Volume regulatory hormones and plasma volume in pregnant women with sickle cell disorder.
BACKGROUND
Sickle cell disease (haemoglobin SS (HbSS)) mainly affects those of West African origin and is associated with hypervolaemia. Plasma volume rises by up to 50% in normal pregnancy but was previously found to be paradoxically contracted in late sickle cell pregnancy. The renin-angiotensin-aldosterone system is activated very early in human pregnancy to support the plasma volume expansion. We hypothesised that activation of the renin-angiotensin-aldosterone system would be blunted in pregnant women with sickle cell disease.


METHODS
We measured plasma volume and concentrations of plasma renin, angiotensinogen, aldosterone and other volume-related hormones in a cross-sectional study of pregnant and non-pregnant Nigerian women with HbSS or HbAA.


RESULTS
Plasma volume was higher in non-pregnant HbSS than HbAA women, but had not risen by 16 weeks, unlike plasma volume in HbAA women. The concentration of plasma renin also rose significantly less by 16 weeks in HbSS; angiotensinogen and aldosterone concentrations increased.


CONCLUSIONS
The lower plasma renin concentration at 16 weeks with HbSS could be either primary or secondary to vasoconstriction related to inadequate vasodilator activity. The contracted plasma volume might then stimulate aldosterone synthesis by non-angiotensin II dependent stimulation. Studies of vasodilators such as nitric oxide, vasodilator eicosanoids or the PlGF/VEGF/sFlT-1 axis in pregnant HbSS and HbAA women will test this hypothesis.
Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Nigeria bosedeafolabi2003@yahoo.com.
Bosede B
BB
Afolabi
Department of Pathology, University of Texas Medical Branch, Galveston, USA.
Olajumoke O
OO
Oladipo
Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Nigeria.
Alani S
AS
Akanmu
Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Nigeria.
Olalekan O
OO
Abudu
Department of Physiology, College of Medicine, University of Lagos, Nigeria.
Olusoga A
OA
Sofola
Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Nottingham, UK.
Fiona
F
Broughton Pipkin
Sickle cell disease; plasma volume; pregnancy; renin–angiotensin–aldosterone system (RAAS); sickle cell anaemia; volume regulatory hormones
Obstet Gynecol. 2004 Jun;103(6):1278-85
15172865
Hypertension. 2006 Feb;47(2):203-8
16380519
J Obstet Gynaecol Br Commonw. 1973 Oct;80(10):884-7
4585824
Int J Endocrinol Metab. 2014 Apr 01;12(2):e14098
24803942
Obstet Gynecol. 1998 Aug;92(2):171-3
9699745
Am J Hypertens. 1992 Jun;5(6 Pt 1):366-71
1524761
Nature. 2010 Nov 4;468(7320):108-11
20927107
Br J Obstet Gynaecol. 1983 Mar;90(3):220-6
6338900
N Engl J Med. 1987 Oct 22;317(17):1098
3657876
Clin Exp Hypertens. 1997 Jul-Aug;19(5-6):713-26
9247750
J Physiol Pharmacol. 2008 Dec;59 Suppl 8:27-45
19258663
Lancet. 2010 Dec 11;376(9757):2018-31
21131035
Clin Haematol. 1985 Oct;14(3):601-12
4075604
Clin Sci (Lond). 1984 Apr;66(4):399-406
6365409
Compr Physiol. 2014 Jul;4(3):1017-55
24944029
Arch Gynecol Obstet. 2009 Nov;280(5):793-7
19271230
Int J Gynaecol Obstet. 2006 May;93(2):171-5
16563397
Am J Physiol. 1989 Aug;257(2 Pt 2):F159-69
2669525
J Obstet Gynaecol. 2009 Feb;29(2):104-6
19274540
Hum Reprod. 2005 Nov;20(11):3157-62
16006463
Am J Obstet Gynecol. 1990 Nov;163(5 Pt 1):1612-21
2146881
West J Med. 1994 Oct;161(4):393-408
7817551
J Natl Med Assoc. 1988 Aug;80(8):906-12
3246704
Ann Intern Med. 1979 Mar;90(3):310-16
34341
Obstet Gynecol. 2001 May;97(5 Pt 1):669-72
11339913
Am J Physiol Regul Integr Comp Physiol. 2014 Jan 15;306(2):R91-101
24089380
Clin Lab Haematol. 1995 Jun;17(2):189-94
8536425
Blood. 2015 May 21;125(21):3316-25
25800049
Kidney Int. 1998 Dec;54(6):2056-63
9853271
Cytokine Growth Factor Rev. 2013 Oct;24(5):411-25
23800655
Hemoglobin. 2014;38(2):91-4
24417305
J Hypertens. 2012 Nov;30(11):2168-72
22940682
Am J Physiol Renal Physiol. 2015 Apr 1;308(7):F697-705
25587116
Cancer Epidemiol Biomarkers Prev. 2007 Sep;16(9):1720-3
17855687
Hemoglobin. 2013;37(6):507-15
23952263
Am J Physiol Regul Integr Comp Physiol. 2010 Nov;299(5):R1326-32
20686170
Exp Physiol. 2014 May 1;99(5):816-23
24563165
Hypertension. 2001 Sep;38(3 Pt 2):718-22
11566964
Lancet. 2003 May 3;361(9368):1511-7
12737861
Int J Epidemiol. 2002 Dec;31(6):1235-9
12540728
J Perinat Med. 2014 Jul;42(4):487-92
24344096