Abstract
BackgroundAlthough the exact pathophysiology of preeclampsia is not well understood, autonomic nervous system imbalance is suggested as one of the main factors.AimsTo investigate heart rate variability (HRV) and autonomic modulations in Sudanese pregnant women with preeclampsia.Subjects and MethodsA case-control study (60 women in each arm) was conducted at Omdurman Maternity Hospital—Sudan, during the period from June to August, 2014. Cases were women presented with preeclampsia and healthy pregnant women were the controls. Studied groups were matched for important determinants of HRV. Natural logarithm (Ln) of total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) were used to determine HRV. Normalized low and high frequencies (LF Norm and HF Norm) were used to evaluate sympathetic and parasympathetic autonomic modulations respectively.ResultsPatients with preeclampsia achieved significantly higher LF Norm [49.80 (16.25) vs. 44.55 (19.15), P = 0.044] and LnLF/HF [0.04 (0.68) vs. -0.28 (0.91), P = 0.023] readings, but lower HF Norm [49.08 (15.29) vs. 55.87 (19.56), P = 0.012], compared with healthy pregnant women. Although all other HRV measurements were higher in the patients with preeclampsia compared with the controls, only LnVLF [4.50 (1.19) vs. 4.01 (1.06), P = 0.017] and LnLF [4.01 (1.58) vs. 3.49 (1.23), P = 0.040] reached statistical significance.ConclusionThe study adds further evidence for the dominant cardiac sympathetic modulations on patients with preeclampsia, probably secondary to parasympathetic withdrawal in this group. However, the higher LnVLF and LnLF readings achieved by preeclamptic women compared with the controls are unexpected in the view that augmented sympathetic modulations usually depresses all HRV parameters including these two measures.
Highlights
Preeclampsia is a multi-systemic disorder characterized by hypertension, proteinuria and/or end-organ dysfunction after 20 weeks of gestation [1]
All other heart rate variability (HRV) measurements were higher in the patients with preeclampsia compared with the controls, only LnVLF [4.50 (1.19) vs. 4.01 (1.06), P = 0.017] and LnLF [4.01 (1.58) vs. 3.49 (1.23), P = 0.040] reached statistical significance
The higher LnVLF and LnLF readings achieved by preeclamptic women
Summary
Preeclampsia is a multi-systemic disorder characterized by hypertension, proteinuria and/or end-organ dysfunction after 20 weeks of gestation [1]. Several studies were conducted to evaluate pattern of autonomic activity in pregnant and preeclamptic women based on levels of catecholamines [5,6,7,8]. Some researchers were able to demonstrate higher resting plasma catecholamines levels and increased sympathetic activity in preeclampsia compared with normal pregnancy [5, 6], other studies either failed to reproduce such differences [7] or prove the reverse [8]. Recent reports on autonomic balance are mostly based on evaluation of the modulatory effects of sympathetic and parasympathetic nervous systems on the heart rate (HR) [9,10,11] and the blood pressure [12]. The exact pathophysiology of preeclampsia is not well understood, autonomic nervous system imbalance is suggested as one of the main factors
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