Plasma volume and blood pressure regulation in hypertensive pregnancy

Ganzevoort, Wessel; Rep, Annelies; Bonsel, Gouke J.; Vries, J.I.P. de; Wolf, Hans

doi:10.1097/01.hjh.0000125436.28861.09

Cited by 70 publications

(51 citation statements)

References 84 publications

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“…These result in decreased systemic vascular resistance, increased cardiac output, and a large increase in plasma and blood volume. 18 Blood and plasma volume can increase as much as 40% and 45% to 55%, respectively, compared with prepregnancy levels. 19 These changes may underlie the trend we observed toward improvement in OI during the second and third trimesters.…”

Section: Parous Vs Nulliparous Women With Potsmentioning

confidence: 99%

Effect of Pregnancy on Postural Tachycardia Syndrome

Kimpinski

Iodice

Sandroni

et al. 2010

Mayo Clinic Proceedings

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P ostural tachycardia syndrome (POTS) is defined as the development of orthostatic symptoms associated with an increase in heart rate (HR) greater than 30 beats/min. More severe cases are associated with a standing HR increase greater than 120 beats/min. 1 Orthostatic symptoms most often include light-headedness, palpitations, presyncope, and exacerbations with heat or exercise. 2 Overall, the prognosis of POTS has been reported to be favorable in follow-up studies, with 80% of patients reporting improvement and 60% becoming functionally normal. 3 Onset of POTS occurs predominantly between the ages of 15 and 50 years, 4 with a female predominance. 1,2,[5][6][7] The female-to-male ratio has been reported to be as high as 5:1. 8 Given the female predominance and the occurrence of POTS during the childbearing years, the effects of this disorder on pregnancy is often raised in clinical practice.ObjECTIvES: To compare the clinical presentation, autonomic dysfunction, and pregnancy outcomes in parous and nulliparous women with postural tachycardia syndrome (POTS) and in women with POTS before and after pregnancy. PATIENTS AND METHODS:This study consists of women who had at least 1 pregnancy during which time they met criteria for POTS between May 1993 and July 2009. All patients underwent standard autonomic testing. POTS was defined as a heart rate (HR) increase of greater than 30 beats/min on head-up tilt (HUT) with symptoms of orthostatic intolerance. Patients' charts were reviewed retrospectively to determine pregnancy outcomes. RESULTS:Clinical characteristics related to POTS did not differ between parous and nulliparous women except for disease duration (parous, 3.7±2.6; nulliparous, 2.1±2.2; P<.001). Autonomic dysfunction did not differ between groups (change in HR on HUT: parous, 42.6±12.0 beats/min; nulliparous, 41.3±10.6 beats/min; P=.39). Of 116 total pregnancies, adverse pregnancy outcomes were reported in 9% and maternal complications in 1%. No complication was related to POTS. There was a trend toward modest improvement in autonomic dysfunction before and after pregnancy (change in HR on HUT: before pregnancy, 38.1±22.7 beats/min; after pregnancy, 21.9±14.9 beats/min; P=.07). CONCLUSION:The long-term impact of pregnancy on POTS does not appear to be clinically important. However, there does appear to be a trend toward improvement in the short-term postpartum period. Adverse pregnancy events were similar to those seen in the general public and do not present a barrier to women with POTS who want to have children.Mayo Clin Proc. 2010;85(7):639-644 CASS = composite autonomic severity score; HR = heart rate; HUT = head-up tilt; OI = orthostatic intolerance; POTS = postural tachycardia syndrome; TST = thermoregulatory sweat test However, until recently published data have been minimal. A recent study in 22 women indicated that, although the effect on symptoms related to POTS during pregnancy varied, the actual pregnancy was not affected. 9 The objectives of this study were as follows: (1) to determine whether ...

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Section: Parous Vs Nulliparous Women With Potsmentioning

confidence: 99%

Effect of Pregnancy on Postural Tachycardia Syndrome

Kimpinski

Iodice

Sandroni

et al. 2010

Mayo Clinic Proceedings

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“…Such physiological adaptations during gestation include concentric (reversible) cardiac hypertrophy, increased cardiac output, increased heart rate and decreased blood pressure and decreased peripheral vascular resistance [7][8][9][10]. Changes in the uterine vascular bed include significant expansion of the capacity of the uterine arteries, veins and downstream vessels.…”

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confidence: 99%

Circulatory and renal consequences of pregnancy in diabetic NOD mice

et al. 2011

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Objectives-Women with diabetes have elevated gestational risks for severe hemodynamic complications, including preeclampsia in mid-to late pregnancy. This study employed continuous, chronic radiotelemetry to compare the hemodynamic patterns in non-obese diabetic (NOD) mice who were overtly diabetic or normoglycemic throughout gestation. We hypothesized that overtly diabetic, pregnant NOD mice would develop gestational hypertension and provide understanding of mechanisms in progression of this pathology.Study Design-Telemeter-implanted, age-matched NOD females with and without diabetes were assessed for six hemodynamic parameters (mean, systolic, diastolic, pulse pressures, heart rate and activity) prior to mating, over pregnancy and over a 72 hr post-partum interval. Urinalysis, serum biochemistry and renal histopathology were also conducted.Results-Pregnant, normoglycemic NOD mice had a hemodynamic profile similar to other inbred strains, despite insulitis. This pattern was characterized by an interval of pre-implantation stability, post implantation decline in arterial pressure to mid gestation, and then a rebound to prepregnancy baseline during later gestation. Overtly diabetic NOD mice had a blood pressure profile that was normal until mid-gestation then become mildly hypotensive (−7mmHg, P<0.05), severely bradycardic (−80bpm, P<0.01) and showed signs of acute kidney injury. Pups born to diabetic dams were viable but growth restricted, despite their mothers' failing health, which did not rebound post-partum (−10% pre-pregnancy pressure and HR, P<0.05).Conclusions-Pregnancy accelerates circulatory and renal pathologies in overtly diabetic NOD mice and is characterized by depressed arterial pressure from mid-gestation and birth of growth 45 restricted offspring. KeywordsType 1 Diabetes Mellitus; Pregnancy; Radiotelemetry; Hemodynamics Correspondence: Anne Croy, Department of Biomedical and Molecular Sciences, Room 924 Botterell Hall, 18 Stuart Street, Queen's University, Kingston, Ontario, Canada K7L 3N6, Fax: 1-613-533-2022, Telephone: 1-613-533-2859 CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptCardiovascular complications are common and progressive in Type 1 Diabetes Mellitus (T1DM), often leading to significant morbidity and death. Pregnancy has been described as a physiological stressor and early predictor of cardiovascular disease when outcomes are abnormal [1]. Women with pre-existing diabetes (autoimmune and non-insulin-dependent diabetes mellitus) are considered high-risk obstetrical patients with significantly increased risks for complications; including worsening of pre-existing diabetic sequelae (diabetic nephropathy, retinopathy and altered glycemic control), pregnancy-induced hypertension, preeclampsia and thromboembolic events [2][3][4][5]. Severity of the pre-existing diabetic disease status rather than glycemic control is used to stratify risk for these women. Risks for the fetuses and children of mothers with diabetes include congenital defects, growth restricti...

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“…3,4 The cause of the transient congestive heart failure in our patient was unclear, but we speculate that it was closely related to expansion of maternal plasma volume and peripheral vascular resistance. In the normal physiological state in pregnant women, the maternal plasma volume is expanded through reduction in peripheral vascular resistance and retention of sodium and water 5 ; these changes allow an adequate supply of blood to reach the placenta and the developing fetus. 5,6 The maximum plasma volume is observed around 34 weeks of a normal pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…In the normal physiological state in pregnant women, the maternal plasma volume is expanded through reduction in peripheral vascular resistance and retention of sodium and water 5 ; these changes allow an adequate supply of blood to reach the placenta and the developing fetus. 5,6 The maximum plasma volume is observed around 34 weeks of a normal pregnancy. 7 Although the sodium and water content in pregnant women undergoing hemodialysis can be artifi cially controlled, peripheral vascular resistance depends on the physiology of the patient.…”

Section: Discussionmentioning

confidence: 99%

Difficulties in the Determination of Target Dry Weight in Hemodialysis During the Third Trimester of Pregnancy

Shimizu

Kaneko

Watanabe

et al. 2008

Dialysis & Transplantation

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Pregnancies in women with chronic renal disease who are undergoing hemodialysis are rare, but are increasingly observed because of technical advances. 1 Estimating the appropriate dry weight for pregnant women on hemodialysis is very diffi cult, but if the maternal target dry weight is inappropriate, this may affect fetal prognosis due to excessive shifts in maternal intravascular volume and unstable haemodynamics. 2 Several reports on the management of pregnant women on hemodialysis have been published and are helpful for decisions made at bedside. 3,4 These reports recommend that maternal dry weight be adjusted based on the estimated pregnancyinduced weight gain. 3 A minimal weight gain of 1-1.5 kg in the fi rst trimester with a linear weight gain of 0.45 kg, or 1 pound per week, after the fi rst trimester has been proposed 3 ; alternatively, it has been suggested that dry weight should increase progressively at an average of 1.2 Ϯ 0.5 kg over the fi rst trimester and at 0.5 kg per week from the start of the second trimester. 4 We report a successful pregnancy in a hemodialysis patient; however, this patient did develop transient congestive heart failure during the third trimester, even though her target dry weight was increased by 0.5 kg per week during this period. This case suggests that improved guidelines are required for setting a maternal target dry weight for managing pregnant women on hemodialysis, especially during the third trimester. Case ReportA 41-year-old woman who had been on hemodialysis for 18 years because of chronic glomerulonephritis became pregnant, and an ultrasound examination confi rmed an 8-week-old fetus. Her history included Guillain-Barre syndrome, hyperthyroidism, and left idiopathic sudden sensorineural hearing loss, each of which was transient and had resolved. She had conceived twice, at ages 22 and 40; however, the earlier pregnancy was aborted artifi cially because she was receiving warfarin for treatment of glomerulonephritis, and the more recent pregnancy aborted spontaneously. The patient neither drank alcohol nor smoked.Hemodialysis was performed at a satellite dialysis center for 4 hours 3 times per week until the patient conceived. Drug therapy included heparin calcium with dia lysis and erythropoietin. Her blood pressure, serum calcium, and phosphate had been in the normal ranges since initiation of hemodialysis, and so she had never received antihypertensive agents, vitamin D, or calcium carbonate. Her treatment had progressed satisfactorily because of good compliance with fl uid and dietary restrictions, even though she had been anuretic. Diffi culties in the Determination of Target Dry Weight in Hemodialysis During the Third Trimester of PregnancyYoshio Shimizu, MD, PhD; Shuzo Kaneko, MD; Fumiyo Watanabe, MD; Masahiro Hagiwara, MD, PhD; Keigyo Yoh, MD, PhD; Kunihiro Yamagata, MD, PhD; Akio Koyama, MD, PhD Drs. Shimizu, Kaneko, Watanabe, Hagiwara, Yoh, and BACKGROUND: Pregnancies in women with chronic renal disease undergoing hemodialysis are rare but are increa...

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Plasma volume and blood pressure regulation in hypertensive pregnancy

Cited by 70 publications

References 84 publications

Effect of Pregnancy on Postural Tachycardia Syndrome

Effect of Pregnancy on Postural Tachycardia Syndrome

Circulatory and renal consequences of pregnancy in diabetic NOD mice

Difficulties in the Determination of Target Dry Weight in Hemodialysis During the Third Trimester of Pregnancy

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