Serial assessment of cardiovascular control shows early signs of developing pre-eclampsia

Sasika Rang, H. Wolf, G. A. van Montfrans, J. M. Karemaker

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Abstract

Purpose To evaluate whether differences in autonomic cardiovascular control between normal pregnant women and women who develop pre-eclampsia later in pregnancy can be detected even before or early in pregnancy. Design We studied 42 women, 21 multigravid with a history of pre-eclampsia and 21 primigravid, before pregnancy, at 6, 8, 12, 16, 20 and 32 weeks gestation and 15 weeks after delivery. Methods The outcome of pregnancy was classified after delivery as normal pregnancy (NP group) or pre-eclampsia (PE group). Continuous heart rate and blood pressure were recorded by Portapres (TNO, Amsterdam, The Netherlands) during orthostatic stress, during rest in a supine and sifting position, and during paced breathing for periods of 1 min at breathing frequencies of 6, 10 and 15 breaths/min. Baroreflex gain from heart rate and blood pressure variability and the phase angle between both signals at low (similar to0.1 Hz) and high frequency (respiratory rate) were analyzed by spectral analysis. Results Eight women were diagnosed with pre-eclampsia. Subgroups did not differ in age, weight or height. The PE group showed a significantly higher mean arterial pressure before and during pregnancy [analysis of variance (ANOVA), P = 0.001], a significantly larger initial blood pressure drop to orthostatic stress before and in the first half of pregnancy (ANOVA, P = 0.002) and a significantly larger negative phase difference during supine rest at low frequency from 8 weeks onward (ANOVA P = 0.003). Conclusions These findings are compatible with increased resting sympathetic activity and decreased circulating volume, already present before and early in pregnancy, in women who will later develop pre-eclampsia. (C) 2004 Lippincott Williams Wilkins
Original languageEnglish
Pages (from-to)369-376
JournalJournal of hypertension
Volume22
Issue number2
DOIs
Publication statusPublished - 2004

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