1
|
Heidema WH, Van Drongelen J, Spaanderman MEA, Scholten RR. Impact of body mass index on markers of vascular health in normotensive women with history of pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:122-129. [PMID: 36807940 DOI: 10.1002/uog.26182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/23/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Obesity and pre-eclampsia (PE) are both associated with vascular dysfunction, which translates into an increased risk for cardiovascular disease in later life. The aim of this study was to investigate whether there is an interaction between body mass index (BMI) and a history of PE in their effects on vascular health. METHODS This was an observational case-control study of 30 women with a history of PE who were compared with 31 age- and BMI-matched controls who had an uncomplicated pregnancy. Flow-mediated dilation (FMD), carotid intima-media thickness (cIMT) and carotid distensibility (CD) were measured 6-12 months postpartum. To evaluate the impact of physical fitness, maximum oxygen uptake capacity was assessed using a standardized maximum exhaustion cycling test using breath-by-breath analysis. To specify further BMI subgroups, metabolic syndrome constituents were assessed in all individuals. RESULTS Formerly pre-eclamptic women had significantly lower FMD (5.1 ± 2.1% vs 9.4 ± 3.4%; P < 0.01), higher cIMT (0.59 ± 0.09 vs 0.49 ± 0.07 µm; P < 0.01) and lower CD (1.54 ± 0.37%/10 mmHg vs 1.80 ± 0.39%/10 mmHg; P < 0.01) compared with controls. In our study, population BMI correlated negatively with FMD (P = 0.04) but not with cIMT or CD. BMI and PE did not exhibit an interaction effect on these vascular parameters. Physical fitness was lower in women with a history of PE and in women with higher BMI. Constituents of the metabolic syndrome, including insulin, homeostasis model assessment for insulin resistance (HOMA-ir), triglyceride, microalbuminuria and systolic and diastolic blood pressure, were significantly higher in formerly pre-eclamptic women. BMI affected glucose metabolism but not lipids or blood pressure. BMI and PE positively interacted in their effect on insulin (P = 0.04) and HOMA-ir (P = 0.02). CONCLUSIONS Both BMI and a history of PE have negative effects on endothelial function, insulin resistance and physical fitness. In formerly pre-eclamptic women, the effect of BMI on insulin resistance was particularly high, suggesting a synergistic effect. Additionally, independently of BMI, a history of PE was associated with reduced FMD and CD and increased cIMT and blood pressure. Recognizing the cardiovascular risk profile is important for informing patients and encouraging targeted lifestyle modifications. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- W H Heidema
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
| | - J Van Drongelen
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
| | - M E A Spaanderman
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
| | - R R Scholten
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Barranca C, Pereira TJ, Edgell H. Oral contraceptive use and menstrual cycle influence acute cerebrovascular response to standing. Auton Neurosci 2023; 244:103054. [PMID: 36516546 DOI: 10.1016/j.autneu.2022.103054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine if the menstrual cycle and oral contraceptives (OC) influence responses to acute orthostatic stress and if these factors are clinically relevant to the diagnosis of initial orthostatic hypotension (iOH). METHODS Young, healthy women were recruited, including OC users (n = 12) and non-users (NOC; n = 9). Women were tested during the low hormone (LH; placebo pills; days 2-5 natural cycle) and high hormone (HH; active dose; days 18-24 natural cycle) menstrual phases. Changes in mean arterial pressure, cardiac output, heart rate, the 30:15 heart rate ratio and cerebrovascular resistance indices within 30 s of standing were examined. RESULTS There were no effects of OC or menstrual cycle on hemodynamic responses during standing (all p>0.05). In the LH phase, OC users had a greater fall in mean middle cerebral artery blood velocity (MCAV) compared to NOC (p<0.05). However, this was reversed in the HH phase, where OC users had a reduced fall in mean MCAV (p<0.05). Interestingly, 8 women (OC and NOC) had drops in systolic/diastolic blood pressure meeting the criteria for iOH, and 7 of those 8 women displayed this drop in a single phase of the menstrual cycle. CONCLUSION Our results indicate that chronic versus acute OC use (i.e., long-term use observed via LH phase versus short-term use observed via HH phase) have opposing effects on cerebral blood velocity during standing. Further, our results highlight that multiple assessments across the cycle may be necessary to accurately diagnose iOH, as most women met the diagnostic criteria during a single menstrual phase.
Collapse
Affiliation(s)
- C Barranca
- School of Kinesiology and Health Sciences, York University, Toronto, ON M3J1P3, Canada
| | - T J Pereira
- School of Kinesiology and Health Sciences, York University, Toronto, ON M3J1P3, Canada
| | - H Edgell
- School of Kinesiology and Health Sciences, York University, Toronto, ON M3J1P3, Canada; Muscle Health Research Centre, York University, Toronto, ON, Canada.
| |
Collapse
|
3
|
Booz GW, Kennedy D, Bowling M, Robinson T, Azubuike D, Fisher B, Brooks K, Chinthakuntla P, Hoang NH, Hosler JP, Cunningham MW. Angiotensin II type 1 receptor agonistic autoantibody blockade improves postpartum hypertension and cardiac mitochondrial function in rat model of preeclampsia. Biol Sex Differ 2021; 12:58. [PMID: 34727994 PMCID: PMC8562001 DOI: 10.1186/s13293-021-00396-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022] Open
Abstract
Women with preeclampsia (PE) have a greater risk of developing hypertension, cardiovascular disease (CVD), and renal disease later in life. Angiotensin II type I receptor agonistic autoantibodies (AT1-AAs) are elevated in women with PE during pregnancy and up to 2-year postpartum (PP), and in the reduced uterine perfusion pressure (RUPP) rat model of PE. Blockade of AT1-AA with a specific 7 amino acid peptide binding sequence (‘n7AAc’) improves pathophysiology observed in RUPP rats; however, the long-term effects of AT1-AA inhibition in PP is unknown. Pregnant Sprague Dawley rats were divided into three groups: normal pregnant (NP) (n = 16), RUPP (n = 15), and RUPP + ‘n7AAc’ (n = 16). Gestational day 14, RUPP surgery was performed and ‘n7AAc’ (144 μg/day) administered via osmotic minipump. At 10-week PP, mean arterial pressure (MAP), renal glomerular filtration rate (GFR) and cardiac functions, and cardiac mitochondria function were assessed. MAP was elevated PP in RUPP vs. NP (126 ± 4 vs. 116 ± 3 mmHg, p < 0.05), but was normalized in in RUPP + ‘n7AAc’ (109 ± 3 mmHg) vs. RUPP (p < 0.05). PP heart size was reduced by RUPP + ’n7AAc’ vs. RUPP rats (p < 0.05). Complex IV protein abundance and enzymatic activity, along with glutamate/malate-driven respiration (complexes I, III, and IV), were reduced in the heart of RUPP vs. NP rats which was prevented with ‘n7AAc’. AT1-AA inhibition during pregnancy not only improves blood pressure and pathophysiology of PE in rats during pregnancy, but also long-term changes in blood pressure, cardiac hypertrophy, and cardiac mitochondrial function PP.
Collapse
Affiliation(s)
- George W Booz
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Daniel Kennedy
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael Bowling
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Taprieka Robinson
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Daniel Azubuike
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brandon Fisher
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Karen Brooks
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Pooja Chinthakuntla
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ngoc H Hoang
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jonathan P Hosler
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mark W Cunningham
- Department of Physiology and Anatomy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA.
| |
Collapse
|
4
|
Aguree S, Gernand AD. A methodology for examining the association between plasma volume and micronutrient biomarker mass and concentration in healthy eumenorrheic women. PeerJ 2021; 8:e10535. [PMID: 33391876 PMCID: PMC7759127 DOI: 10.7717/peerj.10535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/19/2020] [Indexed: 01/01/2023] Open
Abstract
Background Accurate estimation and interpretation of nutritional biomarker concentrations are important in nutritional research, clinical care, and public health surveillance. Plasma volume (PV) may affect the interpretation of plasma biomarkers but is rarely measured. We aimed to examine the association between plasma volume (PV) and micronutrient biomarker concentrations and mass as part of pilot work to develop methods. Methods Nine healthy women with regular menstrual cycles provided fasting blood samples to measure micronutrient biomarkers. Indocyanine green was injected, and five timed blood draws were taken from 2 to 5 min to measure PV. Visits were scheduled around menstrual cycle day 2. Retinol, 25-hydroxyvitamin D, riboflavin, alpha-tocopherol, zinc, copper, magnesium, manganese, cobalt, iron, and ferritin concentrations were measured in serum. Total circulating micronutrient biomarker mass was calculated from PV and concentration. Results The mean PV was 2067 ± 470 mL. PV correlated positively with concentration of iron (r = 0.87, P = 0.005); other correlations were weaker with p > 0.05. PV and total mass of retinol (r = 0.90), 25(OH)D (r = 0.75), zinc (r = 0.88), copper (r = 0.83), magnesium (r = 0.93), manganese (r = 0.72), and iron (r = 0.92) were strongly correlated (all p < 0.05). PV was positively correlated with circulating micronutrient mass for most biomarkers, implying that concentrations are maintained at different volumes of plasma. Larger studies are needed to further examine these relationships. Conclusion Though there appear to be some association between micronutrient biomarker mass and plasma volume, we are unable to draw a firm conclusion about any relationship from these results because of the small sample size. We consider these findings as a preliminary analysis to establish methods for future studies.
Collapse
Affiliation(s)
- Sixtus Aguree
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States of America.,Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
| |
Collapse
|
5
|
Aguree S, Bethancourt HJ, Taylor LA, Rosinger AY, Gernand AD. Plasma volume variation across the menstrual cycle among healthy women of reproductive age: A prospective cohort study. Physiol Rep 2020; 8:e14418. [PMID: 32323928 PMCID: PMC7178826 DOI: 10.14814/phy2.14418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022] Open
Abstract
Increases in reproductive hormones like estrogen, play an important role in the remarkable increases in plasma volume observed in pregnancy. Accurate estimates of plasma volume expansion during pregnancy depend on correctly timing and measuring plasma volume in nonpregnant women. However, to date, there is no consensus on the pattern of plasma volume across the menstrual cycle. We prospectively measured plasma volume in 45 women across a single menstrual cycle. A urine-based fertility monitor was used to time three clinic visits to distinct points in the menstrual cycle: the early follicular phase (~day 2), periovulation (~day 12), and the mid-point of the luteal phase (~day 21)-based on a 28-day cycle length. Healthy women aged 18-41 years with regular menstrual cycles and a healthy body weight were enrolled in the study. At each visit, blood samples were collected before and after injection of 0.25 mg/kg body weight of indocyanine green dye (ICG). Pre- and post-ICG injection plasma samples were used to measure plasma volume. Preinjection samples were used to measure ovarian hormones and plasma osmolality. Mean plasma volume was highest during the early follicular phase (2,276 ± 478 ml); it declined to 2,232 ± 509 ml by the late follicular phase and to 2,228 ± 502 ml by the midluteal phase. This study found that overall variations in plasma volume are small across the menstrual cycle. Therefore, in clinical practice and research, the menstrual cycle phase may not be an important consideration when evaluating plasma volume among women of reproductive age.
Collapse
Affiliation(s)
- Sixtus Aguree
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Hilary J. Bethancourt
- Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Leigh A. Taylor
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Asher Y. Rosinger
- Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkPAUSA
- Department of AnthropologyThe Pennsylvania State UniversityUniversity ParkPAUSA
| | - Alison D. Gernand
- Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPAUSA
| |
Collapse
|
6
|
Gyselaers W, Spaanderman M. Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:174-185. [PMID: 29120514 DOI: 10.1002/uog.18952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Venous hemodynamics and volume homeostasis are important aspects of cardiovascular physiology. However, today their relevance is still very much underappreciated. Their most important role is maintenance and control of venous return and, as such, cardiac output. A high-flow/low-resistance circulation, remaining constant under physiological circumstances, is mandatory for an uncomplicated course of pregnancy. In this article, characteristics of normal and abnormal venous and volume regulating functions are discussed with respect to normal and pathologic outcomes of pregnancy, and current (non-invasive) methods to assess these functions are summarized. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- W Gyselaers
- Department of Obstetrics and Gynecology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - M Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
7
|
Cunningham MW, LaMarca B. Risk of cardiovascular disease, end-stage renal disease, and stroke in postpartum women and their fetuses after a hypertensive pregnancy. Am J Physiol Regul Integr Comp Physiol 2018; 315:R521-R528. [PMID: 29897824 DOI: 10.1152/ajpregu.00218.2017] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Women with hypertensive pregnancy complications are at greater risk of developing cardiovascular disease (CVD), metabolic diseases, stroke, and end-stage renal disease (ESRD) later in life. Pregnancy complications affect not only the mother's long-term health but also the health of the fetus immediately after delivery and into adulthood. The health of the fetus until adulthood can be influenced by developmental programming, in which the fetus is exposed to insults that will ultimately affect the growth of the offspring and increase the offspring's risk of developing hypertension, coronary heart disease, metabolic disease, and chronic kidney disease in adulthood. Preeclampsia, the onset of hypertension during pregnancy, is one of the major risk factors for the development of renal disease, cerebral disease, and CVD in the mother. Women with preeclampsia are at a 5-12-fold increased risk of developing ESRD, 2-fold increased risk of stroke, and 2-fold increased risk of developing CVD later in life. In this review article, we discuss 1) preeclampsia, 2) the risk of developing CVD, renal disease, or stroke later in life for women with hypertensive pregnancies, and 3) the effects of a hypertensive pregnancy on the offspring.
Collapse
Affiliation(s)
- Mark W Cunningham
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center , Jackson, Mississippi
| | - Babbette LaMarca
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center , Jackson, Mississippi.,Department of Obstetrics and Gynecology, University of Mississippi Medical Center , Jackson, Mississippi
| |
Collapse
|
8
|
Lin TH, Hsieh SF, Chen FJ, Su SY. Differences in the radial pulse spectrum between the follicular and luteal phases of the normal menstrual cycle. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
Why non-invasive maternal hemodynamics assessment is clinically relevant in early pregnancy: a literature review. BMC Pregnancy Childbirth 2016; 16:302. [PMID: 27729024 PMCID: PMC5059982 DOI: 10.1186/s12884-016-1091-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/27/2016] [Indexed: 01/15/2023] Open
Abstract
Background The maternal cardiovascular system adapts quickly when embryo implantation is recognized by the body. Those adaptations play an important role, as a normal cardiovascular adaptation is a requirement for a normal course of pregnancy. Disturbed adaptations predispose to potential hypertensive disorders further in pregnancy [1–3]. This report aims to briefly inform the obstetricians, general practitioners and midwives, who are the key players in detecting and treating hypertensive disorders during pregnancy. Methods The PubMed database was used as main tool to find studies involving clearly defined first trimester hemodynamic changes in normal pregnancies and hypertensive pregnancies. In addition, the bibliographies of these studies were investigated for further relevant literature. Results A comprehensive overview is given concerning the normal adaptations in the cardiovascular tree in a first trimester pregnancy. Additionally, signs of abnormal cardiovascular changes observed in first trimester are described together with the normal reference range for each non-invasive, easily applicable technique for maternal hemodynamics assessment. Conclusions With a combination of techniques, it is possible to integrate and evaluate the maternal heart, veins and arteries at 12 weeks of pregnancy. Applying those techniques into the daily clinic opens perspectives to prevention and prophylactic treatment, aiming for a reduction of the risk for hypertension during pregnancy.
Collapse
|
10
|
Bernstein IM, Hale SA, Badger GJ, McBride CA. Differences in cardiovascular function comparing prior preeclamptics with nulliparous controls. Pregnancy Hypertens 2016; 6:320-326. [PMID: 27939476 DOI: 10.1016/j.preghy.2016.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/30/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the current study was to evaluate cardiovascular function; including blood pressure, cardiac output, pulse wave velocity and vascular compliance in nonpregnant nulliparous women compared to women with a history of preterm preeclampsia. STUDY DESIGN This was a case control study. Blood pressure was measured using the Finapres Pro. Baseline cardiac output was determined by echocardiography. Pulse wave velocity was estimated using simultaneous electrocardiographic tracings and ultrasound determined arterial flow waveforms and calculated as estimated distance divided by the time interval between EKG r-wave peak and ultrasound derived peak popliteal artery flow. During volume challenge, 500mL of lactated Ringers solution was infused through an indwelling antecubital catheter over 10min. Cardiac output and blood pressure during and 15min after the infusion were estimated using the Finapres Pro. MAIN OUTCOME MEASURES Indices of arterial stiffness and vascular compliance. RESULTS Previous preeclamptics exhibited a significant increase in pulse pressure and cardiac output in response to volume challenge when compared with nulliparous controls. Prior preeclamptics had a strong positive correlation between blood pressure indices (r=0.50-0.68, p⩽0.01) and pulse pressure (r=0.58, P=0.008) with pulse wave velocity that was not evident in control women. CONCLUSIONS In women with prior preterm preeclampsia a relationship between blood pressure, intravascular volume and arterial stiffness, is evident in the nonpregnant state and in the absence of hypertension or overt cardiovascular disease. This supports an overarching hypothesis that nonpregnant physiology is an important contributor to pregnancy adaptations.
Collapse
Affiliation(s)
- Ira M Bernstein
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT 05405, United States.
| | - Sarah A Hale
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT 05405, United States
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT 05405, United States
| | - Carole A McBride
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT 05405, United States
| |
Collapse
|
11
|
Scholten RR, Lotgering FK, Hopman MT, Van Dijk A, Van de Vlugt M, Janssen MCH, Spaanderman MEA. Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension. Hypertension 2015; 66:1066-72. [PMID: 26370891 DOI: 10.1161/hypertensionaha.115.05934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/18/2015] [Indexed: 12/26/2022]
Abstract
Formerly preeclamptic women are at risk for cardiovascular disease. Low plasma volume may reflect latent hypertension and potentially links preeclampsia with chronic cardiovascular disease. We hypothesized that low plasma volume in normotensive formerly preeclamptic women predisposes to hypertension. We longitudinally studied n=104 formerly preeclamptic women in whom plasma volume was measured 3 to 30 months after the preeclamptic pregnancy. Cardiovascular variables were assessed at 2 points in time (3-30 months postpartum and 2-5 years thereafter). Study population was divided into low plasma volume (≤1373 mL/m(2)) and normal plasma volume (>1373 mL/m(2)). Primary end point was hypertension at the second visit: defined as ≥140 mm Hg systolic or ≥90 mm Hg diastolic. Secondary outcome of this study was change in traditional cardiovascular risk profile between visits. Variables correlating univariately with change in blood pressure between visits were introduced in regression analysis. Eighteen of 104 (17%) formerly preeclamptic women who were normotensive at first visit had hypertension at second evaluation 2 to 5 years later. Hypertension developed more often in women with low plasma volume (10/35 [29%]) than in women with normal plasma volume (8/69 [12%]; odds ratio, 3.2; 95% confidence interval, 1.4-8.6). After adjustments, relationship between plasma volume status and subsequent hypertension persisted (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.5). Mean arterial pressure at second visit correlated inverse linearly with plasma volume (r=-0.49; P<0.01). Initially normotensive formerly preeclamptic women have 17% chance to develop hypertension within 5 years. Women with low plasma volume have higher chance to develop hypertension than women with normal plasma volume. Clinically, follow-up of blood pressure seems warranted in women with history of preeclampsia, even when initially normotensive.
Collapse
Affiliation(s)
- Ralph R Scholten
- From the Departments of Obstetrics and Gynecology (R.R.S., F.K.L.), Physiology (R.R.S., M.T.H.), Cardiology (A.V.D., M.V.d.V.), and Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands (M.E.A.S.).
| | - Fred K Lotgering
- From the Departments of Obstetrics and Gynecology (R.R.S., F.K.L.), Physiology (R.R.S., M.T.H.), Cardiology (A.V.D., M.V.d.V.), and Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands (M.E.A.S.)
| | - Maria T Hopman
- From the Departments of Obstetrics and Gynecology (R.R.S., F.K.L.), Physiology (R.R.S., M.T.H.), Cardiology (A.V.D., M.V.d.V.), and Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands (M.E.A.S.)
| | - Arie Van Dijk
- From the Departments of Obstetrics and Gynecology (R.R.S., F.K.L.), Physiology (R.R.S., M.T.H.), Cardiology (A.V.D., M.V.d.V.), and Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands (M.E.A.S.)
| | - Maureen Van de Vlugt
- From the Departments of Obstetrics and Gynecology (R.R.S., F.K.L.), Physiology (R.R.S., M.T.H.), Cardiology (A.V.D., M.V.d.V.), and Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands (M.E.A.S.)
| | - Mirian C H Janssen
- From the Departments of Obstetrics and Gynecology (R.R.S., F.K.L.), Physiology (R.R.S., M.T.H.), Cardiology (A.V.D., M.V.d.V.), and Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands (M.E.A.S.)
| | - Marc E A Spaanderman
- From the Departments of Obstetrics and Gynecology (R.R.S., F.K.L.), Physiology (R.R.S., M.T.H.), Cardiology (A.V.D., M.V.d.V.), and Internal Medicine (M.C.H.J.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands (M.E.A.S.)
| |
Collapse
|
12
|
Hsieh SF, Shen LL, Su SY. Tongue color changes within a menstrual cycle in eumenorrheic women. J Tradit Complement Med 2015; 6:269-74. [PMID: 27419092 PMCID: PMC4936755 DOI: 10.1016/j.jtcme.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/30/2015] [Accepted: 07/14/2015] [Indexed: 12/02/2022] Open
Abstract
Tongue color (舌色 shé sè) has been used to diagnose abnormal body conditions for thousands of years in traditional Chinese Medicine (中醫 zhōng yī). However, it is not clear whether tongue color alters with physiological changes within a normal menstrual cycle (月經周期 yuè jīng zhōu qī). This study investigated difference in tongue color between the follicular phase and luteal phase in eumenorrheic women. Tongue surface photographs were taken in the follicular phase and the luteal phase of thirty-two volunteers with biphasic basal body temperature. Color values on five areas of the tongue surface were examined and comparisons of color values were made between the two phases according to the red–green–blue (RGB), hue–saturation–brightness (HSB), luminance-a-b (Lab), and cyan–magenta–yellow–black (CMYK) models. Based on the RGB model, the values of green and blue in the tip area were larger in the follicular phase than both in the luteal phase. The values of magenta and yellow based in the CMYK model were smaller in the tip area in the follicular phase than that in the luteal phase. The saturation in the tip area was smaller in the follicular phase than that in the luteal phase. Based on the Lab model, b value in the middle area was smaller in the follicular phase than that in the luteal phase. The data revealed that tongue color varied within a eumenorrheic menstrual cycle, suggesting that tongue color differences between the follicular and luteal phases need to be considered while practicing tongue diagnosis (舌診 shé zhěn) or performing clinical studies among childbearing women.
Collapse
Key Words
- B (in HSB), brightness
- B (in RGB), blue
- BBT, basal body temperature
- C, cyan
- CMYK model
- CMYK, cyan–magenta–yellow–black
- E2, estradiol
- G, green
- H, hue
- HSB model
- HSB, hue–saturation–brightness
- K, black
- L, luminance
- Lab model
- Lab, luminance-a-b
- M, magenta
- Menstrual cycle
- R, red
- RGB model
- RGB, red–green–blue
- S, saturation
- TCM, traditional Chinese Medicine
- Tongue inspection
- Y, yellow
Collapse
Affiliation(s)
- Shu-Feng Hsieh
- Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Li-Ling Shen
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Shan-Yu Su
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan; School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| |
Collapse
|
13
|
Ghossein-Doha C, Spaanderman M, van Kuijk SMJ, Kroon AA, Delhaas T, Peeters L. Long-Term Risk to Develop Hypertension in Women With Former Preeclampsia: A Longitudinal Pilot Study. Reprod Sci 2014; 21:846-853. [PMID: 24440998 PMCID: PMC4107566 DOI: 10.1177/1933719113518989] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Women with former preeclampsia (exPE) develop chronic hypertension 4 times more often than healthy parous controls. Women, destined to develop remote chronic hypertension, had increased left ventricular mass index (LVMI) and diastolic blood pressure (BP) prior to the onset of hypertension as compared to those remaining normotensive. However, longitudinal data on the progress of this increased LVMI in women destined to develop hypertension are lacking. METHODS We included 20 women with exPE and 8 parous controls. At both 1- and 14-year postpartum (pp), we performed cardiac ultrasound and determined circulating levels of the metabolic syndrome variables. Of 14-year pp, 7 (35%) former patients had developed chronic hypertension. We compared these 7 former patients with both the 13 former patients who remained normotensive and the 8 parous controls using the Mann-Whitney U test and Kruskal-Wallis analysis. RESULTS Women with hypertensive exPE differed from their normotensive counterparts by a higher incidence of early-onset preeclampsia (PE) in their index pregnancy and a higher rate of recurrence in next pregnancies. At 1-year pp, they also had high/normal BP and higher fasting insulin levels. At 14 years pp, the relative left ventricular wall thickness was higher, and the E/A ratio was lower, in the hypertensive group relative to those remaining normotensive. CONCLUSION Women with exPE are at increased risk of developing chronic hypertension, when (1) the PE in the index pregnancy had an early-onset and/or recurred in next pregnancies and (2) the 1-year pp. Blood pressure was high normal. We also noticed that at 14 years pp, the hypertensive group showed signs of concentric left ventricular remodeling along with a decreased E/A ratio.
Collapse
Affiliation(s)
- Chahinda Ghossein-Doha
- Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands Department of Biomedical Engineering, Maastricht University, Maastricht, the Netherlands
| | - Marc Spaanderman
- Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sander M J van Kuijk
- Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, the Netherlands
| | - Louis Peeters
- Division "Vrouw & Baby", University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
14
|
Ghossein-Doha C, van Kuijk SMJ, Spaanderman MEA, Delhaas T, Peeters LLH. Age-related alterations in cardiac geometry in formerly preeclamptic women and healthy parous controls: an explorative study. Reprod Sci 2014. [PMID: 23203321 DOI: 10.1177/1933719112459230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Preeclamptic pregnancies induce concentric left ventricular hypertrophy instead of eccentric left ventricular hypertrophy as seen in healthy pregnancies. Although these differences persist for at least several months postpartum, the long-term fate of these changes is unknown. OBJECTIVE To explore the age-related changes in cardiovascular structure and function in formerly preeclamptic women relative to parous controls. METHODS A total of 20 formerly preeclamptic women and 8 parous controls underwent 2 echocardiograms at 1 and 14 years of postpartum. With the nonparametric Mann-Whitney U test and the Wilcoxon Signed Ranks test, we analyzed the between-group differences in cardiac structure and function at both time points and the time-related changes in these indices. RESULTS Left ventricular geometry and dimensions and systolic function were comparable in the 2 study groups at both time points. The age-related decline in E/A ratio and increase in intraventricular septum thickness were noted in both groups over time, without appreciable differences between groups. CONCLUSION A history of preeclampsia does not affect the age-related cardiac remodeling over a period of 14 years.
Collapse
Affiliation(s)
- Chahinda Ghossein-Doha
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
15
|
Freire AC, Basit AW, Choudhary R, Piong CW, Merchant HA. Does sex matter? The influence of gender on gastrointestinal physiology and drug delivery. Int J Pharm 2011; 415:15-28. [DOI: 10.1016/j.ijpharm.2011.04.069] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/01/2011] [Accepted: 04/04/2011] [Indexed: 12/14/2022]
|
16
|
Zanten JJCSV, Carroll D, Ring C. Mental stress-induced haemoconcentration in women: Effects of menstrual cycle phase. Br J Health Psychol 2010; 14:805-16. [DOI: 10.1348/135910709x425734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
17
|
Su SY, Wei CC, Hsieh CL, Tsao JY, Li TC, Lin TH, Chang HH, Lo LC. Influence of Menstrual Cycle on Pulse Pressure Waveforms Measured from the Radial Artery in Biphasic Healthy Women. J Altern Complement Med 2009; 15:645-52. [PMID: 19480601 DOI: 10.1089/acm.2008.0022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shan-Yu Su
- Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Chuan Wei
- Department of Information and Communication Engineering, Chaoyang University of Technology, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Jung-Ying Tsao
- Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan
- Biostatistics Center, China Medical University, Taichung, Taiwan
| | - Tsai-Hui Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hen-Hong Chang
- Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital and Chang Gung University, Changwua, Taiwan
| | - Lun-Chien Lo
- Department of Chinese Medicine, Changhua Christian Hospital, Changhua, Taiwan
| |
Collapse
|
18
|
|
19
|
Krabbendam I, Janssen BJ, Van Dijk APJ, Jongsma HW, Oyen WJG, Lotgering FK, Spaanderman MEA. The Relation Between Venous Reserve Capacity and Low Plasma Volume. Reprod Sci 2008; 15:604-12. [DOI: 10.1177/1933719108316983] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ineke Krabbendam
- Departments of Obstetrics and Gynecology, Radboud University of Nijmegen Medical Centre,
| | - Ben J. Janssen
- Department of Pharmacology and Toxicology, University of Maastricht, Maastricht, the Netherlands
| | | | - Henk W. Jongsma
- Departments of Obstetrics and Gynecology, Radboud University of Nijmegen Medical Centre
| | - Wim J. G. Oyen
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Fred K. Lotgering
- Departments of Obstetrics and Gynecology, Radboud University of Nijmegen Medical Centre
| | | |
Collapse
|
20
|
Hladunewich MA, Myers BD, Derby GC, Blouch KL, Druzin ML, Deen WM, Naimark DM, Lafayette RA. Course of preeclamptic glomerular injury after delivery. Am J Physiol Renal Physiol 2008; 294:F614-20. [DOI: 10.1152/ajprenal.00470.2007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We evaluated the early postpartum recovery of glomerular function over 4 wk in 57 women with preeclampsia. We used physiological techniques to measure glomerular filtration rate (GFR), renal plasma flow, and oncotic pressure (πA) and computed a value for the two-kidney ultrafiltration coefficient ( Kf). Compared with healthy, postpartum controls, GFR was depressed by 40% on postpartum day 1, but by only 19% and 8% in the second and fourth postpartum weeks, respectively. Hypofiltration was attributable solely to depression, at corresponding postpartum times, of Kf by 55%, 30%, and 18%, respectively. Improvement in glomerular filtration capacity was accompanied by recovery of hypertension to near-normal levels and significant improvement in albuminuria. We conclude that the functional manifestations of the glomerular endothelial injury of preeclampsia largely resolve within the first postpartum month.
Collapse
|
21
|
Courtar DA, Spaanderman MEA, Janssen BJA, Peeters LLH. Orthostatic stress response during the menstrual cycle is unaltered in formerly preeclamptic women with low plasma volume. Reprod Sci 2007; 14:66-72. [PMID: 17636218 DOI: 10.1177/1933719106298214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Plasma volume (PV) varies with the menstrual cycle not only in healthy parous controls (CON) but also in formerly preeclamptic women with a subnormal PV (LPV). It is unknown whether formerly preeclamptic women with LPV are more susceptible to orthostatic stress than healthy controls. In this study, the authors compared autonomic responses to acute (standing from supine position) and gradual (menstrual cycle) orthostatic stress between LPV and CON. In 11 LPV (PV<or= 49 mL/kg lean body mass) and 7 CON, beat-to-beat blood pressure (BP) and heart rate (HR) were measured in supine position and after an orthostatic stress test, during the follicular phase (FP) and luteal phase (LP) of the menstrual cycle. Spectral analysis (fast Fourier transform) was performed on beat-to-beat signals to quantify the magnitude of the spontaneous BP and pulse interval (PI) fluctuations. The absolute powers within the low-frequency (0.04-0.15 Hz) and high-frequency (0.15-0.4 Hz) ranges of BP and PI were used as estimates for sympathetic and parasympathetic activity, respectively. Baroreflex sensitivity was calculated as the transfer function gain from low-frequency systolic BP to PI. Differences between groups, menstrual phase, and response to standing were compared by analysis of variance. Basal BP was comparable in both study groups. However, basal PI and spontaneous baroreflex sensitivity were lower in LPV than in CON. The autonomic responses to acute and gradual orthostatic stress were similar in the 2 groups, irrespective of the phase of the menstrual cycle. The cardiovascular response to acute and gradual orthostatic stress in both FP and LP is comparable in LPV and CON.
Collapse
Affiliation(s)
- Dorette A Courtar
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands
| | | | | | | |
Collapse
|
22
|
Al Kadi H, Nasrat H, Broughton Pipkin F. A prospective, longitudinal study of the renin–angiotensin system, prostacyclin and thromboxane in the first trimester of normal human pregnancy: association with birthweight. Hum Reprod 2005; 20:3157-62. [PMID: 16006463 DOI: 10.1093/humrep/dei184] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Very early human pregnancy is a state of cardiovascular underfilling. The renin-angiotensin system (RAS) is directly concerned with sodium and water homeostasis. Angiotensinogen is known to be the rate-limiting component in the generation of angiotensin I, and hence angiotensin II, in pregnancy. The usual measurement of 'renin activity' does not differentiate between enzyme and substrate. We hypothesized that the RAS is activated from the start of pregnancy; plasma renin concentration (PRC) and angiotensinogen will show differential regulation and might stimulate the rise in prostacyclin. METHODS A prospective study of 12 nulliparous normal women. PRC and angiotensinogen and excretion of prostacyclin and thromboxane metabolites were measured pre-pregnancy and four to six times after conception to 13 weeks. RESULTS By 6 weeks gestation, mean PRC was markedly raised and remained stable to 13 weeks. The initial angiotensinogen response varied, but rose consistently after 6-8 weeks. Regression analysis showed angiotensinogen in the first trimester to be strongly associated with corrected birthweight centile (P < 0.001). Excretion of eicosanoid metabolites was very variable, but rose significantly from 6 weeks; the ratio between prostacyclin and thromboxane excretion did not alter over this time. There was no correlation between the various hormones measured. CONCLUSION Angiotensinogen is known to be rate-limiting in pregnancy. Its association with birthweight may be through effects on early plasma volume expansion and may have implications for intrauterine growth restriction and pre-eclampsia.
Collapse
Affiliation(s)
- H Al Kadi
- Department of Physiology, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | |
Collapse
|
23
|
Yun AJ, Bazar KA, Lee PY. Autonomic dysfunction may be an under-recognized cause of female fertility disorders. Med Hypotheses 2005; 63:172-7. [PMID: 15193372 DOI: 10.1016/j.mehy.2004.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Accepted: 02/19/2004] [Indexed: 11/18/2022]
Abstract
Female conditions of impaired fertility comprise a heterogeneous group of disorders that are attributed to various anatomic, hormonal and immunologic disturbances. We hypothesize that autonomic dysfunction may be a previously unrecognized factor in female fertility disorders. Emerging physiologic and molecular evidence suggests that autonomic balance varies during normal menstrual cycles with a shift to sympathetic bias during the luteal phase. Furthermore, many diseases associated with autonomic dysfunction show catamenial variations in patterns consistent with a shift to sympathetic bias occurs during the second half of normal menstrual cycles. The shift to sympathetic bias during the normal luteal phase may be an evolutionary adaptation to address the immunologic and physiologic demands for successful implantation and gestation. Through direct modulation of the lymphoid system and activation of the cortisol pathway, sympathetic bias promotes a shift to relative T helper (Th)-2 biased immunity which may favor maternal tolerance of the embryo by attenuating Th-1 mediated interference of implantation. Indeed, a growing body of evidence has implicated abnormal Th balance in fertility disorders, but the link has been attributed to factors other than autonomic function, such as hormonal factors. After implantation, maternal sympathetic bias may further support gestation through physiologic changes necessary to maintain placental perfusion pressure. We propose that insufficient shift to sympathetic bias during the luteal phase, which manifests in inadequate shift towards Th-2 bias and down-regulation of Th-1 function, may be the mechanism of impaired fertility in certain patients. Our hypothesis portends new potential methods to treat fertility disorders by modulating autonomic balance.
Collapse
Affiliation(s)
- A Joon Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
| | | | | |
Collapse
|
24
|
Lee PY, Bazar KA, Yun AJ. Menstrual variation of autonomic balance may be a factor in exacerbations of certain diseases during the menstrual cycle. Med Hypotheses 2004; 63:163-7. [PMID: 15193370 DOI: 10.1016/j.mehy.2004.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 02/19/2004] [Indexed: 11/18/2022]
Abstract
Exacerbation of certain medical conditions during specific phases of the menstrual cycle has long been recognized. Mechanisms of the cyclic variations are poorly understood, but are often attributed to fluctuations in reproductive hormones. We hypothesize that normal variations in autonomic balance during the menstrual cycle, which likely evolved as adaptations for reproduction, may contribute to catamenial variations in diseases independent of hormonal variations. Emerging evidence suggests that autonomic balance shifts towards sympathetic bias during the second half of the menstrual cycle. This shift can be seen as an evolutionary adaptation to address the immunologic and physiologic demands for successful implantation and gestation. Through direct modulation of lymphoid system and activation of the cortisol pathway, sympathetic bias promotes a shift to relative T helper (Th)-2-biased immunity which may favor maternal tolerance of the embryo by attenuating Th-1-mediated interference of implantation. Immune variance during the menstrual cycle has been implicated in menstrual fluctuations of many diseases, but until now the immune variance has been attributed to female hormonal changes. We propose that shifts in autonomic balance independently contribute to fluctuations in diseases by modulating the immune system. Still further, we propose that many other diseases fluctuate due to the direct nervous system actions of shifts in autonomic balance. Our hypothesis portends new therapeutic paradigms based on cyclical modulation of autonomic balance to address catamenial variations of medical conditions.
Collapse
Affiliation(s)
- Patrick Y Lee
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA
| | | | | |
Collapse
|
25
|
Hirshoren N, Tzoran I, Makrienko I, Edoute Y, Plawner MM, Itskovitz-Eldor J, Jacob G. Menstrual cycle effects on the neurohumoral and autonomic nervous systems regulating the cardiovascular system. J Clin Endocrinol Metab 2002; 87:1569-75. [PMID: 11932284 DOI: 10.1210/jcem.87.4.8406] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Gonadal hormones may affect homeostatic mechanisms regulating the cardiovascular system. We investigated this relationship at five different crucial hormonal time points along the menstrual cycle. Eight eumenorrheic healthy subjects underwent a battery of autonomic tests, hemodynamics, and volume-regulatory hormone measurements. Fluid-regulatory hormones, plasma renin activity, and aldosterone increased along the luteal phase (P = 0.003 and 0.02, respectively), whereas rest supine-corrected hematocrit declined in the course of the menstrual cycle (P = 0.001). Plasma norepinephrine decreased from 1.4 +/- 0.2 to 0.95 +/- 0.1 nmol/liter (P < 0.02) [early follicular (EF) to late follicular]. Thereafter, concentrations gradually returned to EF levels. Lf to Hf domain ratio (spectral analysis of electrocardiogram) showed a difference from that of norepinephrine. The cardiovagal baroreflex sensitivity increased significantly along the luteal phase (P = 0.04). The dose of isoproterenol required to increase heart rate (HR) 15 beats per minute was 0.19 +/- 0.04 microg during the EF time point, and it increased to 0.39 +/- 0.06 microg during the late luteal time point (P = 0.05). However, blood pressure, HR, and their responses to orthostatic stress remained unchanged. Fluctuations in the ovarian hormones along the menstrual cycle are associated with unchanged blood pressure and HR, despite the significant variations in the different homeostatic mechanisms regulating the cardiovascular system.
Collapse
Affiliation(s)
- Nir Hirshoren
- Jacob Recanati Autonomic Dysfunction Center, Department of Medicine "C", Rambam Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | | | | | | | | |
Collapse
|
26
|
Pechère-Bertschi A, Maillard M, Stalder H, Brunner HR, Burnier M. Renal segmental tubular response to salt during the normal menstrual cycle. Kidney Int 2002; 61:425-31. [PMID: 11849382 DOI: 10.1046/j.1523-1755.2002.00158.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It has been suggested that women gain weight and develop peripheral edema during the luteal phase of the menstrual cycle because they tend to retain sodium and water. However, there is actually no clear evidence for physiological, cyclic variations in renal sodium handling during the menstrual cycle. We prospectively assessed the changes in segmental renal sodium handling occurring during the menstrual cycle in response to changes in salt intake. METHODS Thirty-five normotensive women were enrolled. Seventeen women were randomized and studied in the follicular and 18 in the luteal phases of their menstrual cycle. All women were assigned at random to receive a low (40 mmol/day) or a high (250 mmol/day) sodium diet for seven days on two consecutive menstrual cycles. Renal sodium handling and hemodynamics were measured at the end of each diet period. RESULTS The changes in sodium intake induced comparable variations in sodium excretion in both phases of the menstrual cycle. In the follicular phase, the increase in salt intake was associated with no change in renal hemodynamics, an increased fractional excretion of lithium (FELi) and a decreased fractional distal reabsorption of sodium (FDRNa), suggesting that sodium reabsorption is reduced both in the proximal and the distal tubules. In contrast, in the luteal phase, the renal response to salt was characterized by a significant renal vasodilation and a marked salt escape from the distal nephron, compared to the women investigated in the follicular phase (P < 0.01). Sodium reabsorption by the proximal nephron was not reduced as indicated by the unchanged FELi. CONCLUSIONS These results show that the segmental renal handling of sodium differs markedly in the two phases of the menstrual cycle. They suggest that the female hormones modulate the renal handling of sodium at the proximal and distal segments of the nephron in young normotensive women.
Collapse
|