Time course of maternal plasma volume and hormonal changes in women with preeclampsia or fetal growth restriction
Time course of maternal plasma volume and hormonal changes in women with preeclampsia or fetal growth restriction
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DOI：
10.1161/01.hyp.0000200042.64517.19
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发表时间：
2006-02-01
期刊：
影响因子：
8.3
通讯作者：
Rosso, P
中科院分区：
文献类型：
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作者：
Salas, SP;Marshall, G;Rosso, P
我们测试了一种假设，即患有特发性胎儿生长受限(FGR)或先兆子痫(PE)的妇女在这些妇女出现血浆容量下降之前或伴随着这些妇女出现血浆容量下降之前或伴随着这些妇女的血浆容量下降，某些保水激素，如醛固酮和雌二醇的浓度较低。对135名孕妇从第10周到足月每隔一个月连续测量血浆雌二醇、孕酮和醛固酮的体积和浓度。23例发生特发性FGR，17例发生PE，95例血压正常并分娩正常大小的婴儿(对照组)。使用混合模型研究了每个变量随时间的变化。所有组的产妇年龄、产次和足月体重/身高都相似。FGR组和PE组的出生体重、身长和体重指数均低于对照组。对照组的血浆容量在整个妊娠期间都有所增加，但FGR组和PE组的血浆容量从14周到17周一直到足月都较低。从26周到29周，PE组和34周后的FGR组的醛固酮值均较低。从第18~21周到足月，PE组孕酮浓度高于对照组或FGR组。相比之下，FGR妊娠34周后孕酮和雌二醇浓度降低。孕酮/雌二醇比值仅在PE组显著高于PE组。在患有特发性FGR或PE的母亲中，在激素浓度改变之前，血浆容量的扩张较少。我们推测孕酮的早期升高可能在子痫前期的发生发展中起致病作用。
We tested the hypothesis that women with idiopathic fetal growth restriction (FGR) or preeclampsia (PE) have lower concentrations of some water-retaining hormones, such as aldosterone and estradiol, either preceding or concomitant with the onset of the reduced plasma volume described in these women. Plasma volume and serum concentrations of estradiol, progesterone, and aldosterone were measured serially at monthly intervals in 135 pregnant women from week 10 until term. Twenty-three developed idiopathic FGR, 17 had PE, and 95 remained normotensive and delivered normal-size infants ( controls). Changes over time for each variable were studied using mixed models. Maternal age, parity, and weight/height at term were similar in all of the groups. Birth weight, body length, and ponderal index were lower in FGR and PE than in controls. Plasma volume increased throughout pregnancy in controls but was lower in FGR and PE from week 14 to 17 until term. Aldosterone values were lower in PE from week 26 to 29 onwards and in FGR after week 34. Progesterone concentrations were higher in PE than either control or FGR from week 18 to 21 until term. In contrast, FGR pregnancies had reduced progesterone and estradiol concentrations after week 34. Progesterone: estradiol ratio was significantly higher only in the PE group. In mothers with idiopathic FGR or PE, less expansion in plasma volume occurred before alterations in hormonal concentrations. We speculate that the early rise in progesterone may have a pathogenic role in the development of preeclampsia.