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Kember AJ, Anderson JL, Gorazd NE, House SC, Kerr KE, Torres Loza PA, Reuter DG, Hobson SR, Goergen CJ. Maternal posture-physiology interactions in human pregnancy: a narrative review. Front Physiol 2024; 15:1370079. [PMID: 39100275 PMCID: PMC11294255 DOI: 10.3389/fphys.2024.1370079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
There are several well-known medical conditions in which posture and gravity interact with natural history, including pregnancy. In this review, we provide a comprehensive overview of interactions between maternal posture and maternal physiology and pathophysiology at rest during pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 644 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We present a narrative review of the resulting literature and highlight discrepancies, research gaps, and potential clinical implications. We organize the results by organ system and, commencing with the neurological system, proceed in our synthesis generally in the craniocaudal direction, concluding with the skin. The circulatory system warranted our greatest and closest consideration-literature concerning the dynamic interplay between physiology (heart rate, stroke volume, cardiac output, blood pressure, and systemic vascular resistance), pathophysiology (e.g., hypertension in pregnancy), and postural changes provide an intricate and fascinating example of the importance of the subject of this review. Other organ systems discussed include respiratory, renal, genitourinary, gastrointestinal, abdominal, and endocrine. In addition to summarizing the existing literature on maternal posture-physiology interactions, we also point out gaps and opportunities for further research and clinical developments in this area. Overall, our review provides both insight into and relevance of maternal posture-physiology interactions vis à vis healthcare's mission to improve health and wellness during pregnancy and beyond.
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Affiliation(s)
- Allan J. Kember
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Jennifer L. Anderson
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Natalyn E. Gorazd
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Sarah C. House
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Katherine E. Kerr
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Paula A. Torres Loza
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - David G. Reuter
- Cardiac Innovations, Seattle Children’s, Seattle, WA, United States
| | - Sebastian R. Hobson
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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Gyselaers W, Dreesen P, Staelens AS, Tomsin K, Bruckers L, Vonck S. First-Trimester Normotension Is a Weak Indicator of Normal Maternal Cardiovascular Function. Hypertension 2023; 80:343-351. [PMID: 36148652 PMCID: PMC9847688 DOI: 10.1161/hypertensionaha.122.19346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND As by definition, mean arterial pressure equals the product of cardiac output (CO) and total vascular resistance (TPR), we hypothesized that, irrespective of thresholds to define hypertension, a CO-TPR imbalance might exist in first-trimester normotensive pregnancies with altered risks for adverse gestational outcomes. METHODS A standard protocol was used for automated blood pressure measurement combined with impedance cardiography assessment of CO and TPR (NICCOMO). First-trimester normotensive pregnant women were categorized into 3 groups relative to the reference 75th percentile (P75) of CO and TPR: (1) normal CO and TPR, (2) high CO, and (3) high TPR. These subgroups were compared at blood pressure thresholds 140/90, 130/85, and 130/80 mmHg. The gestational outcome was categorized after birth according to International Society for Studies of Hypertension in Pregnancy criteria. RESULTS Compared with pregnancies with normal CO and TPR (≤P75), women with high TPR at blood pressure <140/90 mmHg are at risk for developing gestational hypertension (odds ratio, 3.795 [1.321-10.904]; P<0.010), late-onset preeclampsia (odds ratio, 3.137 [1.060-9.287]; P<0.050), and neonates small for gestational age (odds ratio, 1.780 [1.056-2.998]; P<0.050). CONCLUSIONS Cardiovascular imbalance can present in normotensive women in the first trimester and is associated with increased risks for adverse gestational outcomes. This study illustrates the relevance of CO and TPR assessments as an adjunct to blood pressure measurement and invites for further exploring their value in screening algorithms for gestational hypertensive disorders and/or small for gestational age.
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Affiliation(s)
- Wilfried Gyselaers
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium (W.G., P.D., A.S.S., K.T., S.V.).,Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium (W.G., P.D.).,Department of Physiology (W.G., P.D., A.S.S., K.T., S.V.), Hasselt University, Agoralaan, Diepenbeek, Belgium
| | - Pauline Dreesen
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium (W.G., P.D., A.S.S., K.T., S.V.).,Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium (W.G., P.D.).,Department of Physiology (W.G., P.D., A.S.S., K.T., S.V.), Hasselt University, Agoralaan, Diepenbeek, Belgium
| | - Anneleen Simone Staelens
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium (W.G., P.D., A.S.S., K.T., S.V.).,Department of Physiology (W.G., P.D., A.S.S., K.T., S.V.), Hasselt University, Agoralaan, Diepenbeek, Belgium
| | - Kathleen Tomsin
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium (W.G., P.D., A.S.S., K.T., S.V.).,Department of Physiology (W.G., P.D., A.S.S., K.T., S.V.), Hasselt University, Agoralaan, Diepenbeek, Belgium
| | - Liesbeth Bruckers
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (L.B.), Hasselt University, Agoralaan, Diepenbeek, Belgium
| | - Sharona Vonck
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium (W.G., P.D., A.S.S., K.T., S.V.).,Department of Physiology (W.G., P.D., A.S.S., K.T., S.V.), Hasselt University, Agoralaan, Diepenbeek, Belgium
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Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes. J Clin Med 2020; 9:jcm9092891. [PMID: 32906735 PMCID: PMC7565559 DOI: 10.3390/jcm9092891] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022] Open
Abstract
We investigate the relationship between maternal cardiovascular (CV) function and fetal Doppler changes in healthy pregnancies and those with pre-eclampsia (PE), small for gestational age (SGA) or fetal growth restriction (FGR). This was a three-centre prospective study, where CV assessment was performed using inert gas rebreathing, continuous Doppler or impedance cardiography. Maternal cardiac output (CO) and peripheral vascular resistance (PVR) were analysed in relation to the uterine artery, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI, expressed as z-scores by gestational week) using polynomial regression analyses, and in relation to the presence of absent/reversed end diastolic (ARED) flow in the UA. We included 81 healthy controls, 47 women with PE, 65 with SGA/FGR and 40 with PE + SGA/FGR. Maternal CO was inversely related to fetal UA PI and positively related to MCA PI; the opposite was observed for PVR, which was also positively associated with increased uterine artery impedance. CO was lower (z-score 97, p = 0.02) and PVR higher (z-score 2.88, p = 0.02) with UA ARED flow. We report that maternal CV dysfunction is associated with fetal vascular changes, namely raised impedance in the fetal-placental circulation and low impedance in the fetal cerebral vessels. These findings are most evident with critical UA Doppler changes and represent a potential mechanism for therapeutic intervention.
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Gyselaers W, Vonck S, Staelens AS, Lanssens D, Tomsin K, Oben J, Dreesen P, Bruckers L. Gestational hypertensive disorders show unique patterns of circulatory deterioration with ongoing pregnancy. Am J Physiol Regul Integr Comp Physiol 2019; 316:R210-R221. [DOI: 10.1152/ajpregu.00075.2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A combined assessment of heart, arteries, veins, and body fluid content throughout pregnancy has not yet been reported. We hypothesized that a gradual aggravation of circulatory dysfunction exists from the latent to the clinical phase of gestational hypertensive disease (GHD), and that pathways are unique for preeclampsia with early onset < 34 wk (EPE) and late onset ≥ 34 wk (LPE), and gestational hypertension (GH). Women with singleton pregnancy and no known diseases were invited for a prospective, observational study and had standardized sphygmomanometric blood pressure measurement, bioimpedance body water spectrum analysis, impedance cardiography for cardiac and arterial assessment, and combined Doppler-ECG of hepatic and renal interlobar veins and uterine arteries. Outcome was categorized as uncomplicated (UP, n = 1,700), EPE ( n = 87), LPE ( n = 218), or GH ( n = 188). A linear mixed model for repeated measurements, corrected for age, parity, and body mass index, was employed in SAS 9.4 to analyze trimestral changes within and between groups. From the first to the third trimester, body water increased in all groups, and an increasing number of abnormal parameters relative to UP occurred in all GHD. First-trimester blood pressure and peripheral resistance were higher in GHD than UP, together with increased uterine flow resistance and extracellular water in EPE, and with lower heart rate and aorta flow velocity in LPE. An overall gestational rise of body water volumes coexists with a gradual worsening of cardiovascular dysfunction in GHD, of which pathophysiological pathways are unique for EPE, LPE, and GH, respectively.
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Affiliation(s)
- Wilfried Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - Sharona Vonck
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Dorien Lanssens
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Kathleen Tomsin
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jolien Oben
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Pauline Dreesen
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Liesbeth Bruckers
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
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Guy GP, Ling HZ, Machuca M, Poon LC, Nicolaides KH. Effect of change in posture on maternal functional hemodynamics at 35-37 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:368-374. [PMID: 28294444 DOI: 10.1002/uog.17466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/26/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate the effect of posture change from the supine to the sitting position and before and after passive leg raising on maternal functional hemodynamics in pregnant women at 35-37 weeks' gestation, and to compare the changes in pregnancies that subsequently developed pre-eclampsia (PE) or gestational hypertension (GH) with those that remained normotensive. METHODS In 2764 singleton pregnancies at 35-37 weeks' gestation, maternal cardiovascular parameters were measured using an automated non-invasive cardiac monitor. The hemodynamic response to a change from the supine to the sitting position and before and after passive leg raising in the left lateral position was examined and compared between women who subsequently developed PE or GH and those who remained normotensive. RESULTS In normotensive singleton pregnancies at 35-37 weeks' gestation, both change from the supine to the sitting position and passive leg raising were associated with an increase in cardiac index and stroke volume index and a decrease in total peripheral resistance index; there was a small increase in mean arterial pressure with both postural changes and a slight decrease in heart rate with passive leg raising. In pregnancies that subsequently developed PE or GH, compared with normotensive pregnancies, cardiac index and stroke volume index were lower and total peripheral resistance index was higher. In general, change from the supine to the sitting position and passive leg raising were associated with similar but less marked changes in cardiovascular parameters as in normotensive pregnancies. CONCLUSIONS Paradoxically, in late third-trimester normal pregnancy, both change from the supine to a sitting position and passive leg raising may result in an increase in preload with a consequent increase in cardiac and stroke volume indices and a decrease in total peripheral resistance index. In pregnancies that develop PE or GH, the effects of postural change on cardiovascular parameters are similar but less marked than in normotensive pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G P Guy
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - H Z Ling
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - M Machuca
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
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