Iacobaeus C, Andolf E, Thorsell M, Bremme K, Jörneskog G, Östlund E, Kahan T
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Obstetrics and Gynaecology, Stockholm, Sweden.
Department of Women's and Children's Health, Karolinska Institutet, Division of Obstetrics and Gynaecology, Stockholm, Sweden.
Ultrasound Obstet Gynecol. 2017 Jan;49(1):46-53. doi: 10.1002/uog.17326.
To examine alterations in maternal vascular structure and function during normal pregnancy.
We assessed brachial and central blood pressure, pulse-wave velocity and augmentation index (by pulse-wave analysis and applanation tonometry), common carotid artery structure (by ultrasonography) and endothelial function in the brachial artery (by postischemic hyperemia-induced flow-mediated vasodilatation by glyceryl trinitrate) and in the forearm skin microcirculation (by laser Doppler perfusion imaging during iontophoretic administration of acetylcholine and sodium nitroprusside) in 52 healthy nulliparous women at 14, 24 and 34 weeks' gestation, and at 9 months postpartum.
During pregnancy, brachial and central systolic and diastolic blood pressures initially decreased but subsequently increased (all P < 0.05). Flow-mediated vasodilatation in the brachial artery increased during early pregnancy (P < 0.05), whereas non-specific vasodilatation by glyceryl trinitrate decreased (P < 0.01), indicating improved endothelial function. Thus, endothelial function index (forearm blood flow/glyceryl trinitrate) increased during pregnancy (0.30 ± 0.18 in the non-pregnant state at 9 months postpartum and 0.51 ± 0.19, 0.61 ± 0.39 and 0.49 ± 0.30 in the first, second and third trimesters, respectively) (P < 0.001). Endothelium-dependent skin microvascular reactivity to acetylcholine also increased (P < 0.01). Carotid-femoral pulse-wave velocity decreased during pregnancy (5.88 ± 0.91 m/s in the non-pregnant state and 5.55 ± 0.67, 5.12 ± 0.66 and 5.62 ± 0.74 m/s in the first, second and third trimesters, respectively) (P < 0.001).
During normal pregnancy, the blood volume expansion necessary for sufficient fetal growth is accommodated by early and marked changes in the matvascular system. This seems to be dependent on normal adaptive endothelial and vascular function. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
研究正常妊娠期间母体血管结构和功能的变化。
我们评估了52名健康未孕女性在妊娠14周、24周、34周以及产后9个月时的肱动脉和中心血压、脉搏波速度和增强指数（通过脉搏波分析和压平式眼压测量法）、颈总动脉结构（通过超声检查）以及肱动脉的内皮功能（通过缺血后充血诱导的血流介导的血管舒张，使用硝酸甘油）和前臂皮肤微循环的内皮功能（通过离子导入乙酰胆碱和硝普钠期间的激光多普勒灌注成像）。
在妊娠期间，肱动脉和中心收缩压及舒张压最初下降，但随后升高（所有P<0.05）。妊娠早期肱动脉血流介导的血管舒张增加（P<0.05），而硝酸甘油引起的非特异性血管舒张减少（P<0.01），表明内皮功能改善。因此，内皮功能指数（前臂血流量/硝酸甘油）在妊娠期间升高（产后9个月非妊娠状态下为0.30±0.18，妊娠第一、第二和第三孕期分别为0.51±0.19、0.61±0.39和0.49±0.30）（P<0.001）。内皮依赖性皮肤微血管对乙酰胆碱的反应性也增加（P<0.01）。妊娠期间颈股脉搏波速度下降（非妊娠状态下为5.88±0.91米/秒，妊娠第一、第二和第三孕期分别为5.55±0.67、5.12±0.66和5.62±0.74米/秒）（P<0.001）。
在正常妊娠期间，为满足胎儿充分生长所需的血容量增加通过母体血管系统早期和显著的变化来适应。这似乎依赖于正常的适应性内皮和血管功能。版权所有©2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
