Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis

Haas, Sander de; Ghossein‐Doha, Chahinda; Kuijk, Sander M. J. van; Drongelen, J. van; Spaanderman, Marc E. A.

doi:10.1002/uog.17360

Cited by 185 publications

(156 citation statements)

References 63 publications

(136 reference statements)

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“…; De Haas et al . ), and is consistent with pre‐existing cardiovascular dysfunction leading to chronic (type II) cardiorenal syndrome.…”

Section: Cardiorenal Syndromessupporting

confidence: 78%

“…All these mechanisms lead to an increase of total body water by 5–8 l over the course of pregnancy (Widen & Gallagher, ), with 1 l of this being confined to plasma volume (de Haas et al . ). The latter volume expansion in pregnancy is reflected by a measurable increase of intrathoracic fluid from as early as 7 weeks’ gestation (Smeets et al .…”

Section: Cardiovascular and Renal Characteristics Of Preeclampsiamentioning

confidence: 97%

“…In contrast, plasma volume (PV) expansion is known to be less pronounced in preeclampsia than in uncomplicated pregnancy (De Haas et al . ), but increased PV has also been reported in late preeclampsia (Friedberg & Lutz, ; Schrier & Briner, ) with or without persistence of high cardiac output (Easterling et al . ; Bosio et al .…”

Section: Cardiorenal Syndromesmentioning

confidence: 98%

“…Contrary to other states of arterial underfilling, where systemic vasodilatation presents with renal vasoconstriction, pregnancy is a unique condition that combines systemic and renal vasodilatation, in association with an escape from the sodium-retaining effects of aldosterone (Chapman et al 1998;Bekheirnia & Schrier, 2006). All these mechanisms lead to an increase of total body water by 5-8 l over the course of pregnancy (Widen & Gallagher, 2014), with 1 l of this being confined to plasma volume (de Haas et al 2017). The latter volume expansion in pregnancy is reflected by a measurable increase of intrathoracic fluid from as early as 7 weeks' gestation (Smeets et al 2016;Lanssens et al 2018).…”

Section: Pregnancy-related Changes In Circulatory Volume Loadmentioning

confidence: 99%

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Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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“…; De Haas et al . ), and is consistent with pre‐existing cardiovascular dysfunction leading to chronic (type II) cardiorenal syndrome.…”

Section: Cardiorenal Syndromessupporting

confidence: 78%

Section: Cardiovascular and Renal Characteristics Of Preeclampsiamentioning

confidence: 97%

Section: Cardiorenal Syndromesmentioning

confidence: 98%

Section: Pregnancy-related Changes In Circulatory Volume Loadmentioning

confidence: 99%

See 2 more Smart Citations

Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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“…During normal pregnancy, the cardiovascular system undergoes numerous adaptations to ensure adequate uteroplacental perfusion, leading to appropriate oxygenation and nutrient delivery to the fetus (Tan & Tan, ). Blood volume expansion is secondary to an increase in plasma volume that starts during the first trimester and plateaus by 34 weeks of gestation (∼46% greater compared with non‐pregnant women; Chang & Streitman, ; de Haas, Ghossein‐Doha, van Kuijk, van Drongelen, & Spaanderman, ). To accommodate this significant increase in volume, functional changes occur, including an increase in stroke volume and heart rate (HR), which leads to an increase in cardiac output (

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; Melchiorre, Sharma, & Thilaganathan, ).…”

Section: Introductionmentioning

confidence: 99%

Sympathetic neurovascular regulation during pregnancy: A longitudinal case series study

Reyes

Usselman

Skow

et al. 2018

Experimental Physiology

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The adaptations of sympathetic nerve activity (SNA) during pregnancy remain poorly understood. An increase in blood volume, cardiac output and SNA, with a concomitant drop in total peripheral resistance (TPR), suggest that during pregnancy there is a reduced transduction of SNA into TPR. Most of these findings have originated from cross-sectional studies; thus, we conducted a longitudinal assessment of SNA and TPR in two participants. Measurements were made before pregnancy (early follicular phase), on four occasions during pregnancy and at 2 months postpartum. Mean arterial pressure and cardiac output were used to calculate TPR. The SNA was measured using microneurography (peroneal nerve). There was a gestation-dependent increase in SNA burst frequency (r = 0.96, P = 0.009). Neurovascular transduction, however, decreased by 53% in both women. Sympathetic hyperactivity was reversed postpartum, whereas neurovascular transduction remained lower. These longitudinal data highlight the progressive sympatho-excitation of pregnancy, which is offset by a concurrent reduction in neurovascular transduction.

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Hypertensive disorders of pregnancy and long‐term cardiovascular health: FIGO Best Practice Advice

Poon

Nguyen‐Hoang

Smith

et al. 2023

Intl J Gynecology & Obste

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Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high‐income countries and approximately 25% in low‐ and middle‐income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long‐term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.

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Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis

Abstract: Objective

Cited by 185 publications

References 63 publications

Preeclampsia: a gestational cardiorenal syndrome

Preeclampsia: a gestational cardiorenal syndrome

Sympathetic neurovascular regulation during pregnancy: A longitudinal case series study

Hypertensive disorders of pregnancy and long‐term cardiovascular health: FIGO Best Practice Advice

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