Preeclampsia — A State of Sympathetic Overactivity

Schobel, Hans P.; Fischer, T.; Heuszer, Karsten; Geiger, Helmut; Schmieder, Roland E.

doi:10.1056/nejm199611143352002

Cited by 515 publications

(264 citation statements)

References 24 publications

(19 reference statements)

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“…This hypothesis is in keeping with our recent data demonstrating baroreflex resetting during pregnancy, favoring elevated burst incidence for a given arterial pressure. 23 The present data are in line with most, although not all, 12 previous studies which have indicated that pregnancy is associated with an increase in baseline sympathetic activity. 4,[13][14][15] To date, only one previous study has compared muscle sympathetic responses to the CPT between normotensive pregnant women and nonpregnant controls.…”

Section: Discussionsupporting

confidence: 92%

“…4,[13][14][15] To date, only one previous study has compared muscle sympathetic responses to the CPT between normotensive pregnant women and nonpregnant controls. 12 Although similar responses to CPT were observed between groups, the group of pregnant women studied did not exhibit the marked elevations in baseline sympathetic activity, which have come to be associated with pregnancy 4,[13][14][15] ; therefore, these women may not be representative of the general population.…”

Section: Discussionmentioning

confidence: 63%

“…Although vascular responses to the CPT have been shown previously to be blunted in normotensive pregnancy, 8 an augmented blood pressure response to cold pressor stimulation has been observed in women with preeclampsia. 41 Alongside data which indicate that CPT-mediated increases in sympathetic activation are not different between normotensive and hypertensive pregnancies, 12,42 this suggests that an elevation in neurovascular transduction occurs during preeclamptic pregnancies. In fact, the magnitude of the pressor response to the CPT, as assessed during the second trimester of pregnancy, has been shown to be predictive of the subsequent development of preeclampsia during the third trimester.…”

Section: Discussionmentioning

confidence: 95%

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Regulation of Sympathetic Nerve Activity During the Cold Pressor Test in Normotensive Pregnant and Nonpregnant Women

et al. 2015

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T he risk of developing cardiovascular disease is lower in young women when compared with similarly aged men. [1][2][3] However, pregnancy represents a period of increased susceptibility to disordered cardiovascular regulation for women. Pregnant women have an elevated risk for orthostatic intolerance. 4,5 Moreover, ≤8% of pregnancies are associated with the development of de novo hypertension. 6 The cause of such hypertensive pregnancy disorders remains unclear, and as a result, there exist few approaches by which clinicians can predict, screen, or treat the development of the hypertensive disorders of pregnancy (gestational hypertension and preeclampsia). Previous data have shown that the vascular response to the cold pressor test (CPT) is blunted in normal pregnant women compared with women in the nonpregnant, postpartum state. 8 However, an elevated pressor response to the CPT has been observed in women with 9 or who subsequently develop 10 preeclampsia. As such, the CPT has been suggested as a simple screening tool for pregnancy-related hypertensive disorders. The mechanisms driving these divergent responses remain unknown; however, sympathetic nervous system activity is a primary determinant of the pressor response to the CPT. 11Differing vascular responses to the CPT may be mediated by altered sympathetic responses or altered translation of sympathetic activity into a vascular outcome (neurovascular transduction). Studies conducted over the past 2 decades have indicated, albeit not universally, 12 that normotensive Abstract-Baseline neurovascular transduction is reduced in normotensive pregnancy; however, little is known about changes to neurovascular transduction during periods of heightened sympathetic activation. We tested the hypothesis that, despite an exacerbated muscle sympathetic nerve activity (microneurography) response to cold pressor stimulation, the blunting of neurovascular transduction in normotensive pregnant women would result in similar changes in vascular resistance and mean arterial pressure (Finometer) relative to nonpregnant controls. Baseline neurovascular transduction was reduced in pregnant women relative to controls when expressed as the quotient of both total resistance and mean arterial pressure and sympathetic burst frequency (0.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 95%

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Regulation of Sympathetic Nerve Activity During the Cold Pressor Test in Normotensive Pregnant and Nonpregnant Women

et al. 2015

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“…However, in group D (pre-eclamptic patients) urinary kallikrein was significantly decreased, with levels very similar to those of nonpregnant healthy women. This could be explained because pre-eclampsia produces reduction of natriuresis, alteration of sodium balance, decreased prostaglandin synthesis and increased susceptibility to vasoconstrictor substances [5], causing circulatory alterations associated with a wide spectrum of organic and systemic lesions due to inadequate perfusion [6]. …”

Section: Introductionmentioning

confidence: 99%

Activity of Urinary Kallikreinin Patients with Hypertensive Disorders of Pregnancy

Pérez-Blanco¹,

Huertas-González

Navarrete

et al. 1998

Nephron

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“…Furthermore, the impact of prenatal programing of adult disease can be transmitted to future generations. In this regard, pre-eclampsia is characterized by high sympathetic activity that affects blood pressure in gestating mothers and induces changes that affect the progeny (Schobel et al 1996, Takiuti et al 2003, presumably through changes in the availability of NE to the fetal environment. Thus, newborn babies have changes in weight and metabolic parameters.…”

Section: Introductionmentioning

confidence: 99%

Maternal sympathetic stress impairs follicular development and puberty of the offspring

Barra¹,

Cruz²,

Mayerhofer³

et al. 2014

Reproduction

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Chronic cold stress applied to adult rats activates ovarian sympathetic innervation and develops polycystic ovary (PCO) phenotype. The PCO syndrome in humans originates during early development and is expressed before or during puberty, which suggests that the condition derived from in utero exposure to neural-or metabolic-derived insults. We studied the effects of maternal sympathetic stress on the ovarian follicular development and on the onset of puberty of female offspring. Timed pregnant rats were exposed to chronic cold stress (4 8C, 3 h/daily from 1000 to 1300 h) during the entire pregnancy. Neonatal rats exposed to sympathetic stress during gestation had a lower number of primary, primordial, and secondary follicles in the ovary and a lower recruitment of primary and secondary follicles derived from the primordial follicular pool. The expression of the FSH receptor and response of the neonatal ovary to FSH were reduced. A decrease in nerve growth factor (NGF) mRNA was found without change in the low-affinity NGF receptor. The FSH-induced development of secondary follicles was decreased. At puberty, estradiol plasma levels decreased without changes in LH plasma levels. Puberty onset (as shown by the vaginal opening) was delayed. Ovarian norepinephrine (NE) was reduced; there was no change in its metabolite, 3-methoxy-4-hydroxyphenylglycol, in stressed rats and no change in NE turnover. The changes in ovarian NE in prepubertal rats stressed during gestation could represent a lower development of sympathetic nerves as a compensatory response to the chronically increased NE levels during gestation and hence participate in delaying reproductive performance in the rat.

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Preeclampsia — A State of Sympathetic Overactivity

Cited by 515 publications

References 24 publications

Regulation of Sympathetic Nerve Activity During the Cold Pressor Test in Normotensive Pregnant and Nonpregnant Women

Regulation of Sympathetic Nerve Activity During the Cold Pressor Test in Normotensive Pregnant and Nonpregnant Women

Activity of Urinary Kallikreinin Patients with Hypertensive Disorders of Pregnancy

Maternal sympathetic stress impairs follicular development and puberty of the offspring

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