High-end arteriolar resistance limits uterine artery blood flow and restricts fetal growth in preeclampsia and gestational hypertension at high altitude

Autor: Robert C. Roach, Mark D. Shriver, Enrique Vargas, Darleen Cioffi-Ragan, Lorna G. Moore, Megan J. Wilson, Lilian Toledo-Jaldin, Abigail W. Bigham, Benjamin Honigman, Vaughn A. Browne, Luis Pablo Lopez, Henry Yamashiro, R. Daniela Dávila, Colleen G. Julian
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Gestational hypertension
Adult
medicine.medical_specialty
Bolivia
Physiology
Population
Intrauterine growth restriction
Gestational Age
Iliac Artery
Ultrasonography
Prenatal
Preeclampsia
Young Adult
Pre-Eclampsia
Pregnancy
Physiology (medical)
Internal medicine
medicine.artery
Laser-Doppler Flowmetry
Medicine
Humans
education
Uterine artery
education.field_of_study
Analysis of Variance
Fetal Growth Retardation
business.industry
Altitude
Ultrasonography
Doppler
Articles
Hypertension
Pregnancy-Induced
Hypoxia (medical)
Stillbirth
medicine.disease
Uterine Artery
Endocrinology
medicine.anatomical_structure
Cross-Sectional Studies
Regional Blood Flow
Case-Control Studies
Vascular resistance
Small for gestational age
Premature Birth
Female
Vascular Resistance
medicine.symptom
business
Live Birth
Blood Flow Velocity
Popis: The reduction in infant birth weight and increased frequency of preeclampsia (PE) in high-altitude residents have been attributed to greater placental hypoxia, smaller uterine artery (UA) diameter, and lower UA blood flow (QUA). This cross-sectional case-control study determined UA, common iliac (CI), and external iliac (EI) arterial blood flow in Andeans residing at 3,600–4,100 m, who were either nonpregnant (NP, n = 23), or experiencing normotensive pregnancies (NORM; n = 155), preeclampsia (PE, n = 20), or gestational hypertension (GH, n = 12). Pregnancy enlarged UA diameter to ∼0.62 cm in all groups, but indices of end-arteriolar vascular resistance were higher in PE or GH than in NORM. QUAwas lower in early-onset (≤34 wk) PE or GH than in NORM, but was normal in late-onset (>34 wk) illness. Left QUAwas consistently greater than right in NORM, but the pattern reversed in PE. Although QCIand QEIwere higher in PE and GH than NORM, the fraction of QCIdistributed to the UA was reduced 2- to 3-fold. Women with early-onset PE delivered preterm, and 43% had stillborn small for gestational age (SGA) babies. Those with GH and late-onset PE delivered at term but had higher frequencies of SGA babies (GH=50%, PE=46% vs. NORM=15%, both P < 0.01). Birth weight was strongly associated with reduced QUA( R2= 0.80, P < 0.01), as were disease severity and adverse fetal outcomes. We concluded that high end-arteriolar resistance, not smaller UA diameter, limited QUAand restricted fetal growth in PE and GH. These are, to our knowledge, the first quantitative measurements of QUAand pelvic blood flow in early- vs. late-onset PE in high-altitude residents.
Databáze: OpenAIRE
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