Nitric oxide biosynthesis during pregnancy: implications for circulatory changes.

1. The biosynthesis of NO and its second messenger, cGMP, increases from pre-pregnant levels during rat gestation. An increase in plasma level and urinary excretion of cGMP is also evident during human pregnancy. However, the relative contribution of the maternal vasculature and other tissues to increased NO and cGMP biosynthesis during gestation is uncertain. Consensus is lacking about the contribution of NO to reduced maternal vascular tone and reactivity during gestation in various organ beds; clearly, further investigation is still needed. That NO may also regulate vascular smooth muscle behaviour during pregnancy by altering membrane potential is another intriguing possibility. 2. The syncytiotrophoblast of the human placenta expresses significant NO synthase activity, and along with the fetoplacental endothelium undoubtedly contributes to NO production during pregnancy. 3. Finally, it should be emphasized that vascular studies in gravid animal models need to be extended to pregnant women.