Influence of the Menstrual Cycle, Pregnancy, and Preeclampsia on Arterial Stiffness

Abstract

Abstract-Arterial stiffness and compliance are major predictors of adverse cardiovascular events and are influenced by female sex hormones, including estrogen and progesterone. The aim of this longitudinal study was to evaluate the effect of the menstrual cycle, normal pregnancy, and preeclampsia on central and systemic arterial stiffness. Ten healthy nulliparous women with regular menses were studied in the early and midfollicular, periovulatory, and luteal phases of a single menstrual cycle. Twenty-two primigravida pregnant women were studied throughout pregnancy at 16, 24, 32, and 37 weeks gestation and at 7 weeks postpartum. Fifteen primigravida women with preeclampsia were studied at diagnosis and 7 weeks postpartum. Augmentation index and carotid-radial and carotid-femoral pulse wave velocities were measured using applanation tonometry. Augmentation index fell during the luteal phase of the menstrual cycle (luteal phase versus periovulatory phase; PϽ0.05). In normal pregnancy, pulse wave velocity and augmentation index increased from 24 weeks over the third trimester (PՅ0.01 for both). All of the measures were increased in women with preeclampsia (PՅ0.01), with augmentation index and carotid-femoral pulse wave velocity remaining elevated 7 weeks postpartum (PՅ0.02). We conclude that systemic arterial stiffness undergoes major changes during the menstrual cycle and pregnancy and that preeclampsia is associated with greater and more prolonged increases in arterial stiffness. These effects may contribute to adverse cardiovascular outcomes of pregnancy and preeclampsia.

Reference Values of Pulse Wave Velocity in Healthy Children and Teenagers

“…We did not address this question in the present study; however, in their work, Robb et al 30 could show that PWV is not significantly affected by the periodical physiological changes of steroid hormones in women. Thus, in this particular case, the PWV is more than 2 standard deviations higher compared to the healthy population.…”

Obesity, pregnancy, inflammation, and vascular function

“…In order to sustain the developing fetus, extensive cardiovascular adaptation occurs during pregnancy (Robb et al 2009a(Robb et al , 2009b. Increased production of endothelium-derived vasodilators is accompanied by enhancement of endothelial function and reactivity (Anumba et al 1999) and an increase in flow-mediated dilation of the brachial artery (Dorup et al 1999).…”

The Changes of Aortic Stiffness During Normal Menstrual Cycle

“…They revealed that AI reduced during late follicular and early luteal phase. Another study by Robb et al (2009) also observed that AI reduced during luteal phase when compared to periovulatory phase. The possible discrepancy in our result and theirs was probably due to different phases of menstrual cycle used to assess menstrual hormonal fluctuation.…”

“…Another study from Ounis-Skali et al (2006), which involved a comprehensive assessment of central and peripheral PWV, central waveform morphology, and central aortic pressure too showed no significant changes in BP and PWV throughout phases of the normal menstrual cycle. Study by Robb et al (2009), which studied ten healthy nulliparous women with regular menses in the early and midfollicular, periovulatory, and luteal phases of a single menstrual cycle showed no changed in PWV. Another study by Adkisson et al (2010) which measured PWV at early follicular, late follicular, early luteal and late luteal phase also found no changes.…”

“…Oestrogen modulates vascular function by increasing nitric oxide (NO) level in the blood and this may lead to reduce aortic stiffness (Hayashi et al 1995;Rajkumar et al 1997). Previous studies found that vascular functions changed during menstrual cycle (Robb et al 2009;Madhura & Sandhya 2014;Hayashi et al 2006) while other studies found no change (Ounis-Skali et al 2006;Papaioannou et al 2009). …”