Arterial stiffness during pregnancy and after delivery

Background. Physiological pregnancy from conception to birth affects both the woman’s body as a whole and cardiovascular system, in particular. In some cases, there is a failure of adaptive mechanisms of the cardiovascular system without clinical manifestations. As a consequence, such complications as pre-eclampsia, hypertension, pregnancy, fetal growth retardation syndrome and others can develop.

Objective. To evaluate the indicators of arterial rigidity, and their association with blood pressure, heart rate, age, parameters of Doppler study of uterine arteries during pregnancy and after delivery.

Design and methods. In a cohort prospective study, 31 women with physiological pregnancy without somatic pathologies were included (age from 19 to 34 years, mean age 26 years). The following parameters were assessed: arterial stiffness and Doppler study of uterine artery blood flow, anthropometric and clinical indicators.

Results. On average, the studied values vary within 7 % during pregnancy. There was a significant association between age and augmentation index, arterial rigidity index in the second trimester. Pulse wave velocity increases by the third trimester, and returns to the baseline values in postpartum period. Arterial rigidity index increases throughout gestation period. In the third trimester, uterine artery hemodynamics (including the systolic-diastolic ratio, pulse index and resistance index) varies depending on the time of the reflected wave propagation. In the early postpartum period, augmentation index decreases, at the same time heart rate raises significantly. A strong association between arterial rigidity index and the time of the reflected wave propagation is observed.

Conclusions. The indicators of arterial stiffness, measured by the used technique, demonstrate adaptive changes during pregnancy and are promising to forecast potential cardiovascular diseases associated with arterial elasticity changes.

1. Macedo ML, Luminoso D, Savvidou MD, McEniery CM, Nicolaides KH. Maternal wave reflections and arterial stiffness in normal pregnancy as assessed by applanation tonometry. Hypertension. 2009; 51(4):1047–1051.

2. Сидорова И. С., Кулаков В. И., Макаров И. О. Руководство по акушерству. М.: ГЭОТАР-Медиа, 2009. C. 25–47.

3. [Sidorova IS, Kulakov VI, Makarov IO. Guidelines for obstetrics. Moscow: GEOTAR Media, 2009. P. 25–47. In Russian]. 3. Айламазян Э. К., Кулаков В. И., Радзинский В. Е., Серов В. Н. Национальное руководство. Акушерство. М.: ГЭОТАР-Медиа, 2012. C. 30–256. ISBN 978–5-9704–2176–5. [Ailamazyan EK, Kulakov VI, Radzinsky VE, Serov VN. National leadership. Obstetrics. Moscow: GEOTAR-Media, 2012. P. 30–256. In Russian].

4. Серов В. Н., Сухих Г. Т., Баранов И. И. Неотложные состояния в акушерстве. М.: ГЭОТАР-Медиа, 2011. C. 14–278. ISBN 978–5-9704–2001–0. [Serov VN, Dry GT, Baranov II. Emergency conditions in obstetrics. Moscow: GEOTAR Media, 2011. P. 14–278. In Russian].

5. Хитров М. В. Динамика показателей эхокардиографии матери при физиологическом течении беременности. Эхография. 2003;3;298–305. [Khitrov MV. Dynamics of echocardiography mother in physiological pregnancy. Ekhocardiografiya = Sonography. 2003;3;298–305].

6. Crombach G, Vetter K. Intrauterine Wachstumsrestriktion. Teil II: Klinisches Management Gynäkologie. 2007;40 (12):983.

7. Goecke TW, Krüssel JS, Fisher J. Prostacyclin deficiency and reduced fetoplacental blood flow in pregnancy-induced hypertension and preeclampsia. Gynecol Obstet Invest. 2000;50 (7):103–107.

8. Elvan-Taspinar A, Franx A, Bots M, Bruinse HW. Arterial stiffness and fetal growth in normotensive pregnancy. Am J Hypertens 2005;18(3):337–341.

9. O’Rourke T, Yochem J, Connolly AA, Price MH. Genome mapping and genomes. Netherlands: Springer. 2004;1(1):66.

10. Heimrath J, Paprocka M, Czekanski A, Ledwozyw A, Kantor A, Robb AO. Pregnancy-induced hypertension is accompanied by decreased number of circulating endothelial cells and circulating endothelial progenitor cells. Arch Immunol Ther Exp (Warsz). 2014;62(4):353–356. doi: 10.1007/s00005–014–0278‑x

11. Новичкова Е. А. Характеристика эластических свойств сосудов и вегетативной регуляции у женщин с артериальной гипертонией в период беременности. Автореф. дис. канд. мед. наук. Иваново, 2009. C. 23–60. [Novichkova EA. Vascular elasticity and autonomic regulation in hypertensive women during pregnancy. PhD thesis. Ivanovo, 2009. P. 23–60. In Russian].

12. Ланг Т. А., Сесик М. Как описывать статистику в медицине. Аннотированное руководство для авторов, редакторов и рецензентов (перевод с английского под ред. В. П. Леонова). М.: Практическая медицина, 2011. 480 с. [Lang TA, Sesik M. How to describe statistics in medicine. Annotated Guide to the authors, editors and reviewers (translated from English ed. V. P. Leonov). Moscow: Practical Medicine, 2011. 480 p. In Russian].

13. Рогоза А. Н. Жесткость сосудистой стенки и функциональное состояние сосудов микроциркуляторного русла кожи у лиц средней возрастной группы с артериальной гипертензией. Регионарное кровообращение и микроциркуляция. 2014;4:18–27. [Rogoza AN. The rigidity of the vascular wall and the functional state of microvascular skin in middle-aged individuals with hypertension. Regional Circulation and Microcirculation. 2014;4:18–27. In Russian].

14. Стрижаков А. Т., Бунин А. Т., Медведьев М. В. Ультразвуковая диагностика в акушерской клинике. М.: М–Медицина, 1990. 239 c. [Strizhakov AT, Bunin AT, Medvedev MV. Ultrasound diagnosis in obstetrics clinic. Moscow: Medicine, 1990. 239 p. In Russian].

15. Агеева М. И., Митьков В. В., Малахова Е. Е. Сравнительная оценка состояния плацентарного кровообращения и гемодинамики плода с патологическими типами актокардиограмм различной степени тяжести. Ультразвуковая и функциональная диагностика. 2002;39(3):34. [Ageeva MI, Mit’kov VV, Malakhov EE. Comparative assessment of the placental circulation and fetal hemodynamics with pathological types aktocardiograms varying severity. Ultrasonic and Functional Diagnostics. 2002;39(3):34. In Russian].

16. Апресян С. В. Беременность и роды при экстрагенитальных заболеваниях. М.: ГЭОТАР-Медиа, 2009. 56 c. [Apresian SV. Pregnancy and childbirth at extragenital diseases. Moscow: GEOTAR Media, 2009. 56 p. In Russian].

17. Стрюк Р. И. Пути решения проблемы артериальной гипертонии при беременности. Российский кардиологический журнал. 2013;4(102):64–69. [Stryuk RI. Ways of solving the problem of hypertension in pregnancy. Journal of Cardiology. 2013;4(102):64–69. In Russian].

18. Кобалава Ж. Д., Чистяков Д. А., Терещенко С. Н. Полиморфизм гена сосудистого рецептора ангиотензина II и сердечно-сосудистые заболевания. Кардиология. 2013;6:75–80. [Kobalava ZhD, Chistyakov DA, Tereschenko SN. Gene polymorphism of angiotensin II receptor vascular and cardiovascular diseases. Kardiologiia. 2013;6:75–80. In Russian].

19. Robb AO, Nicholas М. The influence of the menstrual cycle, normal pregnancy and pre-eclampsia on platelet activation. Thrombosis and haemostasis. 2010;103(2):372–387. ISSN: 0340–6245. DOI: http://dx.doi.org/10.1160/TH09–06–0358

20. Альпин А. Я., Абрамова Р. М. О некоторых противоречиях между гидродинамической теорией кровотока и экспериментальными данными. XXXVII Ломоносовские чтения в Северодвинске, 2009. 53–66 c. [Al’pin AY, Abramova RM. Some contradictions between the theory of hydrodynamic flow and experimental data. XXXVII Lomonosov Readings in Severodvinsk, 2009. P. 53–66. In Russian].

21. Spasojevic M, Smith SA, Morris JM, Gallery EDM. Peripheral arterial pulse wave analysis in women with pre-eclampsia and gestational hypertension. BJOG. 2005;112(11):1475–1478. doi: 10.1111/j.1471–0528.2005.00701

22. Roman MJ, Simone G, Devereux RB, Alderman M, Laragh JH. Impact of diabetes on cardiac structure and function: the strong heart study. Circulation. 2000;101(19):2271–2276.

23. Langrish JP, Mills NL, Bath LE, Robb AO. Cardiovascular effects of physiological and standard sex steroid replacement regimens in premature ovarian failure Hypertension. 2009:53 (5);805–811. doi: 10.1161/HYPERTENSIONAHA.108.126342