood. The goal of this paper is to outline the physiological and emotional development of the maternal-infant dyad from late pregnancy to the postpartum period, and to provide a framework to investigate this development using non-invasive timeseries. We focus on the interaction among neuroendocrine, emotional, and autonomic outputs in the context of late pregnancy, parturition, and post-partum. We then propose that coupled dynamics in these outputs can be leveraged to map both physiologic and pathologic pregnancy, parturition, and parenthood. This approach could address gaps in our knowledge and enable early detection or prediction of problems, with both personalized depth and broad population scale. Giving birth and caring for offspring are dynamic processes that can instill both love and fear. Maternal physiology continuously integrates fetal, social, and environmental cues. The result is coupled change in hormonal, autonomic nervous, and emotional output. Coupling may allow internal state to be assessed from peripheral autonomic markers. Such markers may identify healthy or pathologic pregnancy, parturition, and parenting, and enable creation of real-world tools.
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13
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The venous system during pregnancy. Part 1: physiologic considerations on the venous system. Int J Obstet Anesth 2022; 50:103273. [DOI: 10.1016/j.ijoa.2022.103273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
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Lorigo M, Cairrao E. Fetoplacental vasculature as a model to study human cardiovascular endocrine disruption. Mol Aspects Med 2021; 87:101054. [PMID: 34839931 DOI: 10.1016/j.mam.2021.101054] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/15/2021] [Accepted: 11/18/2021] [Indexed: 12/11/2022]
Abstract
Increasing evidence has associated the exposure of endocrine-disrupting chemicals (EDCs) with the cardiovascular (CV) system. This exposure is particularly problematic in a sensitive window of development, pregnancy. Pregnancy exposome can affect the overall health of the pregnancy by dramatic changes in vascular physiology and endocrine activity, increasing maternal susceptibility. Moreover, fetoplacental vascular function is generally altered, increasing the risk of developing pregnancy complications (including cardiovascular diseases, CVD) and predisposing the foetus to adverse health risks later in life. Thus, our review summarizes the existing literature on exposures to EDCs during pregnancy and adverse maternal health outcomes, focusing on the human placenta, vein, and umbilical artery associated with pregnancy complications. The purpose of this review is to highlight the role of fetoplacental vasculature as a model for the study of human cardiovascular endocrine disruption. Therefore, we emphasize that the placenta, together with the umbilical arteries and veins, allows a better characterization of the pregnant woman's exposome. Consequently, it contributes to the protection of the mother and foetus against CV disorders in life.
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Affiliation(s)
- Margarida Lorigo
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilhã, Portugal; FCS - UBI, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Elisa Cairrao
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilhã, Portugal; FCS - UBI, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
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15
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Skow RJ, Fraser GM, Steinback CD, Davenport MH. Prenatal Exercise and Cardiovascular Health (PEACH) Study: Impact on Muscle Sympathetic Nerve (Re)Activity. Med Sci Sports Exerc 2021; 53:1101-1113. [PMID: 33315812 DOI: 10.1249/mss.0000000000002583] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Women who develop gestational hypertension have evidence of elevated muscle sympathetic nerve activity (MSNA) in early pregnancy, which continues to rise after diagnosis. Exercise has been shown to play a preventative role in the development of gestational hypertension and has been shown to reduce resting and reflex MSNA in nonpregnant populations. We sought to investigate whether aerobic exercise affected the sympathetic regulation of blood pressure between the second and third trimesters of pregnancy. METHODS We conducted a randomized controlled trial of structured aerobic exercise (n = 31) compared with no intervention (control, n = 28) beginning at 16-20 wk and continuing until 34-36 wk of gestation (NCT02948439). Women in the exercise group were prescribed aerobic activity at 50%-70% of their heart rate reserve, on 3-4 d·wk-1 for 25-40 min with a 5-min warm-up and 5-min cool-down (i.e., up to 160 min total activity per week). At preintervention and postintervention assessments, data from ~10 min of quiet rest and a 3-min cold pressor test were analyzed to determine sympathetic nervous system activity and reactivity. RESULTS MSNA was obtained in 51% of assessments. Resting MSNA burst frequency and burst incidence increased across gestation (main effect of gestational age, P = 0.002). Neurovascular transduction was blunted in the control group (P = 0.024) but not in exercisers (P = 0.873) at the postintervention time point. Lastly, MSNA reactivity during the cold pressor test was not affected by gestational age or exercise (P = 0.790, interaction). CONCLUSIONS These data show that exercise attenuates both the rise in MSNA and the blunting of neurovascular transduction. This may partially explain the lower risk of developing gestational hypertension in women who are active during their pregnancies.
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Affiliation(s)
- Rachel J Skow
- Program for Pregnancy and Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, CANADA
| | - Graham M Fraser
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, CANADA
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, CANADA
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, CANADA
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Bresadola V, Brollo PP, Graziano M, Biddau C, Occhiali T, Driul L. The rare Ogilvie's Syndrome in pregnancy. How to manage? A case report and literature review. J OBSTET GYNAECOL 2021; 42:1-9. [PMID: 33938346 DOI: 10.1080/01443615.2021.1887113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute colonic pseudo-obstruction, or Ogilvie's syndrome (OS), is a complication in gynaecology and obstetrics. Its occurrence during pregnancy is rare, redefining the therapeutic decision-making and treatment options. In this review we describe the case of a 37-year-old pregnant patient who developed OS at the 30th week of gestation. A laparotomy with colonic decompression was performed. Foetal condition, regularly monitored throughout the hospital stay, remained normal. The patient experienced an uncomplicated, natural delivery at 40 weeks. A comprehensive literature search, describing the occurrence of OS during pregnancy, was conducted. We identified six cases of OS arising during pregnancy. Demographic, clinical, diagnostic and therapeutic features were analysed. Non-surgical management is generally the first-line option, with intravenous drug administration, rectal and nasogastric tube positioning and colonoscopic decompression the treatments of choice. Surgical decompression in usually performed in cases of failure of the first-line treatments. Including our own experience, in all cases, neither maternal nor foetal mortality was reported. A conservative approach is mandatory as first-line treatment, but when prompt resolution is not achieved, a multidisciplinary team, involving the gynaecologist/obstetrician, the surgeon, the radiologist and the intensivist is mandatory to avoid diagnostic delays, thereby reducing morbidity and mortality rates.
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Affiliation(s)
- Vittorio Bresadola
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Pier Paolo Brollo
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Michele Graziano
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Carlo Biddau
- General Surgery Department and Simulation Center, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Tommaso Occhiali
- Obstetrics and Gynecology Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Lorenza Driul
- Obstetrics and Gynecology Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
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Yu C, Gu J, Liao Z, Feng S. Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies. Int J Obstet Anesth 2021; 47:103175. [PMID: 34034957 DOI: 10.1016/j.ijoa.2021.103175] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal anesthesia is the standard for elective cesarean section but spinal anesthesia-induced hypotension remains an important problem. Accurate prediction of hypotension could enhance clinical decision-making, alter management, and facilitate early intervention. We performed a systematic review of predictors of spinal anesthesia-induced hypotension and their predictive value during cesarean section. METHODS PubMed, Embase, Cochrane Library, Google Scholar and Web of Science databases were searched for prospective observational studies assessing the diagnostic accuracy of predictors of spinal anesthesia-induced hypotension in elective cesarean section. The quality of studies was assessed and predictors were grouped in domains based on the type of predictor. RESULTS Thirty-eight studies (n=3086 patients) were included. In most studies, patients received 500-1000 mL crystalloid preload or 500-2000 mL crystalloid coload. Vasopressors for post-spinal hypotension were boluses of ephedrine 5-15 mg and/or phenylephrine 25-100 µg in most studies. The hypotension rate varied from 29% to 80% based on the definition. For analysis, >30 predictors were classified into seven domains: demographic characteristics, baseline hemodynamic variables, baseline sympathovagal balance, postural stress testing, peripheral perfusion indices, blood volume and fluid responsiveness indices, and genetic polymorphism. CONCLUSIONS Environmental and individual factors increased outcome variability, which restricted the value of the autonomic nervous system and peripheral perfusion indices for prediction of spinal anesthesia-induced hypotension. Supine stress tests may reflect parturients' cardiovascular tolerance during hemodynamic fluctuations and may optimize the predictive value of static state predictors. Future research for predicting spinal anesthesia-induced hypotension should focus on composite and dynamic parameters during the supine stress tests.
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Affiliation(s)
- C Yu
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - J Gu
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Z Liao
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - S Feng
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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18
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Koutras A, Fasoulakis Z, Syllaios A, Garmpis N, Diakosavvas M, Pagkalos A, Ntounis T, Kontomanolis EN. Physiology and Pathology of Contractility of the Myometrium. In Vivo 2021; 35:1401-1408. [PMID: 33910817 DOI: 10.21873/invivo.12392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/10/2022]
Abstract
Uterine atony is a serious obstetrical complication since it is the leading cause of postpartum hemorrhage. Postpartum hemorrhage (PPH) is one of the 5 major causes of postpartum mortality; therefore, it requires immediate medical intervention, independent of whether delivery occurs normally or with a cesarean section. While in the past years most cases of postpartum hemorrhage were caused due to uterine atony following vaginal delivery, in recent years most PPH cases indicate a significant association with cesarean delivery. There are several methods used in order to avoid such a life-threatening complication, ranging from risk assessment to prevention, and finally medical intervention and management, if such an event occurs. In this scientific paper emphasis is given on the so-called "uterotonic" agents that are currently used, including oxytocin among others. It is, therefore, important to be familiar with these agents as well as understand the physiological mechanism by which they work, since they are used in everyday practice, not only for managing but also for preventing PPH. There are several potential questions that arise from the use of such "uterotonic" agents, and most specifically of oxytocin. Maybe one of the most important issues is the determination of optimal dosing of oxytocin in order to avoid PPH after a cesarean section.
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Affiliation(s)
- Antonios Koutras
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Zacharias Fasoulakis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Athanasios Syllaios
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece;
| | - Nikolaos Garmpis
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Diakosavvas
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Athanasios Pagkalos
- Consultant on Department of Obstetrics and Gynecology, General Hospital of Xanthi, Xanthi, Greece
| | - Thomas Ntounis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Emmanuel N Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
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19
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Shah Z, Pal P, Pal GK, Papa D, Bharadwaj B. Assessment of the association of heart rate variability and baroreflex sensitivity with depressive symptoms and stress experienced by women in pregnancy. J Affect Disord 2020; 277:503-509. [PMID: 32882507 DOI: 10.1016/j.jad.2020.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnancy is a unique physiological state with systemic changes including cardiovascular, autonomic, hemodynamic and psychological. Increase in incidence of stress and depression in antenatal period has been reported. Autonomic changes in pregnancy and its dysfunction in depression are well documented. However, there is lack of evidence associating cardiovascular autonomic dysfunction to stress and depressed mood in pregnant women. METHODS In this correlation study, we assessed cardiovascular autonomic functions of 172 pregnant women using heart rate variability (HRV) and baroreflex sensitivity (BRS). The Edinburg postnatal depression scale (EPDS) was used to evaluate depressive symptoms and perceived stress scale (PSS) was used to assess stress. The HRV and BRS parameters were correlated with EPDS and PSS. Multiple regression analysis was performed for EPDS and PSS individually to study their association with cardiac autonomic functions(CAF). RESULTS HRV and BRS were well correlated to EPDS and PSS scores. The depression and stress were found to be significantly associated to autonomic dysfunctions as increased sympathetic and decreased parasympathetic activity. Among various CAF parameters, LF:HF ratio and BRS were found to be significantly associated with depression and stress among these women. CONCLUSION LF:HF ratio and BRS may be associated with depression during antenatal period. The depression in antenatal period may add on to cardiovascular risk in expecting mothers.
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Affiliation(s)
- Zinkal Shah
- Department of Physiology, JIPMER, Puducherry 605006, India
| | - Pravati Pal
- Department of Physiology, JIPMER, Puducherry 605006, India.
| | | | - Dasari Papa
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
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20
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Hissen SL, Fu Q. Neural control of blood pressure during pregnancy in humans. Clin Auton Res 2020; 30:423-431. [PMID: 32564162 DOI: 10.1007/s10286-020-00703-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/10/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Previous microneurographic studies found that muscle sympathetic nerve activity (MSNA) increased in normotensive pregnant women and was even greater in women with gestational hypertension and preeclampsia during the third trimester. It is possible that sympathetic activation during the latter months of normal pregnancy helps return arterial pressure to non-pregnant levels. However, when the increase in sympathetic activity is excessive, hypertension ensues. The key question that must be addressed is whether sympathetic activation develops early during pregnancy and remains high throughout gestation, or whether this sympathetic overactivity only occurs at term, providing the substrate for preeclampsia and other pregnancy-associated cardiovascular complications. METHODS This was a literature review of autonomic neural control during pregnancy. RESULTS Recent work from our laboratory and other laboratories showed that in healthy women resting MSNA increased in early pregnancy, increased further in late pregnancy, and returned to the pre-pregnancy levels shortly after delivery. We found that women who exhibited excessive sympathetic activation during the first trimester, before any clinical signs and symptoms appeared, developed gestational hypertension at term. We also found that the level of corin, an atrial natriuretic peptide-converting enzyme, was increased in the maternal circulation, especially during late pregnancy, as a homeostatic response to elevated sympathetic activity. CONCLUSION These findings provide important insight into the neural mechanisms underlying hypertensive disorders during pregnancy. With this knowledge, early prevention or treatment targeted to the appropriate pathophysiology may be initiated, which may reduce maternal and fetal death or morbidity, as well as cardiovascular risks in women later in life.
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Affiliation(s)
- Sarah L Hissen
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX, 75231, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Qi Fu
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX, 75231, USA. .,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
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21
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Abstract
Maternal cardiovascular changes during pregnancy include an expansion of plasma volume, increased cardiac output, decreased peripheral resistance, and increased uteroplacental blood flow. These adaptations facilitate the progressive increase in uteroplacental perfusion that is required for normal fetal growth and development, prevent the development of hypertension, and provide a reserve of blood in anticipation of the significant blood loss associated with parturition. Each woman's genotype and phenotype determine her ability to adapt in response to molecular signals that emanate from the fetoplacental unit. Here, we provide an overview of the major hemodynamic and cardiac changes and then consider regional changes in the splanchnic, renal, cerebral, and uterine circulations in terms of endothelial and vascular smooth muscle cell plasticity. Although consideration of gestational disease is beyond the scope of this review, aberrant signaling and/or maternal responsiveness contribute to the etiology of several common gestational diseases such as preeclampsia, intrauterine growth restriction, and gestational diabetes.
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Affiliation(s)
- George Osol
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont 05405, USA;
| | - Nga Ling Ko
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont 05405, USA;
| | - Maurizio Mandalà
- Department of Biology, Ecology and Earth Science, University of Calabria, 87036 Arcavacata di Rende (CS), Italy
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Garg P, Yadav K, Jaryal AK, Kachhawa G, Kriplani A, Deepak KK. Sequential analysis of heart rate variability, blood pressure variability and baroreflex sensitivity in healthy pregnancy. Clin Auton Res 2020; 30:433-439. [PMID: 31981003 DOI: 10.1007/s10286-020-00667-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/14/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to demonstrate the temporal profile of changes in heart rate variability (HRV), blood pressure variability (BPV), and cardiac baroreflex sensitivity (BRS) during the course of a healthy pregnancy. MATERIALS AND METHODS This was a longitudinal study during which autonomic variability parameters (HRV, BPV, BRS) were assessed in 66 pregnant women at 11-13, 20-22 and 30-32 weeks of gestation. A lead II electrocardiogram tracing and beat-to-beat blood pressure were recorded with the subject breathing spontaneously in the supine position. Changes in the parameters were analyzed using repeated measures analysis of variance. RESULTS Overall HRV (SDNN; standard deviation of all NN intervals) was found to decrease significantly over the course of pregnancy (p < 0.05). Similarly, indices which represent the parasympathetic component of these variables (SDSD [standard deviation of differences between adjacent NN intervals]; pNN50 [NN50 count {number of pairs of adjacent NN intervals differing by more than 50 ms} divided by the total number of all NN intervals]; high-frequency [HF] power) were also found to decrease significantly from the first to third trimester of pregnancy (p < 0.05). Low-frequency (LF) power increased over the course of pregnancy (p < 0.05). The LF/HF ratio increased significantly from first to third trimester of pregnancy (median: 0.66 [first trimester] vs.1.02 [second] vs. 0.91 [third]; p < 0.05) Overall BPV increased during the course of pregnancy, with a significant rise in the HF component of BPV and a significant fall in the LF component of BPV with advancing gestation (p < 0.05). BRS decreased over the course of pregnancy (median: 16.31, interquartile range [IQR] 11.04-23.13 [first trimester] vs. 11.42, IQR 8.54-19.52 [second] vs. 8.84, IQR 7.15-12.45 [third] ms/mmHg; p < 0.05). CONCLUSION Pregnancy is associated with decreased vagal and increased sympathetic modulation of cardiac autonomic tone with advancing gestation, together with increased BPV. The reduction in cardiac BRS may play a role in increasing BPV and decreasing HRV over the course of pregnancy.
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Affiliation(s)
- Priyanka Garg
- Department of Physiology, Government Allopathic Medical College, Banda, UP, India
| | - Kavita Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Kishore Kumar Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Brooks VL, Fu Q, Shi Z, Heesch CM. Adaptations in autonomic nervous system regulation in normal and hypertensive pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:57-84. [PMID: 32736759 DOI: 10.1016/b978-0-444-64239-4.00003-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is an increase in basal sympathetic nerve activity (SNA) during normal pregnancy; this counteracts profound primary vasodilation. However, pregnancy also impairs baroreflex control of heart rate and SNA, contributing to increased mortality secondary to peripartum hemorrhage. Pregnancy-induced hypertensive disorders evoke even greater elevations in SNA, which likely contribute to the hypertension. Information concerning mechanisms is limited. In normal pregnancy, increased angiotensin II acts centrally to support elevated SNA. Hypothalamic sites, including the subfornical organ, paraventricular nucleus, and arcuate nucleus, are likely (but unproven) targets. Moreover, no definitive mechanisms for exaggerated sympathoexcitation in hypertensive pregnancy have been identified. In addition, normal pregnancy increases gamma aminobutyric acid inhibition of the rostral ventrolateral medulla (RVLM), a key brainstem site that transmits excitatory inputs to spinal sympathetic preganglionic neurons. Accumulated evidence supports a major role for locally increased production and actions of the neurosteroid allopregnanolone as one mechanism. A consequence is suppression of baroreflex function, but increased basal SNA indicates that excitatory influences predominate in the RVLM. However, many questions remain regarding other sites and factors that support increased SNA during normal pregnancy and, more importantly, the mechanisms underlying excessive sympathoexcitation in life-threatening hypertensive pregnancy disorders such as preeclampsia.
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Affiliation(s)
- Virginia L Brooks
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, United States.
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, United States; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Zhigang Shi
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, United States
| | - Cheryl M Heesch
- Department of Biomedical Sciences and Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, United States
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Badrov MB, Park SY, Yoo JK, Hieda M, Okada Y, Jarvis SS, Stickford AS, Best SA, Nelson DB, Fu Q. Role of Corin in Blood Pressure Regulation in Normotensive and Hypertensive Pregnancy. Hypertension 2019; 73:432-439. [PMID: 30580684 DOI: 10.1161/hypertensionaha.118.12137] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Corin (an atrial natriuretic peptide-converting enzyme) represents a potential biomarker for gestational hypertensive disorders; yet, its role in blood pressure (BP) regulation throughout pregnancy remains unclear. We investigated the time course of change in blood corin content in relation to BP and sympathetic nerve activity throughout pregnancy. Forty-four women (29±0.9 years) participated. Following-term, 23 had low-risk (no personal history of gestational hypertensive disorders) normal pregnancies, 13 had high-risk (personal history of gestational hypertensive disorders) normal pregnancies, and 8 developed gestational hypertension. BP, heart rate, muscle sympathetic nerve activity, and serum corin were measured before pregnancy, during early (4-8 weeks) and late pregnancy (32-36 weeks), and postpartum (6-10 weeks). Overall, compared with prepregnancy, corin remained unchanged during early pregnancy, increased markedly during late pregnancy ( P<0.001), and returned to prepregnancy levels postpartum. In women who developed gestational hypertension, the change in corin from early to late pregnancy was greater than those with low-risk normal pregnancies (Δ971±134 versus Δ486±79 pg/mL; P<0.05). Throughout pregnancy, BP and muscle sympathetic nerve activity were augmented in women with gestational hypertension (all P<0.05). Finally, changes in corin from early to late pregnancy were related to all indices of BP ( R=0.454-0.551; all P<0.01) in late pregnancy, whereas burst frequency, burst incidence, and total muscle sympathetic nerve activity ( R=0.576-0.614; all P<0.001) in early pregnancy were related to changes in corin from early to late pregnancy. Corin plays a unique role in BP regulation throughout normotensive and, especially, hypertensive pregnancy and may represent a promising biomarker for determining women at high risk of adverse pregnancy outcome.
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Affiliation(s)
- Mark B Badrov
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Sun Young Park
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Jeung-Ki Yoo
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Michinari Hieda
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Yoshiyuki Okada
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.).,Department of Dentistry, Hiroshima University, Japan (Y.O.)
| | - Sara S Jarvis
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.).,Department of Biological Sciences, Northern Arizona University, Flagstaff (S.S.J.)
| | - Abigail S Stickford
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.).,Department of Health and Exercise Science, Appalachian State University, Boone, NC (A.S.S.)
| | - Stuart A Best
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - David B Nelson
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
| | - Qi Fu
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., Q.F.).,Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.B.B., S.Y.P., J.-K.Y., M.H., Y.O., S.S.J., A.S.S., S.A.B., D.B.N., Q.F.)
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25
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Hughes AE, Smart NJ, Daniels IR. Acute colonic pseudo‐obstruction after caesarean section: a review and recommended management algorithm. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/tog.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alice E Hughes
- Academic Clinical Fellow and ST2 trainee in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology Rosie Hospital Cambridge CB2 0QQ UK
| | - Neil J Smart
- Consultant Colorectal Surgeon, Royal Devon and Exeter NHS Foundation Trust and Honorary Associate Professor, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
| | - Ian R Daniels
- Consultant Colorectal Surgeon, Royal Devon and Exeter Hospital NHS Foundation Trust and Honorary Clinical Senior Lecturer, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
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Yousif D, Bellos I, Penzlin AI, Hijazi MM, Illigens BMW, Pinter A, Siepmann T. Autonomic Dysfunction in Preeclampsia: A Systematic Review. Front Neurol 2019; 10:816. [PMID: 31447757 PMCID: PMC6691156 DOI: 10.3389/fneur.2019.00816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Preeclampsia (PE) is a major obstetric complication that leads to severe maternal and fetal morbidity. Early detection of preeclampsia can reduce the severity of complications and improve clinical outcomes. It is believed that the autonomic nervous system (ANS) is involved in the pathogenesis of PE. We aimed to review the current literature on the prevalence and nature of ANS dysfunction in women with PE and the possible prognostic value of ANS testing in the early detection of PE. Methods: Literature search was performed using Medline (1966–2018), EMBase (1947–2018), Google Scholar (1970–2018), BIOSIS (1926–2018), Web of science (1900–2018); CINAHL (1937–2018); Cochrane Library, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Methodology Register (1999–2018). Additionally, the reference lists of articles included were screened. Results: A total of 26 studies were included in the present review presenting data of 1,854 pregnant women. Among these women, 453 were diagnosed with PE, 93.6% (424/453) of which displayed autonomic dysfunction. ANS function was assessed by cardiovascular reflex tests (n = 9), heart rate variability (n = 11), cardiac baroreflex gain (n = 5), muscle sympathetic nerve activity (MSNA) (n = 3), and biomarkers of sympathetic activity (n = 4). Overall, 21 studies (80.8%) reported at least one of the following abnormalities in ANS function in women diagnosed with PE compared to healthy pregnant control women: reduced parasympathetic activity (n = 16/21, 76%), increased sympathetic activity (n = 12/20, 60%), or reduced baroreflex gain (n = 4/5, 80%). Some of these studies indicated that pressor and orthostatic stress test may be useful in early pregnancy to help estimate the risk of developing PE. However, autonomic function tests seem not to be able to differentiate between mild and severe PE. Conclusions: Current evidence suggests that autonomic dysfunction is highly prevalent in pre-eclamptic women. Among autonomic functions, cardiovascular reflexes appear to be predominantly affected, seen as reduced cardiac parasympathetic activity and elevated cardiac sympathetic activity. The diagnostic value of autonomic testing in the prediction and monitoring of autonomic failure in pre-eclamptic women remains to be determined.
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Affiliation(s)
- Dalia Yousif
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ana Isabel Penzlin
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Mido Max Hijazi
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alexandra Pinter
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Timo Siepmann
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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27
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Kim H, An J, Kim E, Lee J, Son J, Woo K, Noh H. A pilot study on the role of autonomic function testing in predicting hypotension in patients undergoing cesarean section under spinal anesthesia. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.3.259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hyun Kim
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jihyun An
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Eunju Kim
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jihyang Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jongcheol Son
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Kyeongyoon Woo
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Heeyun Noh
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
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Shi Z, Hansen KM, Bullock KM, Morofuji Y, Banks WA, Brooks VL. Resistance to the sympathoexcitatory effects of insulin and leptin in late pregnant rats. J Physiol 2019; 597:4087-4100. [PMID: 31209877 DOI: 10.1113/jp278282] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/10/2019] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS Pregnancy increases sympathetic nerve activity (SNA), although the mechanisms responsible for this remain unknown. We tested whether insulin or leptin, two sympathoexcitatory hormones increased during pregnancy, contribute to this. Transport of insulin across the blood-brain barrier in some brain regions, and into the cerebrospinal fluid (CSF), was increased, although brain insulin degradation was also increased. As a result, brain and CSF insulin levels were not different between pregnant and non-pregnant rats. The sympathoexcitatory responses to insulin and leptin were abolished in pregnant rats. Blockade of arcuate nucleus insulin receptors did not lower SNA in pregnant or non-pregnant rats. Collectively, these data suggest that pregnancy renders the brain resistant to the sympathoexcitatory effects of insulin and leptin, and that these hormones do not mediate pregnancy-induced sympathoexcitation. Increased muscle SNA stimulates glucose uptake. Therefore, during pregnancy, peripheral insulin resistance coupled with blunted insulin- and leptin-induced sympathoexcitation ensures adequate delivery of glucose to the fetus. ABSTRACT Pregnancy increases basal sympathetic nerve activity (SNA), although the mechanism responsible for this remains unknown. Insulin and leptin are two sympathoexcitatory hormones that increase during pregnancy, yet, pregnancy impairs central insulin- and leptin-induced signalling. Therefore, to test whether insulin or leptin contribute to basal sympathoexcitation or, instead, whether pregnancy induces resistance to the sympathoexcitatory effects of insulin and leptin, we investigated α-chloralose anaesthetized late pregnant rats, which exhibited increases in lumbar SNA (LSNA), splanchnic SNA and heart rate (HR) compared to non-pregnant animals. In pregnant rats, transport of insulin into cerebrospinal fluid and across the blood-brain barrier in some brain regions increased, although brain insulin degradation was also increased; brain and cerebrospinal fluid insulin levels were not different between pregnant and non-pregnant rats. Although i.c.v. insulin increased LSNA and HR and baroreflex control of LSNA and HR in non-pregnant rats, these effects were abolished in pregnant rats. In parallel, pregnancy completely prevented the actions of leptin with respect to increasing lumbar, splanchnic and renal SNA, as well as baroreflex control of SNA. Blockade of insulin receptors (with S961) in the arcuate nucleus, the site of action of insulin, did not decrease LSNA in pregnant rats, despite blocking the effects of exogenous insulin. Thus, pregnancy is associated with central resistance to insulin and leptin, and these hormones are not responsible for the increased basal SNA of pregnancy. Because increases in LSNA to skeletal muscle stimulates glucose uptake, blunted insulin- and leptin-induced sympathoexcitation reinforces systemic insulin resistance, thereby increasing the delivery of glucose to the fetus.
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Affiliation(s)
- Zhigang Shi
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, USA
| | - Kim M Hansen
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Kristin M Bullock
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Yoichi Morofuji
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - William A Banks
- Geriatrics Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Virginia L Brooks
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, USA
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29
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Lackner HK, Papousek I, Schmid-Zalaudek K, Cervar-Zivkovic M, Kolovetsiou-Kreiner V, Nonn O, Lucovnik M, Pfniß I, Moertl MG. Disturbed Cardiorespiratory Adaptation in Preeclampsia: Return to Normal Stress Regulation Shortly after Delivery? Int J Mol Sci 2019; 20:ijms20133149. [PMID: 31252672 PMCID: PMC6651868 DOI: 10.3390/ijms20133149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/30/2022] Open
Abstract
Women with pregnancies complicated by preeclampsia appear to be at increased risk of metabolic and vascular diseases in later life. Previous research has also indicated disturbed cardiorespiratory adaptation during pregnancy. The aim of this study was to follow up on the physiological stress response in preeclampsia several weeks postpartum. A standardized laboratory test was used to illustrate potential deviations in the physiological stress responding to mildly stressful events of the kind and intensity in which they regularly occur in further everyday life after pregnancy. Fifteen to seventeen weeks postpartum, 35 women previously affected by preeclampsia (19 mild, 16 severe preeclampsia), 38 women after uncomplicated pregnancies, and 51 age-matched healthy controls were exposed to a self-relevant stressor in a standardized stress-reactivity protocol. Reactivity of blood pressure, heart rate, stroke index, and systemic vascular resistance index as well as baroreceptor sensitivity were analyzed. In addition, the mutual adjustment of blood pressure, heart rate, and respiration, partitioned for influences of the sympathetic and the parasympathetic branches of the autonomic nervous system, were quantified by determining their phase synchronization. Findings indicated moderately elevated blood pressure levels in the nonpathological range, reduced stroke volume, and elevated systemic vascular resistance in women previously affected by preeclampsia. Despite these moderate abnormalities, at the time of testing, women with previous preeclampsia did not differ from the other groups in their physiological response patterns to acute stress. Furthermore, no differences between early, preterm, and term preeclampsia or mild and severe preeclampsia were observed at the time of testing. The findings suggest that the overall cardiovascular responses to moderate stressors return to normal in women who experience a pregnancy with preeclampsia a few weeks after delivery, while the operating point of the arterial baroreflex is readjusted to a higher pressure. Yet, their regulation mechanisms may remain different.
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Affiliation(s)
- Helmut K Lackner
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria.
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, 8010 Graz, Austria.
| | - Karin Schmid-Zalaudek
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria.
| | - Mila Cervar-Zivkovic
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria.
| | | | - Olivia Nonn
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8010 Graz, Austria.
| | - Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
| | - Isabella Pfniß
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria.
| | - Manfred G Moertl
- Department of Obstetrics and Gynecology, Clinical Center, 9020 Klagenfurt, Austria.
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Georgiopoulos G, Tsiachris D, Kordalis A, Kontogiannis C, Spartalis M, Pietri P, Magkas N, Stefanadis C. Pharmacotherapeutic strategies for atrial fibrillation in pregnancy. Expert Opin Pharmacother 2019; 20:1625-1636. [PMID: 31136204 DOI: 10.1080/14656566.2019.1621290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Georgios Georgiopoulos
- Department of Cardiology, Athens Medical Center, Athens, Greece
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Christos Kontogiannis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Nikolaos Magkas
- 1stDepartment of Cardiology, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Haruna M, Matsuzaki M, Ota E, Shiraishi M, Hanada N, Mori R. Guided imagery for treating hypertension in pregnancy. Cochrane Database Syst Rev 2019; 4:CD011337. [PMID: 31032884 PMCID: PMC6487386 DOI: 10.1002/14651858.cd011337.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertension (high blood pressure) in pregnancy carries a high risk of maternal morbidity and mortality. Although antihypertensive drugs are commonly used, they have adverse effects on mothers and fetuses. Guided imagery is a non-pharmacological technique that has the potential to lower blood pressure among pregnant women with hypertension. Guided imagery is a mind-body therapy that involves the visualisation of various mental images to facilitate relaxation and reduction in blood pressure. OBJECTIVES To determine the effect of guided imagery as a non-pharmacological treatment of hypertension in pregnancy and its influence on perinatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, and two trials registers (October 2018). We also searched relevant conference proceedings and journals, and scanned the reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs). We would have included RCTs using a cluster-randomised design, but none were identified. We excluded quasi-RCTs and cross-over trials.We sought intervention studies of various guided imagery techniques performed during pregnancy in comparison with no intervention or other non-pharmacological treatments for hypertension (e.g. quiet rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage, device-guided slow breathing, hypnosis, physical exercise, and yoga). DATA COLLECTION AND ANALYSIS Three review authors independently assessed the trials for inclusion, extracted data, and assessed risk of bias for the included studies. We checked extracted data for accuracy, and resolved differences in assessments by discussion. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included two small trials (involving a total of 99 pregnant women) that compared guided imagery with quiet rest. The trials were conducted in Canada and the USA. We assessed both trials as at high risk of performance bias, and low risk of attrition bias; one trial was at low risk for selection, detection, and reporting bias, while the other was at unclear risk for the same domains.We could not perform a meta-analysis because the two included studies reported different outcomes, and the frequency of the intervention was slightly different between the two studies. One study performed guided imagery for 15 minutes at least twice daily for four weeks, or until the baby was born (whichever came first). In the other study, the intervention included guided imagery, self-monitoring of blood pressure, and thermal biofeedback-assisted relaxation training for four total hours; the participants were instructed to practice the procedures twice daily and complete at least three relief relaxation breaks each day. The control groups were similar - one was quiet rest, and the other was quiet rest as bed rest.None of our primary outcomes were reported in the included trials: severe hypertension (either systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher); severe pre-eclampsia, or perinatal death (stillbirths plus deaths in the first week of life). Only one of the secondary outcomes was measured.Low-certainty evidence from one trial (69 women) suggests that guided imagery may make little or no difference in the use of antihypertensive drugs (risk ratio 1.27, 95% confidence interval 0.72 to 2.22). AUTHORS' CONCLUSIONS There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with another non-pharmacological method for hypertension.Large and well-designed RCTs are needed to identify the effects of guided imagery on hypertension during pregnancy and on other relevant outcomes associated with short-term and long-term maternal and neonatal health. Trials could also consider utilisation and costs of health service.
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Affiliation(s)
- Megumi Haruna
- The University of TokyoDepartment of Midwifery and Women’s Health, Division of Health Sciences & Nursing, Graduate School of Medicine7‐3‐1 HongoTokyoJapan113‐0033
| | - Masayo Matsuzaki
- Osaka University Graduate School of MedicineDepartment of Children and Women's Health1‐7 YamadaokaSuitaOsakaJapan565‐0871
| | - Erika Ota
- St. Luke's International UniversityGlobal Health Nursing, Graduate School of Nursing Sciences10‐1 Akashi‐choChuo‐KuTokyoMSJapan104‐0044
| | - Mie Shiraishi
- Osaka UniversityDepartment of Children and Women's Health1‐7 YamadaokaSuitaOsakaJapan565‐0871
| | - Nobutsugu Hanada
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 OkuraTokyoJapan166‐0014
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 OkuraTokyoJapan166‐0014
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Spradley FT. Sympathetic nervous system control of vascular function and blood pressure during pregnancy and preeclampsia. J Hypertens 2019; 37:476-487. [PMID: 30160658 PMCID: PMC6355368 DOI: 10.1097/hjh.0000000000001901] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: Proper vascular tone and blood pressure regulation during pregnancy are important for immediate and long-term cardiovascular health of the mother and her offspring. Preeclampsia is clinically defined as new-onset maternal hypertension accompanied by cardiovascular, renal, and/or neural abnormalities presenting in the second half of pregnancy. There is strong evidence to support that preeclampsia is mediated by attenuations in uteroplacental vascular remodeling and increases in vasoconstriction with subsequent placental ischemia/reperfusion-induced release of hypertensive substances into the maternal circulation. These include antiangiogenic and pro-inflammatory factors. There is also evidence implicating increased sympathetic nervous system activity (SNA) in this maternal disorder, but this mostly includes data correlating severity of disease with catecholamine levels and elevated muscle SNA. These measurements have not confirmed a causative role for SNA in the pathogenesis of preeclampsia. Therefore, studies are needed to provide a comprehensive understanding of SNA and its control of vascular function and blood pressure regulation during normal pregnancy in order to set the stage for exploring the mechanisms mediating the exaggerated SNA and signaling during preeclampsia. This review examines the role of SNA in control of uteroplacental vascular tone and blood pressure regulation during normal pregnancy. Furthermore, it is proposed that over-activation of the SNA contributes to altered uteroplacental vascular tone and perfusion leading to placental ischemic events and modulates the systemic vasoconstriction and hypertensive responses to soluble placenta ischemic factors. Recognizing the integrative role and importance of SNA in the pathophysiology of preeclampsia will advance our understanding of this maternal disorder.
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Affiliation(s)
- Frank T Spradley
- Department of Surgery, The University of Mississippi Medical Center, Jackson, Mississippi, USA
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Holt E, Holden A. A risk-benefit analysis of maintaining an aerobic-endurance triathlon training program during pregnancy: A review. Sci Sports 2018. [DOI: 10.1016/j.scispo.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kolovetsiou-Kreiner V, Moertl MG, Papousek I, Schmid-Zalaudek K, Lang U, Schlembach D, Cervar-Zivkovic M, Lackner HK. Maternal cardiovascular and endothelial function from first trimester to postpartum. PLoS One 2018; 13:e0197748. [PMID: 29782509 PMCID: PMC5962097 DOI: 10.1371/journal.pone.0197748] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/08/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To explore noninvasively the complex interactions of the maternal hemodynamic system throughout pregnancy and the resulting after-effect six weeks postpartum. Methods Eighteen women were tested beginning at the 12th week of gestation at six time-points throughout pregnancy and six weeks postpartum. Heart rate, heart rate variability, blood pressure, pulse transit time (PTT), respiration, and baroreceptor sensitivity were analyzed in resting conditions. Additionally, hemoglobin, asymmetric and symmetric dimethylarginine and Endothelin (ET-1) were obtained. Results Heart rate and sympathovagal balance favoring sympathetic drive increased, the vagal tone and the baroreflex sensitivity decreased during pregnancy. Relative sympathetic drive (sympathovagal balance) reached a maximum at 6 weeks postpartum whereas the other variables did not differ compared to first trimester levels. Postpartum diastolic blood pressure was higher compared to first and second trimester. Pulse transit time and endothelial markers showed no difference throughout gestation. However, opposing variables PTT and asymmetric dimethylarginine (ADMA) were both higher six weeks postpartum. Conclusions The sympathetic up regulation throughout pregnancy goes hand in hand with a decreased baroreflex sensitivity. In the postpartum period, the autonomic nervous system, biochemical endothelial reactions and PTT show significant and opposing changes compared to pregnancy findings, indicating the complex aftermath of the increase of blood volume, the changes in perfusion strategies and blood pressure regulation that occur in pregnancy.
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Affiliation(s)
| | | | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Graz, Austria
| | | | - Uwe Lang
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Dietmar Schlembach
- Vivantes Network of Health, Clinicum Neukoelln, Clinic of Obstetric Medicine, Berlin, Germany
| | - Mila Cervar-Zivkovic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Helmut Karl Lackner
- Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
- Department of Medical Engineering, Graz University of Technology, Graz, Austria
- * E-mail:
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Reyes LM, Usselman CW, Davenport MH, Steinback CD. Sympathetic Nervous System Regulation in Human Normotensive and Hypertensive Pregnancies. Hypertension 2018. [DOI: 10.1161/hypertensionaha.117.10766] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Laura M. Reyes
- From the Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute (L.M.R., C.W.U., M.H.D., C.D.S.) and Alberta Diabetes Institute (M.H.D.), University of Alberta, Edmonton, Canada
| | - Charlotte W. Usselman
- From the Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute (L.M.R., C.W.U., M.H.D., C.D.S.) and Alberta Diabetes Institute (M.H.D.), University of Alberta, Edmonton, Canada
| | - Margie H. Davenport
- From the Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute (L.M.R., C.W.U., M.H.D., C.D.S.) and Alberta Diabetes Institute (M.H.D.), University of Alberta, Edmonton, Canada
| | - Craig D. Steinback
- From the Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute (L.M.R., C.W.U., M.H.D., C.D.S.) and Alberta Diabetes Institute (M.H.D.), University of Alberta, Edmonton, Canada
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Sobierajski FM, Purdy GM, Usselman CW, Skow RJ, James MA, Chari RS, Khurana R, Stickland MK, Davidge ST, Devolin M, Steinback CD, Davenport MH. Maternal Physical Activity Is Associated With Improved Blood Pressure Regulation During Late Pregnancy. Can J Cardiol 2018; 34:485-491. [DOI: 10.1016/j.cjca.2018.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/16/2022] Open
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Hemodynamic and Electrocardiographic Aspects of Uncomplicated Singleton Pregnancy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:413-431. [PMID: 30051399 DOI: 10.1007/978-3-319-77932-4_26] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pregnancy is associated with significant changes in maternal hemodynamics, which are triggered by profound systemic vasodilation and mediated through the autonomic nervous system as well as the renin-angiotensin-aldosterone system. Vascular function changes to help accommodate an increase in intravascular volume due to blood volume expansion associated with pregnancy while maintaining the efficiency of ventricular-arterial coupling and diastolic perfusion pressure. The heart undergoes physiological (eccentric) hypertrophy due to increased volume load and cardiac stroke work, whereas the functional change of the left ventricle remains controversial. There are changes in cardiac electrical activity during pregnancy which can be detected in the electrocardiogram that are not related to disease. Sympathetic activation is a common phenomenon during uncomplicated pregnancy and may be a compensatory mechanism induced by profound systemic vasodilation and a decrease in mean arterial pressure. Despite marked sympathetic activation, vasoconstrictor responsiveness is blunted during uncomplicated pregnancy. There are race and ethnic differences in maternal hemodynamic adaptations to uncomplicated pregnancy, which may be attributed to differences in socioeconomic status or in prevalence rates of cardiovascular risk factors.
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Moroney E, Posma E, Dennis A, d'Udekem Y, Cordina R, Zentner D. Pregnancy in a woman with a Fontan circulation: A review. Obstet Med 2017; 11:6-11. [PMID: 29636807 DOI: 10.1177/1753495x17737680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/23/2017] [Indexed: 11/15/2022] Open
Abstract
More women with congenital heart disease survive to childbearing ages, due to improvements in surgical practice and postoperative care. This review discusses pregnancy in women with a single ventricle, describing maternal obstetric and cardiovascular complications and the increased risks of prematurity and adverse neonatal outcomes. Recommendations are made based on current understanding, guidelines and published literature, with recognition that there is much knowledge yet to be gained.
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Affiliation(s)
- Emily Moroney
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Elske Posma
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Victoria, Australia
| | - Alicia Dennis
- Department of Anaesthesia, The Royal Women's Hospital, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Department of Pharmacology, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,7Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Dominica Zentner
- Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia.,Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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Weber TM, Lackner HK, Roessler A, Papousek I, Kolovetsiou-Kreiner V, Lucovnik M, Schmid-Zalaudek K, Lang U, Moertl MG. Heart rate variability and baroreceptor reflex sensitivity in early- versus late-onset preeclampsia. PLoS One 2017; 12:e0186521. [PMID: 29053723 PMCID: PMC5650147 DOI: 10.1371/journal.pone.0186521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine whether there are differences in autonomic nervous system function in early- versus late-onset preeclampsia. METHODS Matched case-control study. Cases were defined as singleton pregnancies with preeclampsia at < 34+0 weeks of gestation (early-onset preeclampsia) and ≥ 34+0 weeks of gestation (late-onset preeclampsia). For each case in each of the preeclampsia subgroups, three "control"uncomplicated singleton pregnancies were matched by maternal age, height, and week of gestation. Blood pressure and heart rate were measured continuously for 30 minutes in each participant. Baroreceptor reflex sensitivity (assessed using sequence technique), time and frequency domain heart rate variability measures, as SDNN, RMSSD, LFRRI, HFRRI and LF/HFRRI of R-R intervals, were compared between groups (p<0.05 significant). RESULTS 24 women with preeclampsia (10 with early-onset and 14 with late-onset preeclampsia) and 72 controls were included in the study. SDNN, RMSSD and HFRRI were significantly higher in the late-onset preeclampsia group compared to gestational age matched controls (p = 0.033, p = 0.002 and p = 0.018, respectively). No significant differences in SDNN RMSSD and HFRRI between early-onset preeclampsia group and gestational age matched controls were observed (p = 0.304, p = 0.325 and p = 0.824, respectively). Similarly, baroreceptor reflex sensitivity was higher in late-onset preeclampsia compared to controls at ≥ 34 weeks (p = 0.037), but not different between early-onset preeclampsia compared to controls at < 34 weeks (p = 0.50). CONCLUSIONS Heart rate variability and baroreceptor reflex sensitivity are increased in late- but not early-onset preeclampsia compared to healthy pregnancies. This indicates a better autonomic nervous system mediated adaptation to preeclampsia related cardiovascular changes in late-onset disease.
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Affiliation(s)
| | - Helmut Karl Lackner
- Department of Physiology, Medical University of Graz, Graz, Austria
- Department of Medical Engineering, Graz University of Technology, Graz, Austria
| | - Andreas Roessler
- Department of Physiology, Medical University of Graz, Graz, Austria
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Graz, Austria
| | | | - Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Uwe Lang
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Wells CI, O’Grady G, Bissett IP. Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms. World J Gastroenterol 2017; 23:5634-5644. [PMID: 28852322 PMCID: PMC5558126 DOI: 10.3748/wjg.v23.i30.5634] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/29/2017] [Accepted: 07/22/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODS A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTS No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSION Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.
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Mizuno T, Tamakoshi K, Tanabe K. Anxiety during pregnancy and autonomic nervous system activity: A longitudinal observational and cross-sectional study. J Psychosom Res 2017; 99:105-111. [PMID: 28712414 DOI: 10.1016/j.jpsychores.2017.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/26/2017] [Accepted: 06/07/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess the longitudinal change in autonomic nervous system (ANS) activity during pregnancy and the association between anxiety during pregnancy and ANS activity. METHODS Pregnant Japanese women with a singleton fetus and normal pregnancy were recruited (n=65). ANS activity and anxiety were measured using a self-rating questionnaire at approximately 20, 30, and 36weeks of gestation. Very low (VLF) and high (HF) frequency bands of heart rate variability spectrums were used. Anxiety was assessed using the Japanese version of the State-Trait Anxiety Inventory. A score of 45 or more on trait-anxiety and the other represent the trait-anxiety group and the non- trait-anxiety group, respectively. The state-anxiety group and the non-state-anxiety group were defined in the same manner. RESULTS Longitudinal observation of individual pregnant women indicated the significant increasing trend (p=0.002) of VLF power and the significant decreasing trend (p<0.001) of HF power during 20 to 36 gestation weeks. Compared with the non-trait-anxiety group, the trait-anxiety group had significantly lower VLF values at 20 gestational weeks (p=0.033) and had significantly lower HF values at 30 and 36 gestational weeks (p=0.015 and p=0.044, respectively). The increasing rate of VLF from 20 to 36 gestational weeks was higher among the trait-anxiety group. The same associations were observed between the state-anxiety and non-state-anxiety groups at 20 gestational weeks. CONCLUSIONS Anxiety during pregnancy decreased heart rate variability. Anxiety in second trimester pregnancy promoted a subsequent increase in sympathetic activity.
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Affiliation(s)
- Taeko Mizuno
- Department of Nursing, Nagoya University Graduate, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya City, Aichi Prefecture, Japan.
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya City, Aichi Prefecture, Japan.
| | - Keiko Tanabe
- School of Medicine, Graduate School of Nursing, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi Prefecture, Japan.
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Hissen SL, El Sayed K, Macefield VG, Brown R, Taylor CE. Muscle sympathetic nerve activity peaks in the first trimester in healthy pregnancy: a longitudinal case study. Clin Auton Res 2017; 27:401-406. [DOI: 10.1007/s10286-017-0439-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/16/2017] [Indexed: 11/29/2022]
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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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MacPherson MK, Abur D, Stepp CE. Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal during Speech as a Function of Cognitive Load. J Voice 2016; 31:504.e1-504.e9. [PMID: 27939119 DOI: 10.1016/j.jvoice.2016.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to determine the relationship among cognitive load condition and measures of autonomic arousal and voice production in healthy adults. STUDY DESIGN A prospective study design was conducted. METHODS Sixteen healthy young adults (eight men, eight women) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. In both conditions, participants said the font color of the color words instead of the word text. In the incongruent condition, font color differed from the word text, creating an increase in cognitive load relative to the congruent condition in which font color and word text matched. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (sound pressure level, fundamental frequency, cepstral peak prominence, and low-to-high spectral energy ratio) were analyzed for eight sentence productions in each cognitive load condition per participant. RESULTS A logistic regression model was constructed to predict the cognitive load condition (congruent or incongruent) using subject as a categorical predictor and the three autonomic measures and four acoustic measures as continuous predictors. It revealed that skin conductance response amplitude, cepstral peak prominence, and low-to-high spectral energy ratio were significantly associated with cognitive load condition. CONCLUSIONS During speech produced under increased cognitive load, healthy young adults show changes in physiologic markers of heightened autonomic arousal and acoustic measures of voice quality. Future work is necessary to examine these measures in older adults and individuals with voice disorders.
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Affiliation(s)
- Megan K MacPherson
- Department of Communication Science and Disorders, Florida State University, Tallahassee, FL.
| | - Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA; Department of Biomedical Engineering, Boston University, Boston, MA; Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA
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Is there a differential impact of parity on factors regulating maternal peripheral resistance? Hypertens Res 2016; 39:737-743. [DOI: 10.1038/hr.2016.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 03/26/2016] [Accepted: 04/14/2016] [Indexed: 11/09/2022]
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Altay Y, Altay MM, Demirok G, Balta O, Bolu H. Measurements of Pupillary Diameter and Wavefront Aberrations in Pregnant Women. SCIENTIFICA 2016; 2016:4129524. [PMID: 26998383 PMCID: PMC4779841 DOI: 10.1155/2016/4129524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 05/23/2023]
Abstract
Purpose. To show whether pregnancy affects the measurements of pupillary diameter and wavefront (WF) aberrations. Methods. This was a case-control study including 34 healthy pregnant women in the third trimester and age-matched 34 nonpregnant women. Only women who had no ocular abnormalities and no refractive error were included. We measured photopic and mesopic pupil diameter and WF aberrations at the third trimester and at the second postpartum month. Measurements of the right eyes were used in this study. The differences between groups were analysed by paired t-test and t-test. Results. Pregnant women's mean photopic pupil size in the third trimester was significantly higher than in postpartum period and in control group (3.74 ± 0.77, 3.45 ± 0.53, and 3.49 ± 0.15 mm, p < 0.05, resp.). Mesopic pupil size in the third trimester was also higher than in postpartum period and in control group (6.77 ± 0.52, 6.42 ± 0.55, and 6.38 ± 0.21 mm, p < 0.05, resp.). RMS-3 and RMS-5 values were higher in pregnancy but these differences were not statistically significant. Conclusion. Pregnancy increased photopic and mesopic pupil size significantly but did not increase wavefront aberrations notably. Increased pupil size may be due to increased sympathetic activity during pregnancy. And this activity can be noninvasively determined by measuring pupil size.
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Affiliation(s)
- Yesim Altay
- Department of Ophthalmology, Ankara Training and Research Hospital, 06340 Ankara, Turkey
| | - Mehmet Metin Altay
- Etlik Zubeyde Hanim Women's Health Training and Research Hospital, 06010 Ankara, Turkey
| | - Gulizar Demirok
- Department of Ophthalmology, Ufuk University Faculty of Medicine, 06520 Ankara, Turkey
| | - Ozgur Balta
- Department of Ophthalmology, Ankara Training and Research Hospital, 06340 Ankara, Turkey
| | - Hulya Bolu
- Department of Ophthalmology, Batıgoz Eye Hospital, Izmir, Turkey
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Coldren KM, Brown R, Hasser EM, Heesch CM. Relaxin increases sympathetic nerve activity and activates spinally projecting neurons in the paraventricular nucleus of nonpregnant, but not pregnant, rats. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1553-68. [PMID: 26400184 DOI: 10.1152/ajpregu.00186.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/21/2015] [Indexed: 11/22/2022]
Abstract
Pregnancy is characterized by increased blood volume and baseline sympathetic nerve activity (SNA), vasodilation, and tachycardia. Relaxin (RLX), an ovarian hormone elevated in pregnancy, activates forebrain sites involved in control of blood volume and SNA through ANG II-dependent mechanisms and contributes to adaptations during pregnancy. In anesthetized, arterial baroreceptor-denervated nonpregnant (NP) rats, RLX microinjected into the subfornical organ (SFO; 0.77 pmol in 50 nl) produced sustained increases in lumbar SNA (8 ± 3%) and mean arterial pressure (MAP; 26 ± 4 mmHg). Low-dose intracarotid artery infusion of RLX (155 pmol·ml(-1)·h(-1); 1.5 h) had minor transient effects on AP and activated neurons [increased Fos-immunoreactivity (IR)] in the SFO and in spinally projecting (19 ± 2%) and arginine-vasopressin (AVP)-IR (21 ± 5%) cells in the paraventricular nucleus of the hypothalamus of NP, but not pregnant (P), rats. However, mRNA for RLX and ANG II type 1a receptors in the SFO was preserved in pregnancy. RLX receptor-IR is present in the region of the SFO in NP and P rats and is localized in astrocytes, the major source of angiotensinogen in the SFO. These data provide an anatomical substrate for a role of RLX in the resetting of AVP secretion and increased baseline SNA in pregnancy. Since RLX and ANG II receptor expression was preserved in the SFO of P rats, we speculate that the lack of response to exogenous RLX may be due to maximal activation by elevated endogenous levels of RLX in near-term pregnancy.
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Affiliation(s)
- K Max Coldren
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
| | - Randall Brown
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Interdisciplinary Neuroscience Program, University of Missouri, Columbia, Missouri; and
| | - Eileen M Hasser
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Cheryl M Heesch
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Interdisciplinary Neuroscience Program, University of Missouri, Columbia, Missouri; and
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Usselman CW, Skow RJ, Matenchuk BA, Chari RS, Julian CG, Stickland MK, Davenport MH, Steinback CD. Sympathetic baroreflex gain in normotensive pregnant women. J Appl Physiol (1985) 2015; 119:468-74. [PMID: 26139215 DOI: 10.1152/japplphysiol.00131.2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/30/2015] [Indexed: 12/11/2022] Open
Abstract
Muscle sympathetic nerve activity is increased during normotensive pregnancy while mean arterial pressure is maintained or reduced, suggesting baroreflex resetting. We hypothesized spontaneous sympathetic baroreflex gain would be reduced in normotensive pregnant women relative to nonpregnant matched controls. Integrated muscle sympathetic burst incidence and total sympathetic activity (microneurography), blood pressure (Finometer), and R-R interval (ECG) were assessed at rest in 11 pregnant women (33 ± 1 wk gestation, 31 ± 1 yr, prepregnancy BMI: 23.5 ± 0.9 kg/m(2)) and 11 nonpregnant controls (29 ± 1 yr; BMI: 25.2 ± 1.7 kg/m(2)). Pregnant women had elevated baseline sympathetic burst incidence (43 ± 2 vs. 33 ± 2 bursts/100 heart beats, P = 0.01) and total sympathetic activity (1,811 ± 148 vs. 1,140 ± 55 au, P < 0.01) relative to controls. Both mean (88 ± 3 vs. 91 ± 2 mmHg, P = 0.4) and diastolic (DBP) (72 ± 3 vs. 73 ± 2 mmHg, P = 0.7) pressures were similar between pregnant and nonpregnant women, respectively, indicating an upward resetting of the baroreflex set point with pregnancy. Baroreflex gain, calculated as the linear relationship between sympathetic burst incidence and DBP, was reduced in pregnant women relative to controls (-3.7 ± 0.5 vs. -5.4 ± 0.5 bursts·100 heart beats(-1)·mmHg(-1), P = 0.03), as was baroreflex gain calculated with total sympathetic activity (-294 ± 24 vs. -210 ± 24 au·100 heart beats(-1)·mmHg(-1); P = 0.03). Cardiovagal baroreflex gain (sequence method) was not different between nonpregnant controls and pregnant women (49 ± 8 vs. 36 ± 8 ms/mmHg; P = 0.2). However, sympathetic (burst incidence) and cardiovagal gains were negatively correlated in pregnant women (R = -0.7; P = 0.02). Together, these data indicate that the influence of the sympathetic nervous system over arterial blood pressure is reduced in normotensive pregnancy, in terms of both long-term and beat-to-beat regulation of arterial pressure, likely through a baroreceptor-dependent mechanism.
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Affiliation(s)
- Charlotte W Usselman
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Alberta Diabetes Institute, Women and Children's Health Research Institute, and
| | - Rachel J Skow
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Alberta Diabetes Institute, Women and Children's Health Research Institute, and
| | - Brittany A Matenchuk
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Alberta Diabetes Institute, Women and Children's Health Research Institute, and
| | - Radha S Chari
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Colleen G Julian
- Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado; and
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Alberta Diabetes Institute, Women and Children's Health Research Institute, and
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Alberta Diabetes Institute, Women and Children's Health Research Institute, and
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Reyes-Lagos JJ, Echeverría-Arjonilla JC, Peña-Castillo MÁ, García-González MT, Ortiz-Pedroza MDR, Pacheco-López G, Vargas-García C, Camal-Ugarte S, González-Camarena R. A comparison of heart rate variability in women at the third trimester of pregnancy and during low-risk labour. Physiol Behav 2015; 149:255-61. [PMID: 26048301 DOI: 10.1016/j.physbeh.2015.05.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/21/2015] [Accepted: 05/31/2015] [Indexed: 12/19/2022]
Abstract
Heart rate variability (HRV) has been recognised as a non-invasive method for assessing cardiac autonomic regulation. Aiming to characterize HRV changes at labour in women, we studied 10 minute ECG recordings from young mothers (n=30) at the third trimester of pregnancy (P) or during augmentation of labour (L) (n=30). Data of the L group were collected when no-contractions (L-NC) or the contractile activity (L-C) was manifested. Accordingly, the inter-beat interval (IBI) time series were processed to estimate relevant parameters of HRV such as the mean IBI (IBI¯), the mean heart rate HR¯, the root mean square of successive differences (RMSSD) in IBIs, the natural logarithm of high-frequency component (LnHF), the short-term scaling parameters from detrended fluctuation and magnitude and sign analyses such as (α1, α1(MAG), α1(SIGN)), and the sample entropy (SampEn). We found statistical differences (p<0.05) for RMSSD among P and L-NC/L-C groups (25 ± 13 vs. 36 ± 14/34 ± 16 ms) and for LnHF between P and L-NC (5.37 ± 1.15 vs. 6.05 ± 0.86 ms(2)). Likewise, we identified statistical differences (p<0.05) for α1(SIGN) among P and L-NC/L-C groups (0.19 ± 0.20 vs. 0.32 ± 0.17/0.39 ± 0.13). By contrast, L-NC and L-C groups showed statistical differences (p<0.05) in α1(MAG) (0.67 ± 0.12 vs. 0.79 ± 0.12), and SampEn (1.62 ± 0.26 vs. 1.20 ± 0.44). These results suggest that during labour, despite preserving a concomitant non-linear influence, the maternal short-term cardiac autonomic regulation becomes weakly anticorrelated (as indicated by α1(SIGN)); furthermore, an increased vagally mediated activity is observed (as indicated by RMSSD and LnHF), which may reflect a cholinergic pathway activation owing to the use of oxytocin or the anti-inflammatory cholinergic response triggered during labour.
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Affiliation(s)
- José Javier Reyes-Lagos
- Metropolitan Autonomous University (UAM), Campus Iztapalapa, Basic Sciences and Engineering Division, Mexico City 09340, Mexico
| | | | - Miguel Ángel Peña-Castillo
- Metropolitan Autonomous University (UAM), Campus Iztapalapa, Basic Sciences and Engineering Division, Mexico City 09340, Mexico
| | - María Teresa García-González
- Metropolitan Autonomous University (UAM), Campus Iztapalapa, Basic Sciences and Engineering Division, Mexico City 09340, Mexico
| | - María Del Rocío Ortiz-Pedroza
- Metropolitan Autonomous University (UAM), Campus Iztapalapa, Basic Sciences and Engineering Division, Mexico City 09340, Mexico
| | - Gustavo Pacheco-López
- UAM, Campus Lerma, Biological and Health Sciences Division, Lerma 52000, Mexico; University of Leiden, Faculty of Social and Behavioural Sciences, Health, Medical and Neuropsychology Unit, 2333 AK Leiden, The Netherlands.
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Joyner MJ, Barnes JN, Hart EC, Wallin BG, Charkoudian N. Neural control of the circulation: how sex and age differences interact in humans. Compr Physiol 2015; 5:193-215. [PMID: 25589269 PMCID: PMC4459710 DOI: 10.1002/cphy.c140005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The autonomic nervous system is a key regulator of the cardiovascular system. In this review, we focus on how sex and aging influence autonomic regulation of blood pressure in humans in an effort to understand general issues related to the cardiovascular system as a whole. Younger women generally have lower blood pressure and sympathetic activity than younger men. However, both sexes show marked interindividual variability across age groups with significant overlap seen. Additionally, while men across the lifespan show a clear relationship between markers of whole body sympathetic activity and vascular resistance, such a relationship is not seen in young women. In this context, the ability of the sympathetic nerves to evoke vasoconstriction is lower in young women likely as a result of concurrent β2-mediated vasodilation that offsets α-adrenergic vasoconstriction. These differences reflect both central sympatho-inhibitory effects of estrogen and also its influence on peripheral vasodilation at the level of the vascular smooth muscle and endothelium. By contrast postmenopausal women show a clear relationship between markers of whole body sympathetic traffic and vascular resistance, and sympathetic activity rises progressively in both sexes with aging. These major findings in humans are discussed in the context of differences in population-based trends in blood pressure and orthostatic intolerance. The many areas where there is little sex-specific data on how the autonomic nervous system participates in the regulation of the human cardiovascular system are highlighted.
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Affiliation(s)
| | - Jill N. Barnes
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Emma C. Hart
- School of Physiology and Pharmacology, University of Bristol, Bristol UK
| | - B. Gunnar Wallin
- Institute of Neuroscience and Physiology, The Sahlgren Academy at Gothenburg University, Goteborg, Sweden
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
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