Peripartal Temporal Course of Endothelin 1, Angiotensin II, and Atrial Natriuretic Peptide in Pre-Eclampsia and Normotensive Pregnancy

Abstract

Objective: To investigate the temporal peripartal course of plasma endothelin 1 (ET-1), angiotensin II (ANG II), and atrial natriuretic peptide (ANP) in patients with pre-eclampsia as compared to women with normotensive pregnancy. Methods: Levels of ET-1, ANG II, and ANP were measured by means of radio-immunoassay twice a week in 17 patients with pre-eclampsia and in 17 women with normotensive uncomplicated pregnancy during four different periods: (a) from admission to 1 week before delivery, (b) 1st week before delivery, (c) 1st week after delivery, and (d) 2nd week after delivery. Results: ET-1 levels were not statistically different between the two groups. ANG II concentrations were lower in the pre-eclampsia group than in the control group with statistical significance in period c (2.8 ± 3.0 vs. 7.1 ± 5.9 pg/ml, mean ± SD). ANP levels were higher in pre-eclamptic women than in the control group, the difference being statistically significant in period a (54 ± 46 vs. 11 ± 16 pg/ml) and in period c (122 ± 134 vs. 39 ± 22 pg/ml). Conclusions: There are considerable differences in ANP and ANG II concentrations during the peripartal period between patients with pre-eclampsia and normotensive pregnant women. Decreased ANG II and elevated ANP levels in the 1st week postpartum may reflect the clinical observation that some women deteriorate in this period.

Cardiovascular Biomarker Midregional Proatrial Natriuretic Peptide During and After Preeclamptic Pregnancies

“…Such adjustments should lead to lower ANP concentrations in preeclampsia, in contrast to the findings of elevated circulating ANP in the majority of studies on ANP. [13][14][15][16] Our finding of increased MR-proANP in preeclampsia, a hormone released on atrial wall distension, supports the important clinical message of restrictive and cautious fluid resuscitation in preeclampsia, even in the case of oliguria. It is well known that preeclamptic women are prone to the development of pulmonary edema, which is considered to be of multifactorial genesis.…”

“…A previous longitudinal study of circulating ANP concentrations in formerly preeclamptic women had a follow-up period limited to a few weeks postpartum. 15 A significant decrease of ANP concentration in the second week postpartum has been reported. 15 At that time point, there were rat plasma rat heart rat fetal heart SD PE * * * Figure 3.…”

“…15 A significant decrease of ANP concentration in the second week postpartum has been reported. 15 At that time point, there were rat plasma rat heart rat fetal heart SD PE * * * Figure 3. A, Atrial natriuretic peptide (ANP) expression in human tissue of heart, kidney, placenta, and decidua is shown (*PϽ0.0001 vs all other tissues).…”

“…30 Our MR-proANP findings are largely in accord with earlier reports looking at ANP concentrations in preeclampsia. [13][14][15][16] However, other studies were conflicting, [17][18][19] possibly because of differences in the assay methodology. 20 A strength of our study lies in the fact that the assay that we used detects more stable parts of the precursors of ANP.…”

“…9,10 Plasma ANP is considered a prognostic marker for acute heart failure, risk of cardiovascular events, and death. 11,12 Previous studies of ANP in maternal circulation in pregnancy are controversial, with reports of increased, [13][14][15][16] as well as similar, [17][18][19] circulating ANP concentrations in preeclampsia compared with normotensive pregnancy. However, ANP is an unstable peptide, and it has been remarked that ANP assays used in previous studies may have underestimated the quantity of the circulating hormone because of an early degradation of crucial epitopes at the extreme ends of the precursor molecule.…”