Sympathetic neural mechanisms in normal and hypertensive pregnancy in humans.
BACKGROUND
Direct recordings from peripheral sympathetic nerves have shown an increased sympathetic drive in pregnancy-induced hypertension (PIH) and preeclampsia (PE). It is unknown whether sympathetic drive is altered in normal pregnancy, when arterial blood pressure can be normal or relatively low. The aim of this study was to measure and compare peripheral sympathetic discharge, its vasoconstrictor effect and its baroreceptor control, during pregnancy and postpartum in women with normal pregnancy (NP) and PIH and in normotensive nonpregnant (NN) women.


RESULTS
Twenty-one women with NP, 18 women with PIH, and 21 NN women had muscle sympathetic nerve activity assessed from multiunit discharges (MSNA) and from single units with defined vasoconstrictor properties (s-MSNA). The s-MSNA in NP (38+/-6.6 impulses/100 beats) was greater (P<0.05) than in NN women (19+/-1.8 impulses/100 beats) despite similar age and body weight but less than in PIH women (P<0.001) (146+/-23.5 impulses/100 beats). MSNA followed a similar trend. Cardiac baroreceptor reflex sensitivity (BRS) was impaired in NP and PIH women relative to NN. After delivery, sympathetic activity decreased to values similar to those obtained in NN, and there was an increase in BRS. In women with NP, the decrease in sympathetic output occurred despite an insignificant change in blood pressure.


CONCLUSIONS
Central sympathetic output was increased in women with normal pregnancy and was even greater in the hypertensive pregnant group. The findings suggest that the moderate sympathetic hyperactivity during the latter months of normal pregnancy may help to return the arterial pressure to nonpregnant levels, although when the increase in activity is excessive, hypertension may ensue.
Greenwood
J P
JP
Department of Cardiology, St James's University Hospital, Leeds, UK. john_greenwood@hotmail.com
Scott
E M
EM
Stoker
J B
JB
Walker
J J
JJ
Mary
D A
DA
D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D017704:Baroreflex; D001794:Blood Pressure; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D008137:Longitudinal Studies; D010525:Peripheral Nerves / Q000503:physiopathology; D010543:Peroneal Nerve / Q000503:physiopathology; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*; D011263:Pregnancy Trimester, Third; D012119:Respiration; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014661:Vasoconstriction; D044465:White People