Effect of changes in body posture on vasoactive hormones in pre-eclamptic women

Abstract

The aim of this study was to determine the normality or otherwise of neurohormone indices, particularly the sympathetic nervous system, in pre-eclamptic patients and document whether changes in body posture magnify any differences between pre-eclamptic and normal women. We studied 11 women with pre-eclampsia and compared them with 17 matched normotensive pregnant women and eight nonpregnant women. Measurements of arterial pressure, heart rate and neurohormones were carried out with subjects in the left lateral position, then supine, left lateral, with upright posture and finally with assumption of the left lateral position again. Main outcome measures were arterial pressure, heart rate and hormones (plasma norepinephrine, renin activity, natriuretic peptides and endothelin-1). We observed that plasma norepinephrine levels were higher in pre-eclamptic than normotensive pregnant women and this was most obvious in the upright position. Plasma renin activity was likewise higher in pre-eclamptic than normotensive pregnant women, again most obvious with upright posture. Plasma natriuretic peptides and endothelin-1 levels were similar in pre-eclamptics and normotensive pregnant women. These data strengthen the premise that pre-eclampsia is associated with sympathetic overactivity as reflected by plasma norepinephrine levels, most obviously observed in the upright position.

Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

“…This would suggest a possibility of using the circulating levels of natriuretic peptides for the early identification of the degree of cardiac involvement in the different forms of hypertension complicating pregnancy. Our observations are only partially in agreement with those reported in the literature where the plasma levels of the different natriuretic peptides range from a generalized increase in pregnant hypertensive patients [33] to the findings of Kaaja et al [34] that exclude the presence of any significant difference between the plasma levels of such biomarkers in normotensive and pre-eclamptic pregnant women. These discrepancies again might simply reflect some overlapping in the classification of patients or differences in the week of pregnancy or in the posture before or during blood sampling that cannot ruled out.…”

Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia

“…Afferent signals to the CNS can also activate the efferent sympathetic nervous system pathways. In preeclampsia sympathetic overactivity was suggested by elevated norepinephrine levels and plasma renin activity effect of changes in body posture in the upright position [30]. The increase in sympathetic activity is associated with collapse of venous capacitance vessels.…”

Inverted Takotsubo-Like Left Ventricular Dysfunction with Pulmonary Oedema Developed after Caesarean Delivery Complicated by Massive Haemorrhage in a Severe Preeclamptic Parturient with a Prolonged Painful Labour

“…In addition, preeclampsia has been associated with sympathetic overactivity [5]. Furthermore, a severe preeclampsia if any may precipitate a pulmonary oedema linked to fluid administration [6].…”