Preeclampsia and maladaptation to pregnancy: A role for atrial natriuretic peptide?

Spaanderman, Marc E. A.; Ekhart, Timo; Eyck, Jim van; Leeuw, Peter de; Peeters, Louis L.H.

doi:10.1046/j.1523-1755.2001.00943.x

Cited by 52 publications

(62 citation statements)

References 21 publications

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“…7 The resulting lowvolume high-output circulation will exert extra shear stress on the endothelium. 3,7 This may set the stage for endothelial dysfunction, vascular damage, and hypertensive disease in pregnancy and later in life.The venous compartment is the most prominent blood volume reservoir of the body. Although at rest two-thirds of PV is localized in the venous system, it can be rapidly mobilized by sympathetic-mediated venoconstriction in times of increased arterial demands, including pregnancy and exercise.…”

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“…5,6 Formerly PE women with low PV show reduced PV expansion in pregnancy, which suggests that the adaptive capacity of the venous system in these women is limited. 7 When PV expansion cannot meet the physiological demands, the circulation may compensate for it by an increase in sympathetic activity. 7 The resulting lowvolume high-output circulation will exert extra shear stress on the endothelium.…”

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confidence: 99%

“…7 When PV expansion cannot meet the physiological demands, the circulation may compensate for it by an increase in sympathetic activity. 7 The resulting lowvolume high-output circulation will exert extra shear stress on the endothelium. 3,7 This may set the stage for endothelial dysfunction, vascular damage, and hypertensive disease in pregnancy and later in life.…”

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Aerobic Exercise Training in Formerly Preeclamptic Women

et al. 2015

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Women with a history of preeclampsia are at increased risk of recurrent gestational hypertensive disease and cardiovascular disease later in life.1,2 Fifty percent of formerly preeclamptic women (formerly PE women) have low plasma volume (PV) 3 and the recurrence risk of preeclampsia varies inversely with PV. 4 In pregnancy, a marked PV expansion (+30% to 60%) is required to meet the physiological demands of advanced pregnancy. 5,6 Formerly PE women with low PV show reduced PV expansion in pregnancy, which suggests that the adaptive capacity of the venous system in these women is limited.7 When PV expansion cannot meet the physiological demands, the circulation may compensate for it by an increase in sympathetic activity. 7 The resulting lowvolume high-output circulation will exert extra shear stress on the endothelium. 3,7 This may set the stage for endothelial dysfunction, vascular damage, and hypertensive disease in pregnancy and later in life.The venous compartment is the most prominent blood volume reservoir of the body. Although at rest two-thirds of PV is localized in the venous system, it can be rapidly mobilized by sympathetic-mediated venoconstriction in times of increased arterial demands, including pregnancy and exercise. 8,9 Venous capacity is largely determined by venous compliance (VeC) and varies dynamically with sympathetic tone predominantly controlled by the baroreflex system. 8 Dynamic changes in VeC can be tested through orthostatic stress testing. Previous studies demonstrated that formerly PE women at rest have low venous reserve, characterized by low PV, low VeC, and high sympathetic tone. 10Aerobic exercise is perhaps the best intervention to improve venous reserve. It increases PV and reduces sympathetic tone in healthy individuals. 11,12 In formerly PE women with low PV, aerobic exercise training could help to normalize venous reserve and thereby reduce the risk of hypertensive disease in future pregnancy and later in life. The extent to which formerly PE women are able to improve their venous reserve by exercise training is unknown. Our study addresses the question to what extent an aerobic exercise training program Abstract-In women with a history of preeclampsia, low plasma volume (≤1373 mL/m 2 ) is associated with recurrent preeclampsia and chronic hypertension. Interventions that improve volume reserve may reduce these risks in formerly preeclamptic women. In this study, we examined the effects of aerobic exercise training on venous reserves in 24 normotensive formerly preeclamptic women and 20 controls. Before and after 12-week aerobic exercise training, we measured plasma volume with albumin indicator dilution technique and venous compliance with venous occlusion plethysmography. Venous compliance and hemodynamic responses were assessed dynamically during graded head-up tilt (HUT). Formerly preeclamptic women had lower pretraining plasma volume and venous compliance than controls (1348±78 versus 1529±112 mL/m ; P<0.01, respectively). Blood pressure decreased comparably between...

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Aerobic Exercise Training in Formerly Preeclamptic Women

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“…In pregnancy, however, women who develop preeclampsia are not chronically underfilled because compensatory neurohumoral changes such as elevated renin, angiotensin, and aldosterone levels are lacking. 22 Whether neurohumoral changes contribute, either by cause or effect, to LPV status in the nonpregnant situation of formerly preeclamptic women is currently unknown. Therefore neurohumoral explanations for LPV cannot be completely excluded.…”

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Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension

et al. 2015

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P reeclampsia is a serious hypertensive pregnancy disorder complicating 2% to 5% of all pregnancies. Preeclampsia is characterized by hypertension and proteinuria after 20 weeks of gestation. Women with a history of preeclampsia are at increased risk to develop early onset cardiovascular disease (CVD) later in life when compared with women who had an uneventful pregnancy.1 Therefore, in 2011, the American Heart Association added preeclampsia to the list of risk factors for developing CVD.2 The mechanistic explanation for the link between preeclampsia and later CVD remains to be elucidated. 3Numerous studies demonstrated increased prevalence of cardiovascular risk factors after a pregnancy complicated by preeclampsia. [4][5][6] Most formerly preeclampsia women, however, do not demonstrate a traditional cardiovascular risk profile within the first years after preeclampsia.6 Yet, when compared with healthy parous controls, the relative risk of developing chronic hypertension within 15 years after preeclampsia is estimated 3.7 (95% confidence interval, 2.7-5.5).1 This observation indicates that a subset of normotensive formerly preeclampsia women is at risk to develop hypertension within the first years after the affected pregnancy. It is conceivable that these formerly preeclampsia women have subtle or latent abnormalities that could explain the increased cardiovascular risk after pregnancy.Low plasma volume (PV) is considered to reflect latent hypertension, 7 and normotensive formerly preeclampsia women with low PV (LPV) are prone to develop recurrent hypertensive disease in subsequent pregnancy. 8 Whether PV status also relates to chronic hypertension after a pregnancy complicated by preeclampsia has never been studied before. We hypothesized that LPV status in normotensive formerly preeclampsia women predisposes to the development of hypertension. In this longitudinal study, we additionally studied how the traditional cardiovascular and metabolic risk profiles evolve over time after a preeclamptic pregnancy.Abstract-Formerly preeclamptic women are at risk for cardiovascular disease. Low plasma volume may reflect latent hypertension and potentially links preeclampsia with chronic cardiovascular disease. We hypothesized that low plasma volume in normotensive formerly preeclamptic women predisposes to hypertension. We longitudinally studied n=104 formerly preeclamptic women in whom plasma volume was measured 3 to 30 months after the preeclamptic pregnancy. Cardiovascular variables were assessed at 2 points in time (3-30 months postpartum and 2-5 years thereafter). Study population was divided into low plasma volume (≤1373 mL/m 2 ) and normal plasma volume (>1373 mL/m 2 ). Primary end point was hypertension at the second visit: defined as ≥140 mm Hg systolic or ≥90 mm Hg diastolic. Secondary outcome of this study was change in traditional cardiovascular risk profile between visits. Variables correlating univariately with change in blood pressure between visits were introduced in regression analysis. Eighteen of 104 ...

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Optimal first trimester preeclampsia prediction: a comparison of multimarker algorithm, risk profiles and their sequential application

Gabbay‐Benziv

Oliveira²,

Baschat

2015

Prenatal Diagnosis

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Objective To compare performance of multimarker algorithm, risk profiles and their sequential application in prediction of preeclampsia and determining potential intervention targets.Study Design Maternal characteristics, ultrasound variables and serum biomarkers were collected prospectively at first trimester. Univariate analysis identified preeclampsia associated variables followed by logistic regression analysis to determine the prediction rule. Combined characteristics of the cardiovascular, metabolic and the personal risk factors were compared to the multimarker algorithm and the sequential application of both methods.Results Out of 2433 women, 108 developed preeclampsia (4.4%). Probability scores considering nulliparity, prior preeclampsia, body mass index, diastolic blood pressure and placental growth factor had an area under the receiver operating characteristic curve 0.784 (95% CI = 0.721-0.847). While the multimarker algorithm had the lowest false negative rate, sequential application of cardiovascular and metabolic risk profiles in screen positives reduced false positives by 26% and identified blood pressure and metabolic risk in 49/54 (91%) women with subsequent preeclampsia as treatable risk factors.Conclusion Sequential application of a multimarker algorithm followed by determination of treatable risk factors in screen positive women is the optimal approach for first trimester preeclampsia prediction and identification of women that may benefit from targeted metabolic or cardiovascular treatment.

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Preeclampsia and maladaptation to pregnancy: A role for atrial natriuretic peptide?

Cited by 52 publications

References 21 publications

Aerobic Exercise Training in Formerly Preeclamptic Women

Aerobic Exercise Training in Formerly Preeclamptic Women

Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension

Optimal first trimester preeclampsia prediction: a comparison of multimarker algorithm, risk profiles and their sequential application

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