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Blunted Autonomic Response to Volume Expansion in Formerly Preeclamptic Women with Low Plasma Volume

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Abstract

Objective

We hypothesize that low plasma volume in normotensive formerly preeclamptic women reflects reduced venous storage capacity. To test this hypothesis, we compared circulatory and autonomic responses to acute volume loading between women with low and those with normal plasma volume.

Methods

In 24 normotensive formerly preeclamptic women at least 6 months postpartum, we administered 500 mL of iso-oncotic fluid by constant intravenous infusion in 30 minutes, while recording changes in heart rate, blood pressure, cardiac output, and measuring active plasma renin and α-atrial natriuretic peptide concentrations. We estimated arterial sympathetic control, cardiac autonomic regulatory balance, and baroreflex sensitivity using spectral analysis. Intergroup and intragroup changes were analyzed nonparametrically.

Results

17 women (71%) had low plasma volume and 7 (29%) had normal plasma volume. Plasma volume expansion induced comparable changes in blood pressure, heart rate, baroreflex sensitivity, and active plasma renin concentration in low plasma volume and normal plasma volume. Cardiac output and α-atrial natriuretic peptide increased in low plasma volume but not in normal plasma volume. Volume expansion reduced sympathetic activity (from 2.41 to 1.76 mm Hg2, P = .03) in normal plasma volume but not in low plasma volume (from 2.72 to 2.48 mm Hg2, P < .05).

Conclusion

The sympathoinhibitory response to volume expansion is diminished in low plasma volume, which suggests that cardiovascular reflex function is impaired. We speculate that this defect contributes to circulatory maladaptation to pregnancy, sympathetic dominance, and the development of gestational hypertensive disease.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Internal postal code 791, PO Box 9101, 6500 HB, Nijmegen, Netherlands

    Ineke Krabbendam MD & Marc E. A. Spaanderman MD, PhD

  2. Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, Netherlands

    Dorette A. Courtar MD, Robert Aardenburg MD, PhD & Louis L. H. Peeters MD, PhD

  3. Department of Pharmacology and Toxicology, University of Maastricht, Maastricht, Netherlands

    Ben J. A. Janssen PhD

Authors
  1. Ineke Krabbendam MD
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  2. Dorette A. Courtar MD
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  3. Ben J. A. Janssen PhD
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  4. Robert Aardenburg MD, PhD
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  5. Louis L. H. Peeters MD, PhD
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  6. Marc E. A. Spaanderman MD, PhD
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Correspondence to Ineke Krabbendam MD.

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Krabbendam, I., Courtar, D.A., Janssen, B.J.A. et al. Blunted Autonomic Response to Volume Expansion in Formerly Preeclamptic Women with Low Plasma Volume. Reprod. Sci. 16, 105–112 (2009). https://doi.org/10.1177/1933719108324136

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