Abstract
This review analyses the changes in immunological tolerance, and the systemic and local hemodynamic changes observed along human pregnancy. To underscore the conceptual importance of tolerance and adaptation the background is provided by the two main advocates of these ideas: Gandhi and Darwin. The cognate factors that determine immunological tolerance (IT), systemic (SA) and local adaptation (LA) are multiple; IT = desensitisation to paternal antigens, absence of HLA-A, roles of HLA-G, natural killer cells and their receptors; SA = decreased vascular resistance, plasma volume expansion, increased cardiac output and plasma renin activity; LA = prostacyclin, nitric oxide, kallikrein-kinin system, vasodilator arm of the renin angiotensin system, vascular endothelial growth factor (VEGF). A possible role of vasodilators in the crucial process of trophoblast invasion and uterine artery transformation is supported. The relevance of an adequate adaptation to pregnancy is highlighted not only by the intragestational complications derived from a defective process, such as intrauterine growth restriction, preterm birth, and preeclampsia -its foremost expression- but also by the long term cardiovascular complications of the mother and her offspring.
Highlights
This review analyses the changes in immunological tolerance, and the systemic and local hemodynamic changes observed along human pregnancy
To underscore the conceptual importance of tolerance and adaptation the background is provided by the two main advocates of these ideas: Gandhi and Darwin
The relevance of an adequate adaptation to pregnancy is highlighted by the intragestational complications derived from a defective process, such as intrauterine growth restriction, preterm birth, and preeclampsia -its foremost expression- and by the long term cardiovascular complications of the mother and her offspring. (Rev Med Chile 2011; 139: 400-405)
Summary
Departamento de Nefrología y Centro de Investigaciones Médicas. Escuela de Medicina, Pontificia Universidad Católica de Chile. Para enfatizar la fuerza y el significado de los conceptos de tolerancia y adaptación quiero hacerlo con el trasfondo de su sentido más amplio, empleando los ejemplos de sus dos máximos exponentes, Mahatma Gandhi y Charles Darwin (Figura 1). Otro importante factor común entre ellas es la destrucción que genera la falta de tolerancia o de adaptación, entre las que se pueden contar las violentas manifestaciones en Soweto, el asesinato de Gandhi, la desaparición de los dinosaurios y, más recientemente, los efectos del terremoto del 27 de febrero de 2010 en Chile. El síndrome bifásico de la preeclampsia representa un ejemplo del círculo vicioso causado por la falta de tolerancia y de adaptación, contra el cual el manejo clínico habitual con antihipertensivos solo ayuda a reducir la mortalidad materna derivada de la hipertensión. El precio en término de riesgo de mortalidad materna parece ser aceptable desde el punto de vista evolutivo”[4]
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