title: Acute volume expansion in normal pregnancy and preeclampsia. Effects on plasma atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) concentrations and feto-maternal circulation.
abstract: OBJECTIVE
  To compare normal pregnancy with pregnancy-induced hypertension (PIH)/preeclampsia with respect to the effects of acute volume expansion on plasma atrial natriuretic peptide (ANP), cyclic guanosine monophosphate (cGMP) and fetal-maternal circulation.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifteen women with PIH/preeclampsia and 15 healthy pregnant controls.
  
  
  METHODS
  Before and after 30 minutes' infusion of a crystalloid solution (15 ml/kg), maternal venous blood was sampled for ANP and cGMP analysis and echocardiographic and Doppler investigations were performed.
  
  
  RESULTS
  Basal median (range) ANP and cGMP levels were significantly higher in the PIH/preeclampsia group compared to the controls: 6.5 (3.8-30.4) compared to 3.9 (2.0-6.7) pmol/l, p < 0.01 and 5.8 (2.4-11.6) compared to 4.0 (2.3-10.8) nmol/l, p < 0.05. The response to volume load was enhanced: 4.6 (-4.5-21.8) compared to 0.7 (-4.1-8.8), p < 0.05 and 2.9 (0.1-10.9) compared to 1.2 (-5.0-6.0), p < 0.05, respectively. Systemic vascular resistance was initially higher in the patient group, 22.3 (14.1-36.7) compared to 15.6 (10.0-25.5) peripheral resistance units, p < 0.01 but the response to volume load was similar in both groups (12-13% decrease). The pulsatility index of the uterine artery, 0.85 (0.46-1.38) compared to 0.72 (0.49-1.26) and umbilical artery 0.89 (0.66-1.57) compared to 0.97 (0.74-1.31) did not differ between the groups. Volume expansion did not affect any of these variables.
  
  
  CONCLUSIONS
  The pulsatility index of the uterine artery remained unaffected in both preeclamptic patients and healthy controls despite an increase of ANP and cGMP concentration and a systemic vasodilatation during acute volume expansion. This finding may indicate the absence of a vasodilation of the uteroplacental vascular bed.
authors.affiliation: Department of Obstetrics and Gynecology, Karolinska Institute, Huddinge University Hospital, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Grunewald
authors.forename: H
authors.initials: H
authors.lastname: Nisell
authors.forename: K
authors.initials: K
authors.lastname: Carlström
authors.forename: M
authors.initials: M
authors.lastname: Kublickas
authors.forename: I
authors.initials: I
authors.lastname: Randmaa
authors.forename: L
authors.initials: L
authors.lastname: Nylund
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood*; D001775:Blood Circulation; D001810:Blood Volume; D006152:Cyclic GMP / Q000097:blood*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D006977:Hypertension, Renal / Q000097:blood; D008431:Maternal-Fetal Exchange; D011225:Pre-Eclampsia / Q000097:blood*; D011247:Pregnancy / Q000097:blood*; D011263:Pregnancy Trimester, Third; D011673:Pulsatile Flow; D014655:Vascular Resistance
chemical_list: D009320:Atrial Natriuretic Factor; D006152:Cyclic GMP