European Journal of Obstetrics & Gynecology and Reproductive Biology
Arterial stiffness in preeclamptic and chronic hypertensive pregnancies
Introduction
Vascular adaptation has a crucial role in the hemodynamic changes observed in normal pregnancy. Judging from previous findings, a fall in total vascular resistance allows increased intravascular volume during pregnancy without a significant rise in blood pressure [1] and ensures adequate uteroplacental circulation [2] in uncomplicated pregnancies. Hemodynamically, total vascular resistance reflects forces working against steady blood flow in small peripheral muscular arteries and arterioles, but is not characteristic of the larger conduit arteries [3]. These latter turn the pulsatile blood flow produced by the contraction of the heart into a steady flow in the peripheral arteries. The pulsatile arterial load is determined mainly by viscoelastic properties of the conduit arteries and is defined as arterial compliance [4]. In more recent studies, changes in the properties of large conduit arteries have also been shown to take part in vascular accommodation—increased arterial compliance has been paralleled by reduced peripheral vascular resistance in normal pregnancies [1], [5]. Enhanced arterial compliance has been suggested also to constitute part of vascular adaptation to increased intravascular volume [1].
Preeclampsia has been shown to be associated with reduced plasma volume [6] and exceptional peripheral vasoconstriction [7]. Disturbances in arterial compliance might likewise be involved in preeclampsia. Elevated pulse pressure during the first trimester is associated with an increased risk of preeclampsia in nulliparas [8]. Improved macrovascular compliance is paralleled by a fall in peripheral vascular resistance in healthy parous women, but not in previously preeclamptic parturients during the first trimester of pregnancy [5]. In a study by Fukushima and co-workers pregnant women with chronic hypertension had high values for rapid ejection time, suggesting low vascular compliance also in these parturients [9].
How preeclampsia and chronic hypertension affect arterial stiffness during pregnancy has been explored previously scarcely. We hypothesised that hypertensive conditions, either with chronic hypertension or preeclampsia, associate besides with peripheral vasocontriction also with disturbances in macrovascular level. The aim of this study was to compare parameters describing arterial stiffness in pregnancies complicated by hypertension, preeclampsia and chronic hypertension, and in uncomplicated pregnancies and in non-pregnant women.
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Materials and methods
We studied 67 pregnant women during the third trimester of pregnancy. The study group included 29 healthy primiparas with uncomplicated pregnancy, 20 parturients with preeclampsia and 18 patients with chronic hypertension. Twenty-nine healthy primiparas were studied again 6 months after delivery to obtain reference data on non-pregnant women. The study was carried out at Tampere University Hospital. The procedure was explained to each subject and written consent was obtained. The local Ethics
Results
The demographic data are presented in Table 1. All measured parameters: SI/PP, PWV, PP, arterial blood pressure, systemic vascular resistance index (SVRI), SI, HR and cardiac index (CI) showed significant differences between the groups based on one-way ANOVA. The results and differences between the study groups and uncomplicated pregnancies are presented in Table 2.
Parameters describing arterial stiffness and peripheral vasoconstriction in preeclamptic women differed significantly from all
Comment
Vascular relaxation in small peripheral arteries and in large conduit arteries has an important role in hemodynamic adaptation towards increased intravascular volume in normal pregnancy [1]. Pregnancies complicated with hypertension are associated with increased peripheral vasoconstriction, but the hemodynamics of large arteries is less well known. In non-pregnant hypertensive populations parameters reflecting arterial stiffness in conduit areteries have recently gained attention, since they
Acknowledgments
We are grateful to Heini Huhtala, M.Sc. for her valuable statistical assistance, Pirjo Järventausta, RN and Satu Ruusuvuori, RN for their valuable technical assistance. This study was supported by the Medical Research Fund of Tampere University Hospital.
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