Abstract-We tested the hypothesis that women with idiopathic fetal growth restriction (FGR) or preeclampsia (PE) have lower concentrations of some water-retaining hormones, such as aldosterone and estradiol, either preceding or concomitant with the onset of the reduced plasma volume described in these women. Plasma volume and serum concentrations of estradiol, progesterone, and aldosterone were measured serially at monthly intervals in 135 pregnant women from week 10 until term. Twenty-three developed idiopathic FGR, 17 had PE, and 95 remained normotensive and delivered normal-size infants (controls). Changes over time for each variable were studied using mixed models.Maternal age, parity, and weight/height at term were similar in all of the groups. Birth weight, body length, and ponderal index were lower in FGR and PE than in controls. Plasma volume increased throughout pregnancy in controls but was lower in FGR and PE from week 14 to 17 until term. Aldosterone values were lower in PE from week 26 to 29 onwards and in FGR after week 34. Progesterone concentrations were higher in PE than either control or FGR from week 18 to 21 until term. In contrast, FGR pregnancies had reduced progesterone and estradiol concentrations after week 34. Progesterone:estradiol ratio was significantly higher only in the PE group. In mothers with idiopathic FGR or PE, less expansion in plasma volume occurred before alterations in hormonal concentrations. We speculate that the early rise in progesterone may have a pathogenic role in the development of preeclampsia. Key Words: blood Ⅲ aldosterone Ⅲ preeclampsia Ⅲ estrogen P reeclampsia (PE) and fetal growth restriction (FGR) are frequent disorders of pregnancy and a leading cause of prenatal morbidity and mortality. In near-term pregnant women with either PE or FGR, we demonstrated lower plasma volume expansion, reduced cardiac output, and an increased total peripheral vascular resistance when compared with normotensive women who gave birth to normal-size infants. 1-3 Volume expansion during normal pregnancy seems to be secondary to renal and systemic vasodilatation that would activate the renin-angiotensin-aldosterone system that, in turn, would cause renal sodium and water retention. 4 -6 Estrogen production may also have a role in plasma volume expansion by stimulating hepatic angiotensinogen synthesis. 5,7 According to this proposed pathway for volume expansion, in the present study we tested the hypothesis that women with PE or FGR would have lower serum aldosterone and estradiol concentrations either preceding or concomitant with the onset of the reduced plasma volume. We measured plasma volume and hormonal concentrations in initially healthy pregnant women from weeks 10 to 13 until near term. After delivery, we compared the time course of these changes in control, FGR, and PE women.
MethodsParticipants were women attending 2 prenatal clinics of the Southeastern Health Service of Santiago, Chile (Alejandro del Río and La Granja). These women belonged to a low-income population ...