Cardiovascular changes in early phase of pregnancy

Capeless, Eleanor L.; Clapp, James F.

doi:10.1016/0002-9378(89)90902-2

Cited by 231 publications

(55 citation statements)

References 12 publications

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“…1b), we noted its percent changes from the virgin value showed an identical pattern to those in GFR demonstrated in previous studies [17,29]. It has generally been believed that glomerular hyperfiltration during pregnancy is mainly due to the increase in the total body fluid [33], sympathetic nerve-related tonus changes in the systemic vascular resistance [34,35], and the influence of multiple vasoactive factors, such as nitric oxide and relaxin [36,37]. However, since renal PGE 2 directly dilates the afferent arterioles in the glomeruli, and thus contributes to the maintenance of GFR [38], our present findings strongly suggest the physiological relevance between the gestational rise in GFR and the increase in the renal PGE 2 , although additional studies will be required to address the issue.…”

Section: Discussionsupporting

confidence: 57%

Decreased Expression of a Novel Prostaglandin Transporter, OAT-PG, Facilitates Renocortical PGE<sub>2</sub> Accumulation during Rat Pregnancy

Kazama

Matsubara

Kanai

et al. 2013

Gynecol Obstet Invest

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Background: Prostaglandin (PG)-specific organic anion transporter (OAT-PG) is a recently identified renal transporter involved in the local clearance of prostaglandin E₂ (PGE₂). Since the renal biosynthesis of PGE₂ is not increased during pregnancy, this transporter expression would affect the gestational changes in the renal PGE₂ content. Methods: Kidneys from rats at different gestational stages were used to examine gestational changes in the renocortical PGE₂ concentration. The renal expression of OAT-PG and the enzymes for PGE₂ synthesis was also examined sequentially, together with the gestational changes in renal renin production. Results: The renocortical PGE₂ concentration was significantly increased during midterm to late pregnancy, with a maximum increase of 47.6 ± 11.5% from the virgin value. Although the expression of the enzymes, such as cyclooxygenases and PG synthases, was not increased, that of OAT-PG was significantly decreased throughout pregnancy, inversely correlating with changes in the renocortical PGE₂ concentration. Renal renin production was significantly increased during pregnancy. Conclusion: This study demonstrated for the first time that the tissue PGE₂ concentration was increased in pregnant rat kidneys, which may be associated with the gestational rise in glomerular filtration rate. The decreased expression of OAT-PG was thought to be responsible for the increased tissue PGE₂ content.

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Section: Discussionsupporting

confidence: 57%

Decreased Expression of a Novel Prostaglandin Transporter, OAT-PG, Facilitates Renocortical PGE<sub>2</sub> Accumulation during Rat Pregnancy

Kazama

Matsubara

Kanai

et al. 2013

Gynecol Obstet Invest

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“…Three factors contribute to this increase in CO, each varying in dominance over the time course of gestation. Beginning in the 1 st trimester, stroke volume and preload, both associated with the expansion in total blood volume, participates in the augmentation of CO (65, 68–70). Conversely, in the 2 nd and 3 rd trimesters, the HR, increased by 15 to 20 beats/min, becomes the primary cause of the increased CO which enables adequate nutrient/waste exchange to the developing fetus (65, 71).…”

Section: The Autonomic Regulation Of Cardiovascular Physiological Adamentioning

confidence: 99%

Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia

2016

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Preeclampsia (PE) is a form of gestational hypertension that complicates ~ 5 percent of pregnancies worldwide. Over 70 percent of the fatal cases of PE are attributed to cerebral edema, intracranial hemorrhage, and eclampsia. The etiology of PE originates from abnormal remodeling of the maternal spiral arteries, creating an ischemic placenta that releases factors that drive the pathophysiology. An initial neurological outcome of PE is the absence of the autonomically regulated cardiovascular adaptations to pregnancy. PE patients exhibit sympathetic overactivation, in comparison to both normotensive pregnant and hypertensive non-pregnant females. Moreover, PE diminishes baroreceptor reflex sensitivity (BRS) beyond that observed in healthy pregnancy. The absence of the cardiovascular adaptations to pregnancy, combined with sympathovagal imbalance and a blunted BRS leads to life-threatening neurological outcomes. Behaviorally, the increased incidences of maternal depression, anxiety, and post-traumatic stress disorder (PTSD) in PE are correlated to low fetal birth weight, intrauterine growth restriction (IUGR) and premature birth. This review addresses these neurological consequences of PE that present in the gravid female both during and after the index pregnancy.

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“…Two studies19 20 detected a maximum increase in CO in the late third trimester, one showed the peak at 32 weeks of gestation21 and others17 22 in the late second trimester, at 26 and 23–24 weeks, respectively. However, the maximum rise in CO has been reported by one group at 16 weeks23 and in two others at 12 weeks 24 25. A recent systematic review,1 which included studies from 1996 to 2014, showed that peak CO occurs in the early third trimester (when it increases by 31% compared with prepregnancy values).…”

Section: Discussionmentioning

confidence: 83%

Cardiac output changes from prior to pregnancy to post partum using two non-invasive techniques

Masini

Foo

Cornette

et al. 2018

Heart

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ObjectivesWe aimed to describe cardiac output (CO) trend from prepregnancy to post partum using an inert gas rebreathing (IGR) device and compare these measurements with those obtained by a pulse waveform analysis (PWA) technique, both cross-sectionally and longitudinally.MethodsNon-smoking healthy women, aged 18–44 years, with body mass index <35 were included in this prospective observational study. CO measurements were collected at different time points (prepregnancy, at four different gestational epochs and post partum) using IGR and PWA. A linear mixed model analysis tested whether the longitudinal change in CO differed between the techniques. Bland-Altman analysis and intraclass correlation coefficient (ICC) were used for cross-sectional and a four-quadrant plot for longitudinal comparisons.ResultsOf the 413 participants, 69 had a complete longitudinal assessment throughout pregnancy. In this latter cohort, the maximum CO rise was seen at 15.2 weeks with IGR (+17.5% from prepregnancy) and at 10.4 weeks with PWA (+7.7% from prepregnancy). Trends differed significantly (p=0.0093). Cross-sectional analysis was performed in the whole population of 413 women: the mean CO was 6.14 L/min and 6.38 L/min for PWA and IGR, respectively, the percentage of error was 46% and the ICC was 0.348, with similar results at all separate time points. Longitudinal concordance was 64%.ConclusionsDespite differences between devices, the maximum CO rise in healthy pregnancies is more modest and earlier than previously reported. The two methods of CO measurement do not agree closely and cannot be used interchangeably. Technique-specific reference ranges are needed before they can be applied in research and clinical settings.

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Cardiovascular changes in early phase of pregnancy

Cited by 231 publications

References 12 publications

Decreased Expression of a Novel Prostaglandin Transporter, OAT-PG, Facilitates Renocortical PGE<sub>2</sub> Accumulation during Rat Pregnancy

Decreased Expression of a Novel Prostaglandin Transporter, OAT-PG, Facilitates Renocortical PGE<sub>2</sub> Accumulation during Rat Pregnancy

Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia

Cardiac output changes from prior to pregnancy to post partum using two non-invasive techniques

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