Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women's Research Institute, Pittsburgh, PA, USA.
Clin Sci (Lond). 2011 Oct;121(8):355-65. doi: 10.1042/CS20110008.
Whether brachial artery FMD (flow-mediated dilation) is altered in pregnancy by 28-35 weeks compared with non-pregnant women remains controversial. The controversy may be due to limitations of previous studies that include failing to: (i) test non-pregnant controls in the mid-late luteal phase, (ii) account for effects of pregnancy on the dilatory shear stimulus, (iii) account for physical activity or (iv) control for inter-individual variation in the time to peak FMD. In the present study, brachial artery FMD was measured in 17 active and eight sedentary pregnant women (34.1±1.6 weeks of gestation), and in 19 active and 11 sedentary non-pregnant women (mid-late luteal phase). Decreased vascular tone secondary to increased shear stress contributes minimally to pregnancy-induced increases in baseline brachial artery diameter, as shear stress removal during distal cuff inflation in pregnant women did not reduce diameter to baseline levels observed in non-pregnant controls. Neither the shear stimulus nor the percentage FMD was affected by pregnancy or regular exercise. Continuous diameter measurements are required to control for delayed peak dilation during pregnancy (57±15 compared with 46±15 s; P=0.012), as post-release diameter measured at 60 or 55-65 s post-release underestimated FMD to a greater extent in non-pregnant than in pregnant women.
妊娠 28-35 周时肱动脉 FMD(血流介导的扩张)是否与非妊娠女性不同仍存在争议。这种争议可能是由于之前的研究存在局限性,包括未能:(i)在黄体中期测试非妊娠对照组,(ii)考虑到妊娠对扩张性剪切刺激的影响,(iii)考虑到体力活动,或(iv)控制 FMD 峰值时间的个体间差异。在本研究中,我们测量了 17 名活跃和 8 名久坐的孕妇(34.1±1.6 周妊娠)以及 19 名活跃和 11 名久坐的非孕妇(黄体中期)的肱动脉 FMD。由于剪切应力增加导致的血管张力降低对妊娠引起的基础肱动脉直径增加的贡献最小,因为在孕妇中远端袖带充气时去除剪切应力并未使直径降低到非孕妇对照组观察到的基础水平。剪切刺激或 FMD 的百分比均不受妊娠或规律运动的影响。需要进行连续直径测量来控制妊娠期间的延迟峰值扩张(57±15 与 46±15 s;P=0.012),因为在释放后 60 或 55-65 s 测量的释放后直径在非孕妇中低估 FMD 的程度大于在孕妇中。