Cardiovascular alterations in normal and preeclamptic pregnancy

Judith U. Hibbard, Sanjeev G. Shroff, F. Gary Cunningham

Research output: Chapter in Book/Report/Conference proceedingChapter

4 Scopus citations

Abstract

The changes in the cardiovascular system during normal pregnancy include increases in cardiac output and arterial compliance, while blood pressure and systemic vascular resistance fall, and the vasculature becomes resistant to pressor hormones, all without significant changes in myocardial contractility. The onset of preeclampsia is characterized by marked reversal of vasculature resistance to pressor hormones, decreases in cardiac output, and a high systemic vascular resistant state. Some note a hyperdynamic, low-resistance disease state preceding this that may indicate a subset of women with, or destined to have, chronic hypertension. However, the hyperdynamic state is hard to reconcile with the early change in vascular reactivity, a decrease in intravascular volume preceding and the exaggerated rise in circulating antiangiogenic proteins that impede vasodilatation. Steady and pulsatile arterial loads decrease in normal pregnancy but fail to do so in preeclampsia. Abnormal vascular responses during preeclampsia may be secondary to changes in vascular tone - autonomic nervous system, hormonal regulation - and/or vascular wall elements. While left ventricular contractility, as measured by load-independent indices, seems to be unaltered during preeclampsia, left ventricular diastolic function is depressed in early-onset preeclampsia. Evidence is accumulating in support of the notion that pregnancy can be considered as a cardio-metabolic "stress test," capable of unmasking underlying subclinical cardiovascular and metabolic abnormalities that increase the risk of both pregnancy disorders such as preeclampsia and later-life cardiovascular disease.

Original languageEnglish (US)
Title of host publicationChesley's Hypertensive Disorders in Pregnancy, Fourth Edition
PublisherElsevier Science
Pages291-313
Number of pages23
ISBN (Electronic)9780124078666
DOIs
StatePublished - Jan 1 2014

Keywords

  • Cardiovascular system
  • Hemodynamics
  • Left ventricular mechanics
  • Preeclampsia
  • Pregnancy response and later-life cardiovascular disease risk
  • Systemic arterial circulation

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Hibbard, J. U., Shroff, S. G., & Gary Cunningham, F. (2014). Cardiovascular alterations in normal and preeclamptic pregnancy. In Chesley's Hypertensive Disorders in Pregnancy, Fourth Edition (pp. 291-313). Elsevier Science. https://doi.org/10.1016/B978-0-12-407866-6.00014-6