Corpus luteum number and the maternal renin-angiotensin-aldosterone system as determinants of utero-placental (vascular) development: the Rotterdam Periconceptional Cohort.
Corpus luteum number and the maternal renin-angiotensin-aldosterone system as determinants of utero-placental (vascular) development: the Rotterdam Periconceptional Cohort.
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DOI：
10.1186/s12958-021-00843-9
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发表时间：
2021-11-04
期刊：
影响因子：
--
通讯作者：
Steegers-Theunissen RPM
中科院分区：
文献类型：
--
作者：
Wiegel RE;Karsten MJH;Reijnders IF;van Rossem L;Willemsen SP;Mulders AGMGJ;Koning AHJ;Steegers EAP;Danser AHJ;Steegers-Theunissen RPM
> 1个黄体（CL）的妊娠表现为高动力循环和小于胎龄分娩的风险增加。在CL释放的因子中，有一种是原肾素，它是肾素的无活性前体。由于肾素-血管紧张素-醛固酮系统（RAAS）参与了早期血液动力学妊娠适应，我们将CL数量和妊娠早期的前肾素浓度（作为RAAS活性的指标）和醛固酮/肾素比值（作为血管紧张素非依赖性醛固酮有效性的指标）与子宫胎盘（血管）发育的非侵入性标志物联系起来，从妊娠早期开始纵向测量。从鹿特丹围受孕队列中选择了201名自然受孕或体外受精治疗后受孕的妇女（CL为0（n = 8）、1（n = 143）或> 1（n = 51））。在妊娠11周时测定母体RAAS组分。在妊娠7、9、11周时通过经阴道三维超声扫描测量胎盘体积和子宫胎盘血管体积，在妊娠7、9、11、13、22和32周时通过脉冲波多普勒超声评估子宫动脉的搏动和阻力指数。出生时，使用标准化程序获得胎盘重量。没有CL的妊娠在整个妊娠期间显示出比1 CL和> 1 CL妊娠更低的子宫动脉指数，而胎盘发育的参数在CL组之间是相当的。校正患者和治疗相关因素后，孕早期的前肾素浓度与子宫动脉搏动和阻力指数呈正相关（β 0.06，95% CI 0.01;0.12，p = 0.04和β 0.10，95% CI 0.01; 0.20，p = 0.04），而高前肾素浓度与妊娠早期子宫胎盘血管容积呈负相关（β-0.23，95% CI -0.44;-0.02，p = 0.04）和胎盘重量（β-93.8，95% CI -160.3;-27.4，p = 0.006）。相比之下，醛固酮/肾素比值与孕早期胎盘体积呈正相关（β 0.12，95% CI 0.01;0.24，p = 0.04）。CL的缺乏导致低的前肾素浓度，与子宫动脉搏动和阻力低有关，而高的前肾素浓度与子宫胎盘血管体积和重量低有关。这些数据支持这样一种情况，即过量的前肾素通过上调血管紧张素II而增加子宫阻力，从而阻止胎盘（血管）正常发育，并增加小于胎龄分娩的风险。同时，高醛固酮浓度，通过确保体积膨胀，发挥相反的作用。在线版本包含补充材料，可通过10.1186/s12958-021-00843-9获得。
Pregnancies with > 1 corpus luteum (CL) display a hyperdynamic circulation and an increased risk of small-for-gestational age deliveries. Among the factors released by the CL is prorenin, the inactive precursor of renin. Since the renin-angiotensin-aldosterone system (RAAS) is involved in early hemodynamic pregnancy adaptation, we linked both CL number and first-trimester concentrations of prorenin (as an indicator of RAAS activity) and the aldosterone/renin ratio (as an indicator of angiotensin-independent aldosterone effectiveness) to non-invasive markers of utero-placental (vascular) development, measured longitudinally from the first trimester onwards. A total of 201 women, who conceived naturally or after in-vitro fertilization treatment (with 0 (n = 8), 1 (n = 143), or > 1 (n = 51) CL), were selected from the Rotterdam Periconceptional Cohort. Maternal RAAS components were determined at 11 weeks gestation. Placental volume and utero-placental vascular volume were measured from transvaginal 3D ultrasound scans at 7, 9 and 11 weeks gestation, pulsatility and resistance indices of the uterine arteries were assessed by pulsed wave Doppler ultrasounds at 7, 9, 11, 13, 22 and 32 weeks gestation. At birth placental weight was obtained using standardized procedures. Pregnancies without a CL show lower uterine artery indices throughout gestation than 1 CL and > 1 CL pregnancies, while parameters of placental development are comparable among the CL groups. After adjustment for patient- and treatment-related factors, first-trimester prorenin concentrations are positively associated with uterine artery pulsatility and resistance indices (β 0.06, 95% CI 0.01;0.12, p = 0.04 and β 0.10, 95% CI 0.01;0.20, p = 0.04, respectively), while high prorenin concentrations are negatively associated with first-trimester utero-placental vascular volume (β -0.23, 95% CI -0.44;-0.02, p = 0.04) and placental weight (β -93.8, 95%CI -160.3;-27.4, p = 0.006). In contrast, the aldosterone/renin ratio is positively associated with first-trimester placental volume (β 0.12, 95% CI 0.01;0.24, p = 0.04). The absence of a CL, resulting in low prorenin concentrations, associates with low uterine artery pulsatility and resistance, while high prorenin concentrations associate with a low utero-placental vascular volume and weight. These data support a scenario in which excess prorenin, by upregulating angiotensin II, increases uterine resistance, thereby preventing normal placental (vascular) development, and increasing the risk of small-for-gestational age deliveries. Simultaneously, high aldosterone concentrations, by ensuring volume expansion, exert the opposite. The online version contains supplementary material available at 10.1186/s12958-021-00843-9.
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影响因子：
7.1
作者：
Cavoretto, P. I.;Farina, A.;Candiani, M.
通讯作者：
Candiani, M.
影响因子：
5.8
作者：
DERKX, FHM;ALBERDA, AT;SCHALEKAMP, MADH
通讯作者：
SCHALEKAMP, MADH
影响因子：
6.1
作者：
Cavoretto, P., I;Farina, A.;Candiani, M.
通讯作者：
Candiani, M.
影响因子：
3.8
作者：
Reijnders, I. F.;Mulders, A. G. M. G. J.;Steegers-Theunissen, R. P. M.
通讯作者：
Steegers-Theunissen, R. P. M.
影响因子：
2.3
作者：
Anton L;Brosnihan KB
通讯作者：
Brosnihan KB