Uterine artery blood flow, fetal hypoxia and fetal growth
Uterine artery blood flow, fetal hypoxia and fetal growth
复制标题
DOI：
10.1098/rstb.2014.0068
复制
发表时间：
2015-03-05
影响因子：
6.3
通讯作者：
Moore, Lorna G.
中科院分区：
文献类型：
--
作者：
Browne, Vaughn A.;Julian, Colleen G.;Moore, Lorna G.
两足行走和大脑扩张所需的进化权衡影响妊娠子宫动脉（UtA）血流的增加，进而影响生殖成功。我们认为UtA血流量的重要性，审查其决定因素和191血压正常（正常，n = 125）或高血压（先兆子痫（PE）或妊娠高血压（GH），n = 29）安第斯居民的非常高（4100-4300米）或低海拔（400米，n = 37）。先前的研究表明，胎儿宫内生长受限（IUGR）的孕妇UtA血流减少，但IUGR是否是由于胎儿缺氧所致尚不清楚。我们发现高海拔地区血压正常的妇女胎儿缺氧的UtA血流和多普勒指数高于低海拔地区，但胎儿生长情况相似。早发型PE孕妇的UtA血流明显低于正常高海拔孕妇，胎儿缺氧程度更高，表现为胎心率、多普勒指数降低和IUGR增大。我们的结论是，尽管胎儿缺氧更大，胎儿生长得到了很好的保护较高的UtA血流量在正常的安第斯山脉在高海拔地区，但当复合较低的UtA血流量在早发性PE，夸大的胎儿缺氧导致胎儿的反应，减少心输出量和重新分配血流，以帮助维持大脑发育的代价在其他地方的增长。我们推测UtA血流不仅是一个重要的供应线，也是刺激代谢和其他过程调节胎儿胎盘代谢和生长的触发器。利用高海拔自然实验室进行的研究对于确定人类生殖成功所涉及的生理和遗传机制是有价值的。
Evolutionary trade-offs required for bipedalism and brain expansion influence the pregnancy rise in uterine artery (UtA) blood flow and, in turn, reproductive success. We consider the importance of UtA blood flow by reviewing its determinants and presenting data from 191 normotensive (normal, n = 125) or hypertensive (preeclampsia (PE) or gestational hypertension (GH), n = 29) Andean residents of very high (4100-4300 m) or low altitude (400 m, n = 37). Prior studies show that UtA blood flowis reduced in pregnancies with intrauterine growth restriction (IUGR) but whether the IUGR is due to resultant fetal hypoxia is unclear. We found higher UtA blood flow and Doppler indices of fetal hypoxia in normotensive women at high versus low altitude but similar fetal growth. UtA blood flow was markedly lower in early-onset PE versus normal high-altitude women, and their fetuses more hypoxic as indicated by lower fetal heart rate, Doppler indices and greater IUGR. We concluded that, despite greater fetal hypoxia, fetal growth was well defended by higher UtA blood flows in normal Andeans at high altitude but when compounded by lower UtA blood flow in early-onset PE, exaggerated fetal hypoxia caused the fetus to respond by decreasing cardiac output and redistributing blood flow to help maintain brain development at the expense of growth elsewhere. We speculate that UtA blood flowis not only an important supply line but also a trigger for stimulating the metabolic and other processes regulating feto-placental metabolism and growth. Studies using the natural laboratory of high altitude are valuable for identifying the physiological and genetic mechanisms involved in human reproductive success.