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Brislane Á, Steinback CD, Davenport MH. The Nine Month Stress Test: Pregnancy and Exercise - Similarities and Interactions. Can J Cardiol 2021; 37:2014-2025. [PMID: 34534622 DOI: 10.1016/j.cjca.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Of all physiological systems, the cardiovascular system takes on the most profound adaptation in pregnancy to support fetal growth and development. The adaptations that arise are systemic and involve structural and functional changes that can be observed at the cerebral, central, peripheral, and microvascular beds. This includes, although is not limited to increased heart rate, stroke volume and cardiac output with negligible change to blood pressure, reductions in vascular resistance and cerebral blood flow velocity, systemic artery enlargement, enhanced endothelial function. All of this takes place to accommodate blood volume expansion and ensure adequate fetal and maternal oxygen delivery. In some instances, the demand placed on the vasculature can manifest as cardiovascular maladaptation and thus, cardiovascular complications can arise. Exercise is recommended in pregnancy because of its powerful ability to reduce the incidence and severity of cardiovascular complications in pregnancy. However, the mechanism by which it acts is poorly understood. The first aim of this review is to describe the systemic adaptations that take place in pregnancy. Secondly, this review aims to describe the influence of exercise on these systemic adaptations. It is anticipated that this review can comprehensively capture the extent of knowledge in this area while identifying areas that warrant further investigation.
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Affiliation(s)
- Áine Brislane
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada
| | - Craig D Steinback
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada.
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Maternal microvascular dysfunction during preeclamptic pregnancy. Clin Sci (Lond) 2021; 135:1083-1101. [PMID: 33960392 DOI: 10.1042/cs20200894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy effecting ∼5-8% of pregnancies in the United States, and ∼8 million pregnancies worldwide. Preeclampsia is clinically diagnosed after the 20th week of gestation and is characterized by new onset hypertension accompanied by proteinuria and/or thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. This broad definition emphasizes the heterogeneity of the clinical presentation of preeclampsia, but also underscores the role of the microvascular beds, specifically the renal, cerebral, and hepatic circulations, in the pathophysiology of the disease. While the diagnostic criteria for preeclampsia relies on the development of de novo hypertension and accompanying clinical symptoms after 20-week gestation, it is likely that subclinical dysfunction of the maternal microvascular beds occurs in parallel and may even precede the development of overt cardiovascular symptoms in these women. However, little is known about the physiology of the non-reproductive maternal microvascular beds during preeclampsia, and the mechanism(s) mediating microvascular dysfunction during preeclamptic pregnancy are largely unexplored in humans despite their integral role in the pathophysiology of the disease. Therefore, the purpose of this review is to provide a summary of the existing literature on maternal microvascular dysfunction during preeclamptic pregnancy by reviewing the functional evidence in humans, highlighting potential mechanisms, and providing recommendations for future work in this area.
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Abstract
Purpose of Review Risks for developing cardiovascular disease and cognitive decline increase with age. In women, these risks may be influenced by pregnancy history. This review provides an integrated evaluation of associations of pregnancy history with hypertension, brain atrophy, and cognitive decline in postmenopausal women. Recent Findings Atrophy in the occipital lobes of the brain was evident in women who had current hypertension and a history of preeclampsia. Deficits in visual memory in women with a history of preeclampsia are consistent with these brain structural changes. The blood velocity response to chemical and sympathoexcitatory stimuli were altered in women with a history of preeclampsia linking impairments in cerebrovascular regulation to the structural and functional changes in the brain. Summary Having a history of preeclampsia should require close monitoring of blood pressure and initiation of anti-hypertensive treatment in perimenopausal women. Mechanisms by which preeclampsia affects cerebrovascular structure and function require additional study.
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Affiliation(s)
- Kathleen B Miller
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Medical Sci Bldg 421, 200 First St SW, Rochester, MN, 55905, USA.
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Medical Sci Bldg 421, 200 First St SW, Rochester, MN, 55905, USA.
| | - Jill N Barnes
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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Abstract
Sex and gender, as biological and social factors, significantly influence health outcomes. Among the biological factors, sex differences in vascular physiology may be one specific mechanism contributing to the observed differences in clinical presentation, response to treatment, and clinical outcomes in several vascular disorders. This review focuses on the cerebrovascular bed and summarizes the existing literature on sex differences in cerebrovascular hemodynamics to highlight the knowledge deficit that exists in this domain. The available evidence is used to generate mechanistically plausible and testable hypotheses to underscore the unmet need in understanding sex-specific mechanisms as targets for more effective therapeutic and preventive strategies.
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Affiliation(s)
- Cristina Duque
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Neurology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Steven K Feske
- Division of Stroke, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Barnes JN, Harvey RE, Miller KB, Jayachandran M, Malterer KR, Lahr BD, Bailey KR, Joyner MJ, Miller VM. Cerebrovascular Reactivity and Vascular Activation in Postmenopausal Women With Histories of Preeclampsia. Hypertension 2017; 71:110-117. [PMID: 29158356 DOI: 10.1161/hypertensionaha.117.10248] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/06/2017] [Accepted: 10/26/2017] [Indexed: 12/21/2022]
Abstract
Cerebrovascular reactivity (CVR) is reduced in patients with cognitive decline. Women with a history of preeclampsia are at increased risk for cognitive decline. This study examined an association between pregnancy history and CVR using a subgroup of 40 age- and parity-matched pairs of women having histories of preeclampsia (n=27) or normotensive pregnancy (n=29) and the association of activated blood elements with CVR. Middle cerebral artery velocity was measured by Doppler ultrasound before and during hypercapnia to assess CVR. Thirty-eight parameters of blood cellular elements, microvesicles, and cell-cell interactions measured in venous blood were assessed for association with CVR using principal component analysis. Middle cerebral artery velocity was lower in the preeclampsia compared with the normotensive group at baseline (63±4 versus 73±3 cm/s; P=0.047) and during hypercapnia (P=0.013-0.056). CVR was significantly lower in the preeclampsia compared with the normotensive group (2.1±1.3 versus 2.9±1.1 cm·s·mm Hg; P=0.009). Globally, the association of the 7 identified principal components with preeclampsia (P=0.107) and with baseline middle cerebral artery velocity (P=0.067) did not reach statistical significance. The interaction between pregnancy history and principal components with respect to CVR (P=0.084) was driven by a nominally significant interaction between preeclampsia and the individual principal component defined by blood elements, platelet aggregation, and interactions of platelets with monocytes and granulocytes (P=0.008). These results suggest that having a history of preeclampsia negatively affects the cerebral circulation years beyond the pregnancy and that this effect was associated with activated blood elements.
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Affiliation(s)
- Jill N Barnes
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN.
| | - Ronée E Harvey
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
| | - Kathleen B Miller
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
| | - Muthuvel Jayachandran
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
| | - Katherine R Malterer
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
| | - Michael J Joyner
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN
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Steinback CD, King EC, Davenport MH. Longitudinal cerebrovascular reactivity during pregnancy: a case study. Appl Physiol Nutr Metab 2015; 40:636-9. [DOI: 10.1139/apnm-2014-0526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Normal cerebrovascular adaptation during pregnancy is poorly understood. We document a case study of progressively increased cerebrovascular reactivity to CO2, despite no change in resting blood flow, from prepregnancy to late gestation in a 36-year-old normotensive participant. Increased cerebral reactivity was related to progressive chronic respiratory alkalosis and specifically elevated pH and reduced HCO3–. These novel data serve as important indicators of normative maternal cerebral adaptation and highlight novel areas of future study.
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Affiliation(s)
- Craig D. Steinback
- Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2E1, Canada
- Physical Activity and Diabetes Lab, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Emily C. King
- Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Margie H. Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2E1, Canada
- Physical Activity and Diabetes Lab, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
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van Veen TR, Panerai RB, Haeri S, Zeeman GG, Belfort MA. Effect of breath holding on cerebrovascular hemodynamics in normal pregnancy and preeclampsia. J Appl Physiol (1985) 2015; 118:858-62. [PMID: 25614597 DOI: 10.1152/japplphysiol.00562.2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/20/2015] [Indexed: 11/22/2022] Open
Abstract
Preeclampsia (PE) is associated with endothelial dysfunction and impaired autonomic function, which is hypothesized to cause cerebral hemodynamic abnormalities. Our aim was to test this hypothesis by estimating the difference in the cerebrovascular response to breath holding (BH; known to cause sympathetic stimulation) between women with preeclampsia and a group of normotensive controls. In a prospective cohort analysis, cerebral blood flow velocity (CBFV) in the middle cerebral artery (transcranial Doppler), blood pressure (BP, noninvasive arterial volume clamping), and end-tidal carbon dioxide (EtCO2) were simultaneously recorded during a 20-s breath hold maneuver. CBFV changes were broken down into standardized subcomponents describing the relative contributions of BP, cerebrovascular resistance index (CVRi), critical closing pressure (CrCP), and resistance area product (RAP). The area under the curve (AUC) was calculated for changes in relation to baseline values. A total of 25 preeclamptic (before treatment) and 25 normotensive women in the second half of pregnancy were enrolled, and, 21 patients in each group were included in the analysis. The increase in CBFV and EtCO2 was similar in both groups. However, the AUC for CVRi and RAP during BH was significantly different between the groups (3.05 ± 2.97 vs. -0.82 ± 4.98, P = 0.006 and 2.01 ± 4.49 vs. -2.02 ± 7.20, P = 0.037), indicating an early, transient increase in CVRi and RAP in the control group, which was absent in PE. BP had an equal contribution in both groups. Women with preeclampsia have an altered initial CVRi response to the BH maneuver. We propose that this is due to blunted sympathetic or myogenic cerebrovascular response in women with preeclampsia.
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Affiliation(s)
- Teelkien R van Veen
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands; Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, Texas;
| | - Ronney B Panerai
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; and
| | - Sina Haeri
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, Texas; St. David's Women's Center of Texas, North Austin Maternal-Fetal Medicine, Austin, Texas
| | - Gerda G Zeeman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
| | - Michael A Belfort
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, Texas
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