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Hallmark AK, Lindley KJ, Banayan JM. Peripartum management of cardiac arrhythmias: a narrative review. Int J Obstet Anesth 2024; 60:104243. [PMID: 39241680 DOI: 10.1016/j.ijoa.2024.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/09/2024]
Abstract
Cardiac arrhythmias are responsible for a significant portion of cardiovascular disease among pregnant people. As the incidence of arrhythmias in pregnancy continues to increase, anesthesiologists who care for obstetric patients should be experts managing arrhythmias in pregnancy. This article examines the most common arrhythmias encountered in pregnancy, including risk factors, diagnosis, and management strategies. Peripartum monitoring and labor analgesia recommendations are discussed. Additionally, management of cardioversion, management of pacemakers and implantable cardioverter-defibrillators, and advanced cardiac life support in the setting of pregnancy is reviewed.
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Affiliation(s)
| | - Kathryn J Lindley
- Vanderbilt University Division of Cardiovascular Medicine, Nashville, TN, USA
| | - Jennifer M Banayan
- Northwestern University Feinberg School of Medicine Department of Anesthesiology, Chicago, IL, USA.
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Berbrier DE, Adler TE, Leone CA, Paidas MJ, Stachenfeld NS, Usselman CW. Blood pressure responses to handgrip exercise but not apnea or mental stress are enhanced in women with a recent history of preeclampsia. Am J Physiol Heart Circ Physiol 2024; 327:H140-H154. [PMID: 38700469 DOI: 10.1152/ajpheart.00020.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
Preeclampsia is a risk factor for future cardiovascular diseases. However, the mechanisms underlying this association remain unclear, limiting effective prevention strategies. Blood pressure responses to acute stimuli may reveal cardiovascular dysfunction not apparent at rest, identifying individuals at elevated cardiovascular risk. Therefore, we compared blood pressure responsiveness with acute stimuli between previously preeclamptic (PPE) women (34 ± 5 yr old, 13 ± 6 mo postpartum) and women following healthy pregnancies (Ctrl; 29 ± 3 yr old, 15 ± 4 mo postpartum). Blood pressure (finger photoplethysmography calibrated to manual sphygmomanometry-derived values; PPE: n = 12, Ctrl: n = 12) was assessed during end-expiratory apnea, mental stress, and isometric handgrip exercise protocols. Integrated muscle sympathetic nerve activity (MSNA) was assessed in a subset of participants (peroneal nerve microneurography; PPE: n = 6, Ctrl: n = 8). Across all protocols, systolic blood pressure (SBP) was higher in PPE than Ctrl (main effects of group all P < 0.05). Peak changes in SBP were stressor specific: peak increases in SBP were not different between PPE and Ctrl during apnea (8 ± 6 vs. 6 ± 5 mmHg, P = 0.32) or mental stress (9 ± 5 vs. 4 ± 7 mmHg, P = 0.06). However, peak exercise-induced increases in SBP were greater in PPE than Ctrl (11 ± 5 vs. 7 ± 7 mmHg, P = 0.04). MSNA was higher in PPE than Ctrl across all protocols (main effects of group all P < 0.05), and increases in peak MSNA were greater in PPE than Ctrl during apnea (44 ± 6 vs. 27 ± 14 burst/100 hb, P = 0.04) and exercise (25 ± 8 vs. 13 ± 11 burst/100 hb, P = 0.01) but not different between groups during mental stress (2 ± 3 vs. 0 ± 5 burst/100 hb, P = 0.41). Exaggerated pressor and sympathetic responses to certain stimuli may contribute to the elevated long-term risk for cardiovascular disease in PPE.NEW & NOTEWORTHY Women with recent histories of preeclampsia demonstrated higher systolic blood pressures across sympathoexcitatory stressors relative to controls. Peak systolic blood pressure reactivity was exacerbated in previously preeclamptic women during small muscle-mass exercises, although not during apneic or mental stress stimuli. These findings underscore the importance of assessing blood pressure control during a variety of experimental conditions in previously preeclamptic women to elucidate mechanisms that may contribute to their elevated cardiovascular disease risk.
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Affiliation(s)
- Danielle E Berbrier
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Tessa E Adler
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
| | - Cheryl A Leone
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
| | - Michael J Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nina S Stachenfeld
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Charlotte W Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
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3
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Rizi SS, Wiens E, Hunt J, Ducas R. Cardiac physiology and pathophysiology in pregnancy. Can J Physiol Pharmacol 2024. [PMID: 38815593 DOI: 10.1139/cjpp-2024-0010] [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: 06/01/2024]
Abstract
Cardiovascular disease is the leading indirect cause of maternal morbidity and mortality, accounting for nearly one third of maternal deaths during pregnancy. The burden of cardiovascular disease in pregnancy is increasing, as are the incidence of maternal morbidity and mortality. Normal physiologic adaptations to pregnancy, including increased cardiac output and plasma volume, may unmask cardiac conditions, exacerbate previously existing conditions, or create de novo complications. It is important for care providers to understand the normal physiologic changes of pregnancy and how they may impact the care of patients with cardiovascular disease. This review outlines the physiologic adaptions during pregnancy and their pathologic implications for some of the more common cardiovascular conditions in pregnancy.
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Affiliation(s)
- Shekoofeh Saboktakin Rizi
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Evan Wiens
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Hunt
- Department of Obstetrics, Gynecology & Reproductive Science, University of Manitoba, Winnipeg, MB, Canada
| | - Robin Ducas
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Obstetrics, Gynecology & Reproductive Science, University of Manitoba, Winnipeg, MB, Canada
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Hissen SL, Takeda R, Badrov MB, Arias-Franklin S, Patel S, Nelson DB, Babb TG, Fu Q. Impact of maternal obesity on resting muscle sympathetic nerve activity during uncomplicated pregnancy: a longitudinal assessment. Am J Physiol Regul Integr Comp Physiol 2024; 326:R10-R18. [PMID: 37955129 PMCID: PMC11283889 DOI: 10.1152/ajpregu.00098.2023] [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: 04/26/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
Maternal obesity increases the risk of adverse pregnancy outcomes. The mechanisms that contribute to this elevated risk are unclear but may be related to greater activity of the sympathetic nervous system, which is associated with hypertensive disorders of pregnancy. We hypothesized that resting muscle sympathetic nerve activity (MSNA) would be greater in women with obesity during pregnancy when compared with normal-weight women. Blood pressure, heart rate, and MSNA were recorded during 5 min of supine rest in 14 normal-weight women [body mass index (BMI) 22.1 ± 2.1 (SD) kg/m2] and 14 women with obesity (BMI 33.9 ± 3.5 kg/m2) during (early and late) pregnancy and postpartum. All women had uncomplicated pregnancies. Resting MSNA burst frequency was not different between groups during early (normal weight 17 ± 10 vs. obesity 22 ± 15 bursts/min, P = 0.35) but was significantly greater in the obesity group during late pregnancy (23 ± 13 vs. 35 ± 15 bursts/min, P = 0.031) and not different postpartum (10 ± 6 vs. 9 ± 7 bursts/min, P = 0.74). These findings were also apparent when comparing burst incidence and total activity. Although still within the normotensive range, systolic blood pressure was greater in the obesity group across all time points (P = 0.002). Diastolic blood pressure was lower during pregnancy compared with postpartum (P < 0.001) and not different between groups (P = 0.488). Heart rate increased throughout pregnancy in both groups (P < 0.001). Our findings suggest that maternal obesity is associated with greater increases in sympathetic activity even during uncomplicated pregnancy. Future research is needed to determine if this is linked with an increased risk of adverse outcomes or is required to maintain homeostasis in pregnancy.NEW & NOTEWORTHY The impact of maternal obesity on resting muscle sympathetic nerve activity was examined during (early and late) and after uncomplicated pregnancy. Resting muscle sympathetic nerve activity is not different during early pregnancy or postpartum but is significantly elevated in women with obesity during late pregnancy when compared with normal-weight women. Future research is needed to determine if this is linked with an increased risk of adverse outcomes or is required to maintain homeostasis in pregnancy.
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Affiliation(s)
- Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Mark B Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- University Health Network, Toronto, Ontario, Canada
| | - Sonia Arias-Franklin
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Shivani Patel
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - David B Nelson
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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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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Feng S, Gu J, Yu C, Liu J, Ni J. Exploring the predictive value of combined ultrasound parameters for spinal anesthesia-induced hypotension in cesarean section: a prospective observational study. BMC Anesthesiol 2023; 23:255. [PMID: 37507678 PMCID: PMC10375731 DOI: 10.1186/s12871-023-02160-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Prophylactic vasopressor infusion can effectively assist with fluid loading to prevent spinal anesthesia-induced hypotension. However, the ideal dose varies widely among individuals. We hypothesized that hypotension-susceptible patients requiring cesarean section (C-section) could be identified using combined ultrasound parameters to enable differentiated prophylactic medical interventions. METHODS This prospective observational trial was carried out within a regional center hospital for women and children in Sichuan Province, China. Singleton pregnant women undergoing combined spinal-epidural anesthesia for elective C-sections were eligible. Women with contraindications to spinal anesthesia or medical comorbidities were excluded. Velocity time integral (VTI) and left ventricular end-diastolic area (LVEDA) in the supine and left lateral positions were measured on ultrasound before anesthesia. Stroke volume, cardiac output, and the percentage change (%) in each parameter between two positions were calculated. Vital signs and demographic data were recorded. Spinal anesthesia-induced hypotension was defined as a mean arterial pressure decrease of > 20% from baseline. The area under the receiver operating characteristic curve (AUROC) was used to analyze the associations of ultrasound measurements, vital signs, and demographic characteristics with spinal anesthesia-induced hypotension. This exploratory study did not have a predefined outcome; however, various parameter combinations were compared using the AUROC to determine which combined parameters had better predictive values. RESULTS Patients were divided into the normotension (n = 31) and hypotension groups (n = 57). A combination of heart rate (HR), LVEDAs, and VTI% was significantly better at predicting hypotension than was HR (AUROC 0.827 vs. 0.707, P = 0.020) or LVEDAs (AUROC 0.827 vs. 0.711, P = 0.039) alone, but not significantly better than VTI% alone (AUROC 0.827 vs. 0.766, P = 0.098). CONCLUSION The combined parameters of HR and LVEDAs with VTI% may predict spinal anesthesia-induced hypotension more precisely than the single parameters. Future research is necessary to determine whether this knowledge improves maternal and neonatal outcomes. TRIAL REGISTRATION ChiCTR1900025191.
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Affiliation(s)
- Shimiao 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, No. 20, Section 3, Renmin South Road, Chengdu, 610000, China
| | - Juan 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, No. 20, Section 3, Renmin South Road, Chengdu, 610000, China
| | - Chao 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, No. 20, Section 3, Renmin South Road, Chengdu, 610000, China
| | - Jin Liu
- Department of Anesthesiology and Translational Neuroscience Centre, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Juan Ni
- 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, No. 20, Section 3, Renmin South Road, Chengdu, 610000, China.
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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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Badrov MB, Yoo JK, Hissen SL, Nelson DB, Shoemaker JK, Fu Q. Sympathetic Action Potential Firing and Recruitment Patterns Are Abnormal in Gestational Hypertension. Hypertension 2023; 80:291-301. [PMID: 36065805 PMCID: PMC9851937 DOI: 10.1161/hypertensionaha.122.19754] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/14/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND We tested the hypothesis that women who develop gestational hypertension (GH) display abnormal sympathetic action potential (AP) discharge patterns during late pregnancy (32-36 weeks), both at supine rest and during postural stress. METHODS Thirteen nonpregnant, female controls (nonpregnant controls [CTRL]) and 32 pregnant women participated; 14 had low-risk (no personal history of GH) normal pregnancies (LR-NP), 10 had high-risk (personal history of GH) normal pregnancies (HR-NP), and 8 developed GH. We measured heart rate, blood pressure, and muscle sympathetic nerve activity (microneurography) at supine rest and 60° head-up tilt. Sympathetic AP patterns were studied using wavelet-based methodology. RESULTS At rest, muscle sympathetic nerve activity burst frequency was elevated in LR-NP, HR-NP, and GH versus CTRL (all P≤0.01); however, the AP content per integrated burst was augmented only in GH (20±5 spikes/burst), compared with CTRL (8±3 spikes/burst), LR-NP (9±2 spikes/burst) and HR-NP (11±4 spikes/burst; all P<0.0001). Thus, total AP firing frequency was greater in GH versus each of CTRL, LR-NP, and HR-NP (all P<0.0001). In pregnancy, AP frequency is related directly to systolic (R2=46%) and diastolic (R2=20%) blood pressure (both P≤0.01). Unlike CTRL (both P<0.01), women who developed GH were unable to increase within-burst AP firing (P=0.71) or recruit latent subpopulations of larger-sized APs (P=0.72) in response to head-up tilt, perhaps related to a ceiling-effect; however, total AP firing frequency in the upright posture was elevated in the GH cohort versus CTRL, LR-NP, and HR-NP (all P<0.05). CONCLUSIONS Women who develop GH display aberrant sympathetic AP firing patterns in both the supine and upright postures.
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Affiliation(s)
- Mark B. Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Medicine, Toronto General Health Research Institute, University Health Network, Toronto, ON, Canada
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah L. Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David B. Nelson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J. Kevin Shoemaker
- School of Kinesiology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hissen SL, Takeda R, Yoo JK, Badrov MB, Stickford ASL, Best SA, Okada Y, Jarvis SS, Nelson DB, Fu Q. Posture-related changes in sympathetic baroreflex sensitivity during normal pregnancy. Clin Auton Res 2022; 32:485-495. [PMID: 36394777 DOI: 10.1007/s10286-022-00903-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022]
Abstract
Normal pregnancy is associated with vast adjustments in cardiovascular autonomic control. Sympathetic baroreflex sensitivity has been reported to be attenuated during pregnancy in animal models, but most studies in humans are cross-sectional and findings from longitudinal case studies are inconclusive. It remains unclear how sympathetic baroreflex sensitivity is altered longitudinally during pregnancy within an individual in different body postures. Therefore, this study examined the impact of posture on sympathetic baroreflex sensitivity in 24 normal-weight normotensive pregnant women. Spontaneous sympathetic baroreflex sensitivity was assessed during early (6-11 weeks) and late (32-36 weeks) pregnancy and 6-10 weeks postpartum in the supine posture and graded head-up tilt (30° and 60°). In addition, data from the postpartum period were compared with (and no different to) 18 age-matched non-pregnant women to confirm that the postpartum period was reflective of a non-pregnant condition (online supplement). When compared with postpartum (-3.8 ± 0.4 bursts/100 heartbeats/mmHg), supine sympathetic baroreflex sensitivity was augmented during early pregnancy (-5.9 ± 0.4 bursts/100 heartbeats/mmHg, P < 0.001). However, sympathetic baroreflex sensitivity at 30° or 60° head-up tilt was not different between any phase of gestation (P > 0.05). When compared to supine, sympathetic baroreflex sensitivity at 60° head-up tilt was significantly blunted during early (Δ2.0 ± 0.7 bursts/100 heartbeats/mmHg, P = 0.024) and late (Δ1.5 ± 0.6 bursts/100 heartbeats/mmHg, P = 0.049) pregnancy but did not change postpartum (Δ0.4 ± 0.6 bursts/100 heartbeats/mmHg, P = 1.0). These data show that time-course changes in sympathetic baroreflex sensitivity are dependent on the posture it is examined in and provides a foundation of normal blood pressure regulation during pregnancy for future studies in women at risk for adverse pregnancy outcomes.
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Affiliation(s)
- Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mark B Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- University Health Network, Toronto, ON, Canada
| | - Abigail S L Stickford
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- Medtronic Plc, Minneapolis, MN, USA
| | - Stuart A Best
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- University of Kentucky, Lexington, KY, USA
| | - Yoshiyuki Okada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- Hiroshima University, Hiroshima, Japan
| | - Sara S Jarvis
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA
- Northern Arizona University, Flagstaff, AZ, USA
| | - David B Nelson
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, TX, 75231, USA.
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Canon V, Recher M, Lafrance M, Wawrzyniak P, Vilhelm C, Agostinucci JM, Thiriez S, Mansouri N, Morel-Maréchal E, Lagadec S, Leroy A, Vermersch C, Javaudin F, Hubert H. Out-of-hospital cardiac arrest in pregnant women: a 55-patient French cohort study. Resuscitation 2022; 179:189-196. [PMID: 35760226 DOI: 10.1016/j.resuscitation.2022.06.016] [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: 05/09/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
AIM To describe a cohort of pregnant women having suffered an out-of-hospital cardiac arrest (OHCA) and to compare them with nonpregnant women of childbearing age having suffered OHCA. METHODS Study data were extracted from the French National OHCA Registry between 2011 and 2021. We compared patients in terms of characteristics, care and survival. RESULTS We included 3,645 women of childbearing age (15-44) who had suffered an OHCA; 55 of the women were pregnant. Pregnant women were younger than nonpregnant victims (30 vs. 35 years, p=0.006) and were more likely to have a medical history (76.4% vs. 50.5%, p<0.001) and a medical cause of the OHCA (85.5% vs. 57.2%, p<0.001). Advanced Life Support was more frequently administered to pregnant women (98.2%, vs. 72.0%; p<0.001). In pregnant women, the median time of MICU arrival was 20 minutes for the Medical Intensive Care Unit with no difference with nonpregnant women. Survival rate on admission to hospital was higher among pregnant women (43.6% vs. 27.3%; p=0.009). There was no difference in 30-day survival between pregnant and nonpregnant groups (14.5% vs. 7.3%; p=0.061). Fetal survival was only observed for OHCAs that occurred during the pregnancy second or third trimester (survival rates: 10.0% and 23.5%, respectively). CONCLUSIONS Our results show that resuscitation performance does not meet European Resuscitation Council's specific guidelines on OHCA in pregnant women. Although OHCA in pregnancy is rare, the associated prognosis is poor for both woman and fetus. Preventive measures should be reinforced, especially when pregnant women have medical history.
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Affiliation(s)
- Valentine Canon
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France.
| | - Morgan Recher
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Martin Lafrance
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | - Perrine Wawrzyniak
- French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | - Christian Vilhelm
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | | | | | - Nadia Mansouri
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU94, F-94000 Créteil, France
| | - Emanuel Morel-Maréchal
- SAMU 76, Centre Hospitalier Intercommunal Elbeuf-Louviers-Val de Reuil, F-76503 Saint-Aubin-Lès-Elbeuf, France
| | - Steven Lagadec
- SAMU 91, CH Sud Francilien, F-91100 Corbeil Essonnes, France
| | | | | | - François Javaudin
- Department of Emergency Medicine, Nantes University Medical Center and University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), University of Nantes, Nantes, France
| | - Hervé Hubert
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
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- The members of the study group are listed in the acknowledgment part at the end of the article
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11
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Ekblad MO, Gissler M, Korhonen PE. New theory about the pathophysiology of preeclampsia derived from the paradox of positive effects of maternal smoking. J Hypertens 2022; 40:1223-1230. [PMID: 35703884 DOI: 10.1097/hjh.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if maternal height affects the link between the inverse association on smoking during pregnancy and preeclampsia. STUDY DESIGN The study population consisted of all women with singleton pregnancies (n = 803 698) in Finland during the years 2004-2018, excluding women with unknown smoking and diagnosis of prepregnancy chronic hypertension. Information on smoking and background factors were derived from the Finnish Medical Birth Register. Smoking was categorized in three classes: no, quitted in the first trimester and continued throughout the pregnancy. Information on preeclampsia was derived from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. Multiple logistic regression models were used to estimate first the association between smoking and preeclampsia, and finally whether maternal height modified the association. RESULTS In the standard comparison, we found evidence of an association between preeclampsia and continued smoking [adjusted odds ratio = 0.74, 95% confidence interval (95% CI) = 0.67-0.81], but no association was found between quitted smoking and preeclampsia. Thus, the interaction of continued smoking and maternal height by z-scores was estimated. Among taller mothers, continued smoking was associated with a higher risk for preeclampsia than in smoking mothers with average height (β = 0.33, SE = 0.14, P = 0.02). CONCLUSION Our results partly challenge the smoking-preeclampsia paradox: smoking seems not to protect tall mothers against preeclampsia. We speculate the findings through a new theory about the pathophysiology of preeclampsia. It seems that tall pregnant smokers must raise their blood pressure aggressively to ensure perfusion in the dysfunctional placenta.
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Affiliation(s)
- Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Karolinska Institute, Department of Molecular Medicine and Surgery.,Region Stockholm, Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
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12
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Du J, Wang P, Gou Q, Jin S, Xue H, Li D, Tian D, Sun J, Zhang X, Teng X, Wu Y. Hydrogen sulfide ameliorated preeclampsia via suppression of toll-like receptor 4-activated inflammation in the rostral ventrolateral medulla of rats. Biomed Pharmacother 2022; 150:113018. [PMID: 35483194 DOI: 10.1016/j.biopha.2022.113018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
This study aims to determine whether toll-like receptor 4 (TLR4)-mediated inflammation in rostral ventrolateral medulla (RVLM) causes sympathetic overactivity leading to preeclampsia (PE) and if TLR4 inhibition with hydrogen sulfide (H2S) would reduce PE severity. Thirty patients with PE and 30 pregnant controls were involved. PE in rats was induced through deoxycorticosterone acetate and normal saline. NaHS (donor of H2S), lipopolysaccharide (LPS) (TLR4 agonist), and TAK-242 (TLR4 inhibitor) were injected in lateral cerebral ventricle to investigate their effect on microglia-mediated inflammation in RVLM, sympathetic activation, and PE symptoms. In patients with PE, plasma levels of NE, TNF-α, and interleukin-1β were high compared with those of controls, whereas levels of H2S were low. Rats with PE showed an increased amount of renal sympathetic nerve activity and plasma levels of NE, with decreased H2S levels in RVLM. Microglia-mediated inflammation was observed in the RVLM of PE rats. Central infusion of LPS in pregnant rats induced microglia-mediated inflammation, sympathetic nervous tension, and PE-like symptoms, whereas TAK-242 reduced PE symptoms. NaHS treatment lessened microglia-mediated inflammation in the RVLM, sympathetic tension, and symptoms of PE both in PE rats and LPS-treating pregnant rats.These results suggest that inflammation in the RVLM caused by microglial activation might contribute to the progression of PE via an overactive sympathetic system. H2S could reduce PE via inhibiting inflammation in the RVLM. These results might provide a new target for the treatment of PE.
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Affiliation(s)
- Jiexian Du
- Department of Physiology, Hebei Medical University, Shijiazhuang, China; Department of Gynecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ping Wang
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Qi Gou
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Sheng Jin
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Hongmei Xue
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Desi Li
- Department of Physiology, Hebei Medical University, Shijiazhuang, China; Department of Medical, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Danyang Tian
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Jianping Sun
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Xiangjian Zhang
- Hebei Collaborative Innovation Center for Cardio-Cerebrovascular Disease, Shijiazhuang, China
| | - Xu Teng
- Department of Physiology, Hebei Medical University, Shijiazhuang, China.
| | - Yuming Wu
- Department of Physiology, Hebei Medical University, Shijiazhuang, China; Hebei Collaborative Innovation Center for Cardio-Cerebrovascular Disease, Shijiazhuang, China.
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13
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Natali LH, Troiano JA, Potje SR, Dias DP, Antoniali C. Pregnancy restores altered sympathetic vasomotor modulation and parasympathetic cardiac modulation in hypertensive rats. Pregnancy Hypertens 2022; 28:180-188. [DOI: 10.1016/j.preghy.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
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14
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Anticoagulation of women with congenital heart disease during pregnancy. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Duran M, Ziyrek M, Sertdemir AL, Günenc O, Bardak Ö. Impact of preeclampsia on ventricular repolarization indices. J Electrocardiol 2021; 69:1-5. [PMID: 34464917 DOI: 10.1016/j.jelectrocard.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Because of cardiac hypertrophy and electrophysiological alterations associated with preeclampsia, worsening of preexisting arrhythmias or occurrence of de novo arrhythmias are common in patients with preeclampsia. Tp-e/QT and Tpe/QTc ratios are accepted as reliable indexes for predicting ventricular arrhythmias. In this study, we examined the impact of preeclampsia on ventricular repolarization indices in patients with preeclampsia by using the QT, QTc and Tp-e interval, Tp-e/QTratio, and Tp-e/QTc ratio. METHODS We analyzed electrocardiographic recordings of sixty pregnant women with preeclampsia and thirty age-matched healthy pregnant women. Women presenting with preeclampsia were divided into 2 groups and classified as early (gestational age < 34 weeks at clinical onset) or late (≥34 weeks) onset preeclampsia. Ventricular repolarization indices were evaluated. RESULTS The QT and Tp-e intervals were found to be longer in patients with earlyonset preeclampsia compared to patients with late-onset preeclampsia and helthy pregnants (377.6 ± 23 ms vs 374.3 ± 15 ms, 362 ± 15 ms & 82.6 ± 9.4 ms vs 74.0 ± 10.6 ms, 68.6 ± 10 ms). In adition, Tp-e/QT and Tp-e/QTc ratio were significantly higher in this patient population compared to others (0.21 ± 0.02 vs 0.19 ± 0.02, 0.18 ± 0.02 & 0.19 ± 0.02 vs 0.16 ± 0.02, 0.15 ± 0,02, p < 0.05 respectively). CONCLUSION Our data showed that preeclampsia has unfavorable effects on electrocardiographic indices of ventricular repolarization compared to healthy pregnant women. This effect is more prominent in patients with early-onset preeclampsia.
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Affiliation(s)
- Mustafa Duran
- Konya City Hospital, Department of Cardiology, Konya, Turkey.
| | - Murat Ziyrek
- Konya City Hospital, Department of Cardiology, Konya, Turkey
| | - Ahmet Lütfi Sertdemir
- Necmettin Erbakan University, Meram Medicine Faculty, Department of Cardiology, Konya, Turkey
| | - Oğuzhan Günenc
- Konya City Hospital, Department of Gynecology and Obstetrics, Konya, Turkey
| | - Ömer Bardak
- Konya City Hospital, Department of Gynecology and Obstetrics, Konya, Turkey
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16
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Pyridostigmine ameliorates preeclamptic features in pregnant rats by inhibiting tumour necrosis factor-α synthetsis and antagonizing tumour necrosis factor-α-related effects. J Hypertens 2021; 39:1774-1789. [PMID: 34232157 DOI: 10.1097/hjh.0000000000002932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Preeclampsia is a hypertensive disorder of pregnancy marked by an excessive inflammatory response. The anti-inflammatory effect of pyridostigmine (PYR) was previously reported; however, its role in hypertensive pregnancies remains unclear. We hypothesized that PYR could attenuate increased blood pressure and other pathological features in preeclampsia models. METHODS The expression of tumour necrosis factor (TNF)-α was evaluated in normal and preeclampsia pregnant women. PYR (20 mg/kg) was administered daily to reduced uterine perfusion pressure (RUPP) and TNF-α (150 ng/day) infused rats from gestation day 14 to GD19. In a cell culture experiment, the effect of acetylcholine (ACh) on TNF-α-stimulated primary human umbilical endothelial cells (HUVEC) was assessed. RESULTS Preeclampsia women had higher placental TNF-α expression than normal pregnant women. Mean arterial pressure (MAP) in the RUPP group was higher than in the Sham group. PYR inhibited serum and placental acetylcholinesterase activity in rats, and reduced MAP, placental oxidative stress, apoptosis and inflammation in the RUPP group but not in the Sham group. In addition, PYR significantly attenuated the TNF-α-induced increase in MAP, placental oxidative stress and apoptosis. Moreover, TNF-α decreased cell viability and increased the number of TUNEL-positive nuclei of HUVEC, which could largely be abolished by ACh treatment. CONCLUSION Collectively, PYR ameliorated hypertension and other preeclampsia-like symptoms in rat models of preeclampsia not only by inhibiting the synthesis of TNF-α but also by acting against TNF-α-induced detrimental effects directly, which is worthy of further investigation and may be used as a potential agent for preeclampsia management.
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17
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Iliodromitis K, Kociszewski J, Bogossian H. Atrial fibrillation during pregnancy: a 9-month period with limited options. Herzschrittmacherther Elektrophysiol 2021; 32:158-163. [PMID: 33822238 DOI: 10.1007/s00399-021-00751-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022]
Abstract
Pregnancy is a physiological condition with reversible hemodynamic, neurohormonal and coagulation changes to the maternal body during this 9‑month period. The occurrence of atrial fibrillation (AF) is altogether rare among pregnant women, but necessitates immediate treatment und further work-up. Despite numerous pharmacological and invasive therapeutic modalities for AF in non-pregnant patients, very few options are considered safe enough for the fetus and the mother during pregnancy. Commonly used medications such as beta blockers, calcium channel antagonists, antiarrhythmic drugs and anticoagulation therapy must be carefully individualized according to the week of gestation and possible underlying comorbidities of the mother, thus highlighting the importance of an interdisciplinary evaluation by a cardiologist and a gynecologist. The current review summarizes the existing knowledge and treatment options for AF in pregnancy and suggests a simplified algorithm for this clinical constellation.
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Affiliation(s)
- Konstantinos Iliodromitis
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen, Brusebrinkstraße 20, 58135, Hagen, Germany
| | - Jacek Kociszewski
- Department of Gynecology, Evangelisches Krankenhaus Hagen, Hagen, Germany
| | - Harilaos Bogossian
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen, Brusebrinkstraße 20, 58135, Hagen, Germany.
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18
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Meah VL, Kimber ML, Khurana R, Howse R, Hornberger LK, Steinback CD, Davenport MH. Cardioautonomic control in healthy singleton and twin pregnancies. J Appl Physiol (1985) 2020; 130:923-932. [PMID: 33356983 DOI: 10.1152/japplphysiol.00707.2020] [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: 11/22/2022] Open
Abstract
In conjunction with significant cardiovascular adaptation, changes in cardioautonomic balance, specifically greater sympathetic activation and vagal withdrawal, are considered normal adaptations to healthy singleton pregnancy. Cardiovascular adaptation to twin pregnancy is more profound than that of singleton pregnancies; however, the changes in cardioautonomic control during multifetal gestation are unknown. To address this gap, beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured continuously in 25 twin pregnancies and 25 singleton pregnancies (matched for age, prepregnancy body mass index, and gestational age) during 10 min of rest. Data extracted from a 3- to 5-min period were used to analyze heart rate variability (HRV), blood pressure variability (BPV), cardiovagal baroreflex gain, and cardiac intervals as indicators of cardioautonomic control. Independent t tests were used to determine statistical differences between groups (α = 0.05), and the false rate discovery was determined to adjust for multiple comparisons. Resting heart rate was greater in twin compared with singleton pregnancies (91 ± 10 vs. 81 ± 10 beats/min; P = 0.001), but blood pressure was not different. Individuals with twin pregnancies had lower HRV, evidenced by lower standard deviation of R-R intervals (32 ± 11 vs. 47 ± 18 ms; P = 0.001), total power (1,035 ± 810 vs. 1,945 ± 1,570 ms2; P = 0.004), and high frequency power (224 ± 262 vs. 810 ± 806 ms2; P < 0.001) compared with singleton pregnancies. There were no differences in cardiac intervals, BPV, and cardiovagal baroreflex gain between groups. Our findings suggest that individuals with twin pregnancies have greater sympathetic and lower parasympathetic contributions to heart rate and that cardiac, but not vascular, autonomic control is impacted during twin compared with singleton pregnancy.NEW & NOTEWORTHY Individuals with healthy twin pregnancies had lower overall heart rate variability compared with those with singleton pregnancies at similar gestational ages. These results suggest a greater sympathetic and reduced parasympathetic contribution to cardiac control in twin pregnancies. Baseline heart rate was elevated, while arterial pressure and spontaneous cardiovagal baroreflex gain were not different between groups. This was result of the upward resetting of the cardiovagal baroreflex during healthy twin pregnancy, thus maintaining arterial pressure.
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Affiliation(s)
- Victoria L Meah
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Miranda L Kimber
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rshmi Khurana
- Departments of Medicine and Obstetrics and Gynecology, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lisa K Hornberger
- Division of Cardiology, Department of Pediatrics, Fetal and Neonatal Cardiology Program, Women's and Children Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Craig D Steinback
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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19
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Reyes LM, Usselman CW, Khurana R, Chari RS, Stickland MK, Davidge ST, Julian CG, Steinback CD, Davenport MH. Preeclampsia is not associated with elevated muscle sympathetic reactivity. J Appl Physiol (1985) 2020; 130:139-148. [PMID: 33211599 DOI: 10.1152/japplphysiol.00646.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To determine whether increased chemoreflex tonic activity is associated with augmented muscle sympathetic nervous system activity (MSNA) in women diagnosed with preeclampsia. Women with preeclampsia (n = 19; 32 ± 5 yr old, 31 ± 3 wk of gestation) were matched by age and gestational age with pregnant women (controls, n = 38, 32 ± 4 yr old, 31 ± 4 wk gestation; 2:1 ratio). MSNA (n = 9 preeclampsia) was assessed during baseline, peripheral chemoreflex deactivation (hyperoxia), and a cold pressor test (CPT). Baroreflex gain and diastolic blood pressure at which there is a 50% likelihood of MSNA occurring (T50) and plasma noradrenaline concentrations were measured. Baseline mean arterial pressure (MAP: 106 ± 11 vs. 87 ± 10 mmHg, P < 0.0001), noradrenaline concentrations (498 ± 152 pg/mL vs. 326 ± 147, P = 0.001), and T50 (79 ± 7 vs. 71 ± 9 mmHg, P = 0.02) were greater in women with preeclampsia than in controls. However, baseline MSNA (burst incidence [BI]: 41 ± 16 vs. 45 ± 13 bursts/100 hb, P = 0.4) was not different between groups. Responses to hyperoxia (ΔBI -5 ± 7 vs. -1 ± 8 bursts/100 hb, P = 0.1; ΔMAP -1 ± 3 vs. -2 ± 3 mmHg, P = 0.7) and CPT (ΔBI 15 ± 7 vs. 12 ± 11 bursts/100 hb, P = 0.6; ΔMAP 10 ± 4 vs. 12 ± 11 mmHg, P = 0.6) were not different between groups. Our findings question the assumption that increased MSNA contributes to hypertension in women with preeclampsia. The chemoreflex does not appear to contribute to an increase in MSNA in women with preeclampsia.NEW & NOTEWORTHY We wanted to determine whether increased chemoreflex tonic activity is associated with augmented muscle sympathetic nervous system activity (MSNA) in women diagnosed with preeclampsia. The chemoreflex does not contribute to increased MSNA in women with preeclampsia. Our data also challenge the belief that preeclampsia is associated with sympathetic neural hyperactivity. Thus, targeting sympathetic neural hyperactivity as therapeutic strategy is unlikely to be the most efficacious approach to treatment and management.
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Affiliation(s)
- Laura Marcela Reyes
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Charlotte W Usselman
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Rshmi Khurana
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Radha S Chari
- Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra T Davidge
- Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen G Julian
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
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20
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Nozaki K, Hamazaki N, Yamamoto S, Kamiya K, Tanaka S, Ichikawa T, Nakamura T, Yamashita M, Maekawa E, Matsunaga A, Yamaoka-Tojo M, Ako J. Prognostic value of pupil area for all-cause mortality in patients with heart failure. ESC Heart Fail 2020; 7:3067-3074. [PMID: 32777862 PMCID: PMC7524244 DOI: 10.1002/ehf2.12933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022] Open
Abstract
Aims The area of the pupil can be used as an indicator of autonomic function. However, the relation between pupil area and prognosis in heart failure (HF) patients remains unclear. This study was performed to examine whether pupil area can be used as a prognostic indicator in patients with HF. Methods and results This retrospective review was performed in 870 consecutive patients (mean age: 67.0 ± 14.1 years, 37.0% women) hospitalized for acute HF. Pupil area was measured with a pupilometer at least 7 days after hospitalization for HF. The primary endpoint was all‐cause mortality, and the secondary endpoint was readmission due to HF. A total of 131 patients died, and 328 patients were readmitted because of HF over a median follow‐up of 1.9 (interquartile range: 1.0–3.7 years) years. After adjustment for several pre‐existing prognostic factors, including Seattle Heart Failure Score (SHFS), pupil area was shown to be independently associated with all‐cause mortality (hazard ratio: 0.72; 95% confidence interval: 0.59–0.88; P = 0.001) and readmission due to HF (hazard ratio: 0.82; 95% confidence interval: 0.73–0.93; P = 0.003). Addition of pupil area to SHFS significantly increased the area under the receiver‐operating characteristic curve for all‐cause mortality (0.69 vs. 0.72, respectively; P = 0.034). Conclusions Pupil area is an independent predictor of all‐cause mortality and readmission due to HF and adds prognostic information to SHFS in patients with HF. The results presented here suggest that pupil area may be useful as a prognostic marker in patients with HF.
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Affiliation(s)
- Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Shohei Yamamoto
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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21
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Reyes LM, Khurana R, Usselman CW, Busch SA, Skow RJ, Boulé NG, Davenport MH, Steinback CD. Sympathetic nervous system activity and reactivity in women with gestational diabetes mellitus. Physiol Rep 2020; 8:e14504. [PMID: 32633077 PMCID: PMC7338594 DOI: 10.14814/phy2.14504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with vascular dysfunction. Sympathetic nervous system activity (SNA) is an important regulator of vascular function, and is influenced by glucose and insulin. The association between GDM and SNA (re)activity is unknown. We hypothesize that women with GDM would have increased SNA during baseline and during stress. METHODS Eighteen women with GDM and 18 normoglycemic pregnant women (controls) were recruited. Muscle SNA (MSNA; peroneal microneurography) was assessed at rest, during a cold pressor test (CPT) and during peripheral chemoreflex deactivation (hyperoxia). Spontaneous sympathetic baroreflex gain was quantified versus diastolic pressure at rest and during hyperoxia. RESULTS Age, gestational age (third trimester) and pre-pregnancy body mass index and baseline MSNA was not different among the groups. Women with GDM had a similar increase in MSNA, but a greater pressor response to CPT compared to controls (% change in MAP 17 ± 7% vs. 9 ± 9%; p = .004). These data are consistent with a greater neurovascular transduction in GDM (% change in total peripheral resistance/% change in burst frequency [BF]: 15.9 ± 30.2 vs. -5.2 ± 16.4, p = .03). Interestingly, women with GDM had a greater reduction in MSNA during hyperoxia (% change in BF -30 ± 19% vs. -6 ± 17%; p = .01). CONCLUSION Women diagnosed with GDM have similar basal SNA versus normoglycemic pregnant women, but greater neurovascular transduction, meaning a greater influence of the sympathetic nerve activity in these women. We also document evidence of chemoreceptor hyperactivity, which may influence SNA in women with GDM but not in controls.
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Affiliation(s)
- Laura M. Reyes
- Program for Pregnancy and Postpartum HealthUniversity of AlbertaEdmontonABCanada
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
- Women and Children's Health Research Institute (WCHRI)University of AlbertaEdmontonABCanada
| | - Rshmi Khurana
- Women and Children's Health Research Institute (WCHRI)University of AlbertaEdmontonABCanada
- Departments of Medicine and Obstetrics and GynecologyFaculty of Medicine & DentistryUniversity of AlbertaEdmontonABCanada
| | - Charlotte W. Usselman
- Program for Pregnancy and Postpartum HealthUniversity of AlbertaEdmontonABCanada
- Women and Children's Health Research Institute (WCHRI)University of AlbertaEdmontonABCanada
| | - Stephen A. Busch
- Program for Pregnancy and Postpartum HealthUniversity of AlbertaEdmontonABCanada
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
| | - Rachel J. Skow
- Program for Pregnancy and Postpartum HealthUniversity of AlbertaEdmontonABCanada
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
- Women and Children's Health Research Institute (WCHRI)University of AlbertaEdmontonABCanada
| | - Normand G. Boulé
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
- Alberta Diabetes InstituteUniversity of AlbertaEdmontonABCanada
| | - Margie H. Davenport
- Program for Pregnancy and Postpartum HealthUniversity of AlbertaEdmontonABCanada
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
- Women and Children's Health Research Institute (WCHRI)University of AlbertaEdmontonABCanada
- Alberta Diabetes InstituteUniversity of AlbertaEdmontonABCanada
| | - Craig D. Steinback
- Program for Pregnancy and Postpartum HealthUniversity of AlbertaEdmontonABCanada
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
- Women and Children's Health Research Institute (WCHRI)University of AlbertaEdmontonABCanada
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22
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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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23
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Badrov MB, Yoo JK, Steinback CD, Davenport MH, Fu Q. Influence of multiparity on sympathetic nerve activity during normal pregnancy. Am J Physiol Heart Circ Physiol 2020; 318:H816-H819. [PMID: 32142381 DOI: 10.1152/ajpheart.00056.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent evidence suggests an elevated risk of cardiovascular disease development in multiparous women. Therefore, we investigated the effects of multiparity on within-pregnancy sympathetic neural regulation in normotensive, pregnant women. We retrospectively analyzed heart rate (HR), blood pressure (BP), and muscle sympathetic nerve activity (MSNA; n = 8) data from 10 women whom participated in microneurographic research studies during two sequential pregnancies (i.e., PREG1 and PREG2). There was no difference in resting BP between pregnancies (P > 0.05), whereas HR trended higher in PREG2 versus PREG1 (P = 0.06). MSNA burst frequency was greater in PREG2 versus PREG1 after adjusting for age (32 ± 12 vs. 22 ± 12 bursts/min; P = 0.049), whereas burst incidence did not differ (40 ± 16 vs. 34 ± 17 bursts/100 heartbeats; P = 0.21). Sympathetic baroreflex sensitivity was not different between PREG1 and PREG2 (P > 0.05). Our results may highlight a possible role of altered within-pregnancy sympathetic neural regulation in the observed relationship in women between parity and future cardiovascular disease risk.NEW & NOTEWORTHY To our knowledge, this is the first study to investigate the effects of multiparity on within-pregnancy sympathetic neural regulation. We observed augmented muscle sympathetic nerve activity in women's second studied pregnancy versus their first. Conversely, blood pressure and sympathetic baroreflex sensitivity did not differ, whereas a trend for increased heart rate was observed. Our results highlight a possible role of altered within-pregnancy sympathetic neural regulation in the relationship between increased parity and cardiovascular disease development.
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Affiliation(s)
- Mark B Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
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24
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Moors S, Staaks KJJ, Westerhuis MEMH, Dekker LRC, Verdurmen KMJ, Oei SG, van Laar JOEH. Heart rate variability in hypertensive pregnancy disorders: A systematic review. Pregnancy Hypertens 2020; 20:56-68. [PMID: 32179490 DOI: 10.1016/j.preghy.2020.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertensive pregnancy disorders (HPD) are associated with dysfunction of the autonomic nervous system. Cardiac autonomic functions can be assessed by heart rate variability (HRV) measurements. OBJECTIVE To study whether HRV detects differences in the function of the autonomic nervous system between pregnant women with HPD compared to normotensive pregnant women and between women with a history of a pregnancy complicated by HPD compared to women with a history of an uncomplicated pregnancy. METHODS A systematic search was performed in Medline, EMBASE, and CENTRAL to identify studies comparing HRV between pregnant women with HPD or women with a history of HPD to women with (a history of) normotensive pregnancies. RESULTS The search identified 523 articles of which 24 were included in this review, including 850 women with (a history of) HPD and 1205 normotensive controls. The included studies showed a large heterogenicity. A decrease in overall HRV was found in preeclampsia (PE), compared to normotensive pregnant controls. A trend is seen towards increased low frequency/high frequency-ratio in women with PE compared to normotensive pregnant controls. CONCLUSION Our systematic review supports the hypothesis a sympathetic overdrive is found in HPD which is associated with a parasympathetic withdrawal. However, the included studies in our review showed a large diversity in the methods applied and their results.
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Affiliation(s)
- S Moors
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - K J J Staaks
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M E M H Westerhuis
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - L R C Dekker
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K M J Verdurmen
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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25
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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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26
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Miller KB, Miller VM, Harvey RE, Ranadive SM, Joyner MJ, Barnes JN. Augmented cerebral blood velocity in response to isometric handgrip exercise in women with a history of preeclampsia. Am J Physiol Regul Integr Comp Physiol 2019; 317:R834-R839. [PMID: 31663771 DOI: 10.1152/ajpregu.00280.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Preeclampsia (PE) is a hypertensive disorder of pregnancy described as a condition of excessive sympathoexcitation. PE places a woman at increased risk for lifelong hypertension and cognitive impairment. Cerebral blood velocity is blunted in response to a vasoactive stimulus in women with a history of PE. This study investigated how a sympathoexcitatory stimulus affects cerebral blood velocity in women with a history of PE. Middle cerebral artery blood velocity (MCAv) and beat-to-beat mean arterial blood pressure (MAP) were measured in postmenopausal women with a history of PE (n = 21; age = 59 ± 5 yr) and a history of a normotensive pregnancy (NP; n = 27; age = 58 ± 4 yr), at baseline, during isometric handgrip to fatigue (IHG) followed by postexercise ischemia (PEI), and a recovery period (REC). Baseline MAP and MAP responses to IHG and PEI did not differ between groups. MCAv at baseline and throughout the stimulus was lower in PE women compared with NP women (P < 0.05 for all). MCAv increased during IHG in both groups (P < 0.05). This increase in MCAv was greater in PE compared with NP women during IHG and REC (IHG: PE 13 ± 2% vs. NP 9 ± 2%; REC: PE 3 ± 2% vs. NP -2 ± 2%; P < 0.05 for both). Thus, a history of PE is associated with low baseline cerebral blood velocity but an augmented response to a sympathoexcitatory stimulus. These changes in cerebral blood flow regulation may lead to an increased risk for cognitive impairment in women with a history of PE.
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Affiliation(s)
- Kathleen B Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Virginia M Miller
- Departments of Surgery, and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Ronée E Harvey
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sushant M Ranadive
- Department of Kinesiology, University of Maryland, College Park, Maryland
| | | | - Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
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27
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Shabtaie SA, Witt CM, Asirvatham SJ. Natural history and clinical outcomes of inappropriate sinus tachycardia. J Cardiovasc Electrophysiol 2019; 31:137-143. [PMID: 31749258 DOI: 10.1111/jce.14288] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/24/2019] [Accepted: 11/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Limited data are available regarding the demographics, disease associations, and long-term prognosis of patients with inappropriate sinus tachycardia (IST). OBJECTIVE To establish epidemiologic data for patients with IST, including symptom onset, comorbid disease, and long-term outcomes. METHODS We retrospectively reviewed all patients with an IST diagnosis at the Mayo Clinic (Rochester, MN) during a 20-year period (1998-2018). We extracted demographic data and clinical outcomes compared to an age and gender-matched control group with atrioventricular nodal reentry tachycardia (AVNRT). RESULTS Within the study period, a total of 305 patients with IST were identified (mean follow-up 3.5 years) with 92.1% female and mean age 33.2 ± 11.2 years. The most frequently identified circumstances triggering the condition included pregnancy (7.9%) and infectious illness (5.9%) while the most common comorbid conditions were depression (25.6%) and anxiety (24.6%). At diagnosis, the mean left ventricular ejection fraction (LVEF) was 62.3 ± 6.2%, with 77 patients having follow-up echocardiographic data. No significant difference in LVEF was seen after a mean 4.9 ± 4.3-year follow-up (baseline LVEF 59.8 ± 10.7% vs subsequent 61.4 ± 8.1%; P = .2971). Two deaths occurred within the study period, with one related to myocardial infarction and the other noncardiac; compared to an age and gender-matched AVNRT control group there was no excess mortality during the follow-up period. CONCLUSIONS In our study cohort, IST predominately affects young females with structurally normal hearts and modest coexistent psychiatric disease. In most cases of IST, a major event occurring just before or at the time of diagnosis could not be identified, although nearly 8% of patients first noted symptoms during or shortly after pregnancy. In our cohort, there was no evidence of cardiomyopathy or mortality related to IST.
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Affiliation(s)
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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28
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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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29
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Spradley FT, Palei AC, Anderson CD, Granger JP. Melanocortin-4 Receptor Deficiency Attenuates Placental Ischemia-Induced Hypertension in Pregnant Rats. Hypertension 2019; 73:162-170. [PMID: 30571561 DOI: 10.1161/hypertensionaha.118.12028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Preeclampsia is a pregnancy-specific disorder of new-onset hypertension linked to placental ischemia. While obesity is a major risk factor for preeclampsia, not all obese pregnant women develop pregnancy-induced hypertension or preeclampsia. Previously, we reported that placental ischemia-induced hypertension is dependent upon intact signaling of the sympathetic nervous system. Moreover, in various models of obesity, blockade of MC4R (melanocortin-4 receptor) signaling protects against the development of hypertension via suppression of the sympathetic nervous system. Less is known about this pathway during obese pregnancy. Although blockade of MC4R may lead to increased body weight during pregnancy, we tested the hypothesis that placental ischemia-induced hypertension is attenuated in obese MC4R-deficient pregnant rats. On gestational day 14, MC4R wild-type or heterozygous-deficient (MC4R-def) rats were subjected to chronic placental ischemia via the reduced uterine perfusion pressure procedure or Sham surgery then examined on gestational day 19. In Sham MC4R-def versus Sham wild-type pregnant rats, there was increased body weight, fat mass, and circulating leptin levels but they had similar fetus weights. Reduced uterine perfusion pressure reduced fetus weights in both strains. Reduced uterine perfusion pressure increased blood pressure in wild-type rats but this response was significantly attenuated in MC4R-def rats, although blood pressure was elevated in Sham MC4R-def over Sham wild-type. These data indicate that while obese MC4R-def pregnant rats have higher blood pressure during pregnancy, placental ischemia-induced hypertension is attenuated in obese MC4R-def pregnant rats. Thus, obese women with abnormal MC4R signaling may be less susceptible to the development of placental ischemia-induced hypertension.
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Affiliation(s)
- Frank T Spradley
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson.,Department of Physiology and Biophysics (F.T.S., J.P.G.), The University of Mississippi Medical Center, Jackson
| | - Ana C Palei
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson
| | - Christopher D Anderson
- From the Department of Surgery (F.T.S., A.C.P., C.D.A.), The University of Mississippi Medical Center, Jackson
| | - Joey P Granger
- Department of Physiology and Biophysics (F.T.S., J.P.G.), The University of Mississippi Medical Center, Jackson
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Fodor P, White B, Khan R. Inflammation-The role of ATP in pre-eclampsia. Microcirculation 2019; 27:e12585. [PMID: 31424615 DOI: 10.1111/micc.12585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/23/2019] [Accepted: 08/15/2019] [Indexed: 12/20/2022]
Abstract
Sterile inflammation may be initiated by molecules in the host organism that signal "damage" or "danger" also known as danger-associated molecular pattern (DAMPs). In pre-eclampsia (PE), a variety of DAMPs may be involved in the etiology or exacerbation of the disorder. Adenosine 5'-triphosphate (ATP) is a key intracellular energy molecule as well as a ligand for purinergic receptors. In humans, under physiological conditions, extracellular ATP (eATP) levels are distinctly low, but can rise to several hundred fold when cells become injured, stressed, or even necrotic. This often initiates a sterile inflammatory response with eATP acting as a DAMP. Extracellular ATP and its derivative nucleotides synthetized by endonucleotidases exhibit many of their effects through purinergic receptors, via inflammatory cascades and the production of proinflammatory molecules. This is clearly seen in the P2X7 gated receptor, which is linked to release of cytokines of the interleukin-1 family. Considering its fundamental role in innate immunity, an imbalance of P2X7 receptor activation may lead to deleterious effects in the coordination of placental vessel tone via the synthesis of various proinflammatory cytokines. This review explores the implication of DAMPs, specifically ATP and uric acid in the inflammation associated with PE.
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Affiliation(s)
- Paul Fodor
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
| | - Benjamin White
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
| | - Raheela Khan
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, 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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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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Kawai VK, Nwosu SK, Kurnik D, Harrell FE, Stein CM. Variants in BMI-Associated Genes and Adrenergic Genes are not Associated with Gestational Weight Trajectory. Obesity (Silver Spring) 2019; 27:1184-1189. [PMID: 31116007 PMCID: PMC6591076 DOI: 10.1002/oby.22505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/19/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study is to define the association between a genetic risk score (GRS) that combined the effect of multiple BMI-associated variants and gestational weight trajectory. Because pregnancy is a state of sympathetic activation, the association between gestational weight trajectory and variants in adrenergic pathways previously associated with weight was examined. METHODS In a previously defined cohort of pregnant women with (n = 1,504) and without gestational diabetes (GDM) (n = 435), weight trajectory was calculated using all weights during pregnancy. A GRS for BMI (GRSBMI ) was calculated using 31 common variants associated with BMI, and 10 variants in the adrenergic pathways were genotyped. Clinical and genetic factors were studied using generalized linear models. RESULTS Prepregnancy BMI was associated with the GRSBMI (P = 9.3 × 10-11 ) and parity (P = 4.54 × 10-17 ). The GRSBMI was associated with gestational weight trajectory in women with and without GDM (P = 0.041 and P < 0.0001, respectively); however, when prepregnancy BMI was included in the models, the associations disappeared (P > 0.05). Variants in adrenergic genes were not associated with gestational weight trajectory. CONCLUSIONS A GRS for BMI was associated with prepregnancy BMI but was not independently associated with gestational weight trajectory in women with and without GDM. Selected variants in adrenergic genes were not associated with gestational weight trajectory.
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Affiliation(s)
- Vivian K. Kawai
- Division of Clinical Pharmacology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel K. Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel Kurnik
- Division of Clinical Pharmacology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
- Clinical Pharmacology Unit, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Frank E. Harrell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C. Michael Stein
- Division of Clinical Pharmacology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
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Steinback CD, Fraser GM, Usselman CW, Reyes LM, Julian CG, Stickland MK, Chari RS, Khurana R, Davidge ST, Davenport MH. Blunted sympathetic neurovascular transduction during normotensive pregnancy. J Physiol 2019; 597:3687-3696. [PMID: 31106429 DOI: 10.1113/jp277714] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/17/2019] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Normotensive pregnancy is associated with elevated sympathetic nervous system activity yet normal or reduced blood pressure. It represents a unique period of apparent healthy sympathetic hyperactivity. The present study models the blood pressure and heart rate (ECG R-R interval) responses to fluctuations in sympathetic nervous system activity aiming to understand neurocardiovascular transduction. The reported data clearly demonstrate that transduction of sympathetic nervous system signalling to systemic cardiovascular outcomes is reduced in normotensive pregnancy. These data are important for understanding how blood pressure regulation adapts during normotensive pregnancy and set the foundation for exploring similar mechanisms in hypertensive pregnancies. ABSTRACT Previously, we described sympathetic nervous system hyperactivity yet decreased blood pressure responses to stress in normotensive pregnancy. To address the hypothesis that pregnant women have blunted neurocardiovascular transduction we assessed the relationship between spontaneous bursts of sympathetic nerve activity (SNA) and fluctuations in mean arterial blood pressure and R-R interval. Resting SNA, blood pressure and ECG were obtained in pregnant (third trimester, n = 18) and non-pregnant (n = 18) women matched for age and pre-/non-pregnant body mass index. Custom software modelled beat-by-beat pressure (photoplethysmography) and R-R interval in relation to sequences of SNA bursts and non-bursts (peroneal microneurography). Sequences were grouped by the number of bursts and non-bursts [singlets, doublets, triplets and quadruplet (four or more)] and mean blood pressure and R-R interval were tracked for 15 subsequent cardiac cycles. Similar sequences were overlaid and averaged. Peak mean pressure in relation to sequences of SNA was reduced in pregnant vs. non-pregnant women (doublets: 1.6 ± 1.1 mmHg vs. 3.6 ± 3.1 mmHg, P < 0.05; triplets: 2.4 ± 1.2 mmHg vs. 3.4 ± 2.1 mmHg, P < 0.05; quadruplets: 3.0 ± 1.0 mmHg vs. 5.5 ± 3.7 mmHg, P < 0.05). The nadir R-R interval following burst sequences was also smaller in pregnant vs. non-pregnant women (singlets: -0.01 ± 0.01 s vs. -0.04 ± 0.04 s, P < 0.05; doublets: -0.02 ± 0.03 s vs. -0.05 ± 0.04 s, P < 0.05; triplets: -0.02 ± 0.01 s vs. -0.07 ± 0.04 s, P < 0.05; quadruplets: -0.01 ± 0.01 s vs. -0.09 ± 0.09 s, P < 0.05). There were no differences between groups in the mean arterial pressure and R-R interval responses to non-burst sequences. Our data clearly indicate blunted systemic neurocardiovascular transduction during normotensive pregnancy. We propose that blunted transduction is a positive adaptation protecting pregnant women from the cardiovascular consequences of sympathetic hyperactivity.
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Affiliation(s)
- Craig D Steinback
- Neurovascular Health Lab, Program for Pregnancy & Postpartum Health, Faculty of Physical Education & Recreation, Women and Children's Health Research Institute, University of Alberta, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Graham M Fraser
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Charlotte W Usselman
- Neurovascular Health Lab, Program for Pregnancy & Postpartum Health, Faculty of Physical Education & Recreation, Women and Children's Health Research Institute, University of Alberta, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Laura M Reyes
- Neurovascular Health Lab, Program for Pregnancy & Postpartum Health, Faculty of Physical Education & Recreation, Women and Children's Health Research Institute, University of Alberta, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Colleen G Julian
- Department of Medicine, University of Colorado Denver School of Medicine, Denver, CO, USA
| | | | - Radha S Chari
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Rshmi Khurana
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sandra T Davidge
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Margie H Davenport
- Neurovascular Health Lab, Program for Pregnancy & Postpartum Health, Faculty of Physical Education & Recreation, Women and Children's Health Research Institute, University of Alberta, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
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Corrêa MDS, Catai AM, Milan-Mattos JC, Porta A, Driusso P. Cardiovascular autonomic modulation and baroreflex control in the second trimester of pregnancy: A cross sectional study. PLoS One 2019; 14:e0216063. [PMID: 31086378 PMCID: PMC6516729 DOI: 10.1371/journal.pone.0216063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim is to evaluate and characterize cardiovascular autonomic control and baroreflex function and their response to an orthostatic stressor in the second trimester of pregnancy via time, frequency, information and symbolic analyses. Methods We evaluated 22 women at 18 weeks of pregnancy, labeled as pregnant group (PG) (30.8±4.4 years), and 22 non-pregnant women (29.8±5.4 years), labeled as control group (CG). Electrocardiogram, non-invasive photoplethysmographic arterial pressure (AP) and respiratory signals were recorded at rest at left lateral decubitus (REST) and during active standing (STAND) for 10 minutes. The heart period (HP) variability and systolic AP (SAP) variability were assessed in the frequency domain. High frequency (HF) and low frequency (LF) spectral indexes were computed. Nonlinear indexes such as symbolic markers (0V%, 1V%, 2LV% and 2UV% indexes), Shannon entropy (SE) and normalized complexity index (NCI) were calculated as well. Baroreflex control was assessed by cross-spectral HP-SAP analysis. We computed baroreflex sensitivity (BRS), HP-SAP squared coherence (K2) and phase in LF and HF bands. Results At REST, the PG had lower mean, variance and HF power of HP series and lower K2(LF), BRS(LF) and BRS(HF) than the CG. During STAND, CG and PG decreased the mean, CI, NCI and 2UV% and increased 0V% of the HP series and augmented the SAP variance. LFabs of SAP series increased during STAND solely in CG. BRS(HF) was reduced during in both PG and CG, while HFabs of HP series did not diminish during STAND either in PG or CG. Complexity of the autonomic control was similar in PG and CG regardless of the experimental condition. Conclusion We conclude that the second trimester of pregnancy was characterized by a lower parasympathetic modulation and reduced BRS at REST, preserved complexity of cardiac and vascular controls, limited sympathetic response to STAND and general conservation of the baroreflex responses to posture changes. Trial registration Begistro Brasileiro de Ensaios clínicos, Number: RBR-9s8t88.
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Affiliation(s)
- Mikaela da Silva Corrêa
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Patricia Driusso
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
- * E-mail:
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Fu Q. Sex differences in sympathetic activity in obesity and its related hypertension. Ann N Y Acad Sci 2019; 1454:31-41. [PMID: 31087350 DOI: 10.1111/nyas.14095] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 01/15/2023]
Abstract
The prevalence of obesity is rapidly increasing in the United States, particularly among women. Approximately 60-70% of hypertension in adults may be directly attributed to obesity. In addition, maternal obesity is a major risk factor for hypertensive disorders during pregnancy. The underlying mechanisms for the association between obesity and cardiovascular risk are multifactorial, but activation of the sympathetic nervous system is one significant contributing factor. This brief review summarizes the current knowledge on sex differences in sympathetic activity in obesity and its related hypertension, with a focus on studies in humans. Evidence suggests that abdominal visceral fat, rather than subcutaneous fat, is related to augmented sympathetic activity regardless of sex. Race/ethnicity may affect the relationship between obesity and sympathetic activity. Obesity-related hypertension has an important neurogenic component, which is characterized by sympathetic overactivity. However, sex may influence the association between hypertension and sympathetic overactivity in obese people. Finally, both body weight and sympathetic overactivity seem to be involved in the development of gestational hypertensive disorders in women. Chronic hyperinsulinemia due to insulin resistance, high plasma levels of leptin, and/or obstructive sleep apnea may be responsible for sympathetic overactivity in obesity-related hypertension.
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Affiliation(s)
- Qi Fu
- Women's Heart Health Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
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Pupillary Light Reflex as a New Prognostic Marker in Patients With Heart Failure. J Card Fail 2019; 25:156-163. [DOI: 10.1016/j.cardfail.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 11/22/2022]
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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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Benschop L, Duvekot JJ, Versmissen J, van Broekhoven V, Steegers EAP, Roeters van Lennep JE. Blood Pressure Profile 1 Year After Severe Preeclampsia. Hypertension 2018; 71:491-498. [PMID: 29437895 DOI: 10.1161/hypertensionaha.117.10338] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/09/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
Preeclampsia increases the long-term risk of cardiovascular disease, possibly through occurrence of hypertension after delivery, such as masked hypertension, night-time hypertension, and an adverse systolic night-to-day blood pressure (BP) ratio. These types of hypertension are often unnoticed and can only be detected with ambulatory BP monitoring (ABPM). We aimed to determine hypertension prevalence and 24-hour BP pattern with ABPM and office BP measurements in women 1 year after severe preeclampsia. This is a retrospective cohort study. As part of a follow-up program after severe preeclampsia, 200 women underwent ABPM and an office BP measurement 1 year after delivery. We calculated hypertension prevalence (sustained hypertension, masked hypertension, and white-coat hypertension) and systolic night-to-day BP ratio (dipping pattern). Medical files and questionnaires provided information on preexisting hypertension and antihypertensive treatment. One year after delivery, 41.5% of women had hypertension (sustained hypertension, masked hypertension, or white-coat hypertension) with ABPM. Masked hypertension was most common (17.5%), followed by sustained hypertension (14.5%) and white-coat hypertension (9.5%). With sheer office BP measurement, only 24.0% of women would have been diagnosed hypertensive. Forty-six percent of women had a disadvantageous dipping pattern. Hypertension is common 1 year after experiencing severe preeclampsia. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. Therefore, ABPM should be offered to all these women at high risk of developing hypertension and possibly future cardiovascular disease.
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Affiliation(s)
- Laura Benschop
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Johannes J Duvekot
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jorie Versmissen
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Valeska van Broekhoven
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeanine E Roeters van Lennep
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
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Dampney RA, Michelini LC, Li DP, Pan HL. Regulation of sympathetic vasomotor activity by the hypothalamic paraventricular nucleus in normotensive and hypertensive states. Am J Physiol Heart Circ Physiol 2018; 315:H1200-H1214. [PMID: 30095973 PMCID: PMC6297824 DOI: 10.1152/ajpheart.00216.2018] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 12/22/2022]
Abstract
The hypothalamic paraventricular nucleus (PVN) is a unique and important brain region involved in the control of cardiovascular, neuroendocrine, and other physiological functions pertinent to homeostasis. The PVN is a major source of excitatory drive to the spinal sympathetic outflow via both direct and indirect projections. In this review, we discuss the role of the PVN in the regulation of sympathetic output in normal physiological conditions and in hypertension. In normal healthy animals, the PVN presympathetic neurons do not appear to have a major role in sustaining resting sympathetic vasomotor activity or in regulating sympathetic responses to short-term homeostatic challenges such as acute hypotension or hypoxia. Their role is, however, much more significant during longer-term challenges, such as sustained water deprivation, chronic intermittent hypoxia, and pregnancy. The PVN also appears to have a major role in generating the increased sympathetic vasomotor activity that is characteristic of multiple forms of hypertension. Recent studies in the spontaneously hypertensive rat model have shown that impaired inhibitory and enhanced excitatory synaptic inputs to PVN presympathetic neurons are the basis for the heightened sympathetic outflow in hypertension. We discuss the molecular mechanisms underlying the presynaptic and postsynaptic alterations in GABAergic and glutamatergic inputs to PVN presympathetic neurons in hypertension. In addition, we discuss the ability of exercise training to correct sympathetic hyperactivity by restoring blood-brain barrier integrity, reducing angiotensin II availability, and decreasing oxidative stress and inflammation in the PVN.
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Affiliation(s)
- Roger A Dampney
- Department of Physiology, University of Sydney , Sydney, New South Wales , Australia
| | - Lisete C Michelini
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo , Brazil
| | - De-Pei Li
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Hui-Lin Pan
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
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Hieda M, Yoo JK, Sun DD, Okada Y, Parker RS, Roberts-Reeves MA, Adams-Huet B, Nelson DB, Levine BD, Fu Q. Time course of changes in maternal left ventricular function during subsequent pregnancy in women with a history of gestational hypertensive disorders. Am J Physiol Regul Integr Comp Physiol 2018; 315:R587-R594. [PMID: 29897820 PMCID: PMC6230888 DOI: 10.1152/ajpregu.00040.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/29/2018] [Accepted: 06/11/2018] [Indexed: 01/04/2023]
Abstract
Women with a history of gestational hypertensive disorders (GHD) are at increased risk for developing perinatal cardiovascular complications (e.g., gestational hypertension, preeclampsia, etc.) in subsequent pregnancies. The underlying mechanisms remain uncertain, but impaired maternal left ventricular function may be one contributing factor for these complications. We evaluated the time course of changes in left ventricular function before, during, and after pregnancy in women with prior GHD. Sixteen women with a history of GHD (the high-risk group) and 25 women without such a history (controls) were enrolled. Resting hemodynamic and echocardiographic measurements were longitudinally performed before pregnancy, during early pregnancy (4-8 wk of gestation), during late pregnancy (32-36 wk of gestation), and postpartum (6-10 wk after delivery). Pregnancy outcomes were obtained after delivery. At prepregnancy, there was no difference in blood pressure and heart rate between the groups. Corrected isovolumic relaxation time was longer, E/ e' was larger, and Tei index was greater in the high-risk group than controls. Moreover, the rate of GHD during the study was significantly greater in the high-risk group than controls [odds ratio = 8.94 (95% confidence interval: 1.55-51.5), P = 0.007]. Multiple logistic regression analysis adjusted for age demonstrated that prepregnancy E/ e' was an independent predictor for GHD ( P = 0.017). Thus, women with a history of GHD have modestly impaired cardiac function prepregnancy compared with controls, which identifies an increased susceptibility to developing cardiovascular complications during a subsequent pregnancy.
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Affiliation(s)
- Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dan-Dan Sun
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yoshiyuki Okada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rosemary S Parker
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Monique A Roberts-Reeves
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Beverley Adams-Huet
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - David B Nelson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
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Heart Rate Variability and Cardiovascular Reflex Tests for Assessment of Autonomic Functions in Preeclampsia. Int J Hypertens 2018; 2018:8163824. [PMID: 30319820 PMCID: PMC6167570 DOI: 10.1155/2018/8163824] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/13/2018] [Accepted: 09/02/2018] [Indexed: 11/23/2022] Open
Abstract
Alterations in the autonomic cardiovascular control have been implicated to play an important etiologic role in preeclampsia. The present study was designed to evaluate autonomic functions in preeclamptic pregnant women and compare the values with normotensive pregnant and healthy nonpregnant controls. Assessment of autonomic functions was done by cardiovascular reflex tests and by analysis of heart rate variability (HRV). Cardiovascular reflex tests included deep breathing test (DBT) and lying to standing test (LST). HRV was analyzed in both time and frequency domain for quantifying the tone of autonomic nervous system to the heart. The time domain measures included standard deviation of normal R-R intervals (SDNN) and square root of mean squared differences of successive R-R intervals (RMSSD). In the frequency domain we measured total power (TP), high frequency (HF) power, low frequency (LF) power, and LF/HF ratio. Cardiovascular reflex tests showed a significant parasympathetic deficit in preeclamptic women. Among parameters of HRV, preeclamptic group had lower values of SDNN, RMSSD, TP, HF, and LF (ms2) and higher value of LF in normalised units along with high LF/HF ratio compared to normotensive pregnant and nonpregnant controls. Furthermore, normotensive pregnant women had lower values of SDNN, TP, and LF component in both absolute power and normalised units compared to nonpregnant females. The results confirm that normal pregnancy is associated with autonomic disturbances which get exaggerated in the state of preeclampsia.
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Purdy GM, James MA, Wakefield PK, Skow RJ, Van Diepen S, May LE, Davenport MH, Steinback CD. Maternal cardioautonomic responses during and following exercise throughout pregnancy. Appl Physiol Nutr Metab 2018; 44:263-270. [PMID: 30138571 DOI: 10.1139/apnm-2018-0397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blood pressure regulation during pregnancy is poorly understood. Cardiovagal baroreflex gain (BRG) is an important contributor to blood pressure regulation through its influence on heart rate. Heart rate fluctuations occur in response to various physiological stimuli and can be measured using heart rate variability (HRV). It is unclear how these mechanisms operate during pregnancy, particularly with regard to exercise. We examined BRG and HRV prior to, during, and following prenatal exercise. Forty-three pregnant (n = 10 first trimester (TM1), n = 17 second trimester (TM2), n = 16 third trimester (TM3)) and 20 nonpregnant (NP) women underwent an incremental peak exercise test. Beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured throughout. BRG (the slope of the relationship between fluctuations in systolic blood pressure and the R-R interval) and HRV (root mean square of the successive differences; RMSSD) were assessed at rest, during steady-state exercise (EX), and during active recovery. BRG decreased with gestation and was lower in the TM3 group than in the NP group (17.9 ± 6.9 ms/mm Hg vs 24.8 ± 7.4 ms/mm Hg, p = 0.017). BRG was reduced during EX in all groups. Resting HRV (RMSSD) also decreased with gestation and was lower in the TM3 group than in the NP group (29 ± 17 ms vs 48 ± 20 ms, p < 0.001). RMSSD was blunted during EX in all groups compared with rest. During active recovery, RMSSD was further blunted compared with EX in the NP group but not during pregnancy (TM1, TM2, and TM3). Compared with the nonpregnant controls, the pregnant women had lower BRG and HRV at rest, but comparable cardioautonomic control during both exercise and active recovery following peak exercise.
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Affiliation(s)
- Graeme M Purdy
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Marina A James
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Paige K Wakefield
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Rachel J Skow
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Sean Van Diepen
- d Faculty of Medicine and Dentistry, Department of Critical Care and Division of Cardiology, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Linda E May
- e Division of Foundational Sciences and Research, East Carolina University, Greenville, NC 27858, USA
| | - Margie H Davenport
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Craig D Steinback
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Stanhewicz AE. Residual vascular dysfunction in women with a history of preeclampsia. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1062-R1071. [PMID: 30133302 DOI: 10.1152/ajpregu.00204.2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy characterized by new-onset hypertension, proteinuria, and edema occurring after 20 wk of gestation, with a prevalence of ~7-10% of pregnancies in the United States and ~8 million pregnancies worldwide. Despite the postpartum remission of preeclamptic symptoms, women who have had preeclampsia are two to four times more likely to develop cardiovascular disease (CVD) and are significantly more likely to die of CVD compared with women with a history of normal pregnancy. Although the relation between history of preeclampsia and elevated CVD risk is well documented, the mechanism(s) underlying this association remains unclear. One hypothesis explaining this association is that the initial vascular damage and dysfunction sustained during the preeclamptic pregnancy persist chronically. Indeed, even in the absence of, or in advance of, overt CVD women who have had preeclampsia have compromised vascular endothelial function. Emerging mechanistic studies in these women have provided some insight into the underlying mechanisms of this persistent vascular dysfunction and have begun to identify potential therapeutic targets for the prevention or mitigation of CVD progression in this vulnerable population. This review summarizes the existing literature examining vascular function and dysfunction in women with a history of preeclampsia and highlights future directions for mechanistic investigations and development of novel intervention strategies aimed at halting or slowing the progression of CVD in these women.
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Affiliation(s)
- Anna E Stanhewicz
- Department of Kinesiology, Pennsylvania State University , University Park, Pennsylvania
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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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47
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Reyes LM, Davenport MH. Exercise as a therapeutic intervention to optimize fetal weight. Pharmacol Res 2018; 132:160-167. [PMID: 29684673 DOI: 10.1016/j.phrs.2018.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/16/2018] [Accepted: 04/18/2018] [Indexed: 12/29/2022]
Abstract
The Developmental Origins of Health and Disease suggest the in utero environment programs offspring obesity and cardiovascular disease. Therefore, there is a need to implement safe therapeutic interventions that do not involve the intake of medications or biological products during pregnancy that can improve maternal and fetal health. Prenatal exercise is established to promote maternal and fetal health. It is generally recommended that women accumulate at least 150 min per week of moderate-intensity exercise. It has been demonstrated that prenatal exercise maintains healthy weight gain and improves maternal glucose control, maternal cardiac autonomic control, placental efficiency (increases angiogenesis, downregulates genes involved in fatty acid transport and insulin transport across the placenta, and upregulates genes involved in amino acid transport across the placenta), and oxidative stress. These adaptations following exercise improve maternal metabolism and provide adequate uteroplacental perfusion. In this review, we will focus on exercise as a therapeutic intervention to optimize fetal weight. It has been established that prenatal exercise does not increase the risk of having a small for gestational age baby. To the contrary, prenatal exercise has been associated with the prevention of excessive fat accumulation in the newborn and the maintenance of fetal muscle mass.
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Affiliation(s)
- Laura M Reyes
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, T6G 2E1, Alberta, Canada.
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, T6G 2E1, Alberta, Canada.
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48
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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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Reyes LM, Usselman CW, Skow RJ, Charkoudian N, Staab JS, Davenport MH, Steinback CD. Sympathetic neurovascular regulation during pregnancy: A longitudinal case series study. Exp Physiol 2018; 103:318-323. [PMID: 29336094 DOI: 10.1113/ep086771] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/09/2018] [Indexed: 01/26/2023]
Abstract
NEW FINDINGS What is the main observation in this case? The main observation of this case report is that during pregnancy there is a progressive sympatho-excitation in basal conditions and under stress, which is offset by a concurrent reduction in neurovascular transduction. Strong correlations between autonomic nervous system activity and sex hormones (oestrogen and progesterone), vasopressin and aldosterone were found. What insights does it reveal? Our findings suggest that hormonal surges might be associated with central sympathetic activation. ABSTRACT The adaptations of sympathetic nerve activity (SNA) during pregnancy remain poorly understood. An increase in blood volume, cardiac output and SNA, with a concomitant drop in total peripheral resistance (TPR), suggest that during pregnancy there is a reduced transduction of SNA into TPR. Most of these findings have originated from cross-sectional studies; thus, we conducted a longitudinal assessment of SNA and TPR in two participants. Measurements were made before pregnancy (early follicular phase), on four occasions during pregnancy and at 2 months postpartum. Mean arterial pressure and cardiac output were used to calculate TPR. The SNA was measured using microneurography (peroneal nerve). There was a gestation-dependent increase in SNA burst frequency (r2 = 0.96, P = 0.009). Neurovascular transduction, however, decreased by 53% in both women. Sympathetic hyperactivity was reversed postpartum, whereas neurovascular transduction remained lower. These longitudinal data highlight the progressive sympatho-excitation of pregnancy, which is offset by a concurrent reduction in neurovascular transduction.
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Affiliation(s)
- Laura M Reyes
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.,Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Charlotte W Usselman
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.,Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Rachel J Skow
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.,Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Nisha Charkoudian
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Jeffery S Staab
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.,Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada.,Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
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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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