Non-invasive assessment of autonomic cardiovascular control in normal human pregnancy and pregnancy- associated hypertensive disorders: a review.
OBJECTIVE
Pre-eclampsia is a major complication of pregnancy. Although the disorder usually becomes apparent only in the third trimester of pregnancy, evidence is available that underlying pathophysiological abnormalities are already present early in pregnancy. The association between alterations in autonomic cardiovascular control and the development of hypertension in pregnancy has been investigated for some time. Non-invasive methods are especially of interest, since they have the advantage of minimal risk for the mother and the conceptus and enable repeated measurements during pregnancy. If non-invasive tests for autonomic cardiovascular control could demonstrate the increased sympathetic activity, as observed by microneurography than this method is a candidate for early identification of pre-eclampsia. Therefore, the literature on non-invasive testing of autonomic cardiovascular control in normal pregnancies and pre-eclampsia was summarized.


METHODS
Medline was searched and 36 articles on autonomic cardiovascular control in human pregnancy by non-invasive test methods were reviewed. For each test method, data of different studies were summarized to evaluate if the method could discriminate between healthy pregnancy and pre-eclampsia.


CONCLUSIONS
Although small differences have been observed between normal pregnancy and pre-eclampsia in individual studies using non-invasive methods, the consistency in the available data is insufficient to discriminate between normal pregnancy and pre-eclampsia. The failure to demonstrate the increased sympathetic activity, as observed by direct microneurography, might be due to methodological factors of the non-invasive studies. Alternatively, sympathetic activity to resistance vessels in skeletal muscle may not be a proper reflection of autonomic cardiovascular control in pregnancy. Well-designed longitudinal research could be useful to test these suppositions.
Rang
Saskia
S
Department of Obstetrics and Gynecology, Internal Medicine and Physiology, Academic Medical Center, Amsterdam, The Netherlands. s.rang@amc.uva.nl
Wolf
Hans
H
Montfrans
Gert A
GA
Karemaker
John M
JM
D001341:Autonomic Nervous System / Q000502:physiology*; D001794:Blood Pressure; D002319:Cardiovascular System / Q000294:innervation; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology*; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000503:physiopathology*; D011247:Pregnancy; D012018:Reflex