Maternal cardiac autonomic function and fetal heart rate in preeclamptic compared to normotensive pregnancies.
BACKGROUND
Preeclampsia during pregnancy increases a woman's risk of cardiovascular disease in two ways. Women who develop preeclampsia are at increased risk for the development of hypertension and cardiovascular disease later in life. As well, fetal adaptations (e.g., growth restriction) may lead to the development of cardiovascular risk factors (e.g., obesity, increased cholesterol) in the offspring. Although atypical maternal cardiac autonomic function has been reported in preeclampsia, to date, its effects on fetal cardiac function have not been determined.


OBJECTIVE
To characterize the pattern of short-term maternal cardiac autonomic modulation and spontaneous fetal heart rate changes in preeclamptic compared to normotensive women and to determine the relationship between them.


METHODS
Twenty-seven mother-fetal pairs (n = 9 preeclamptic, n = 18 normotensive) at 32 to 40 weeks gestation were tested on one occasion. Maternal autonomic modulation of heart rate was measured for 20 minutes using electrocardiographic and beat-by-beat arterial systolic blood pressure recordings. Simultaneously, spontaneous fetal heart rate was obtained using a cardiotachograph. Women's cardiac autonomic responses to orthostatic stress were obtained for five minutes in a standing position.


RESULTS
Comparisons of maternal cardiac measures in the preeclamptic versus the normotensive group showed that the preeclamptic group had a decreased parasympathetic nervous system indicator and an increased sympathetic nervous system indicator with increasing gestation. In response to orthostatic stress, women in both groups showed a similar increase in arterial systolic blood pressure and a decrease in parasympathetic nervous system indicator and R-R interval when standing compared to lying. Fetuses in the normotensive compared to the preeclamptic group had more spontaneous fetal heart rate accelerations; the greater the decrease in the parasympathetic nervous system indicator from lying to standing, the greater the number of fetal heart rate accelerations.


CONCLUSIONS
These findings serve to further our understanding of the cardiovascular pathophysiology of preeclampsia in both the mother and the fetus. Women who develop preeclampsia during pregnancy show atypical autonomic nervous system modulation of heart rate that is associated with a decrease in spontaneous fetal heart rate accelerations in late gestation. Implications for cardiovascular nursing practice include the monitoring of maternal cardiac autonomic function during pregnancy, especially during standing, as well as a need for continued surveillance of maternal cardiovascular function following pregnancy. The negative effect on fetal heart rate accelerations has implications for the interpretation of standardized obstetrical tests of fetal well-being.
Swansburg
M L
ML
School of Nursing, Department of Obstetrics and Gynecology, Queen's University and Kingston General Hospital, ON.
Brown
C A
CA
Hains
S M J
SM
Smith
G N
GN
Kisilevsky
B S
BS
D000328:Adult; D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D015148:Cardiotocography; D016022:Case-Control Studies; D005260:Female; D005323:Fetal Monitoring / Q000379:methods / Q000451:nursing; D005865:Gestational Age; D006339:Heart Rate; D006340:Heart Rate, Fetal; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D016014:Linear Models; D008991:Monitoring, Physiologic / Q000379:methods / Q000451:nursing; D024802:Nurse's Role; D009864:Ontario; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D011263:Pregnancy Trimester, Third; D016683:Supine Position