Abstract
ObjectiveTo determine whether there are differences in autonomic nervous system function in early- versus late-onset preeclampsia.MethodsMatched case-control study. Cases were defined as singleton pregnancies with preeclampsia at < 34+0 weeks of gestation (early-onset preeclampsia) and ≥ 34+0 weeks of gestation (late-onset preeclampsia). For each case in each of the preeclampsia subgroups, three „control”uncomplicated singleton pregnancies were matched by maternal age, height, and week of gestation. Blood pressure and heart rate were measured continuously for 30 minutes in each participant. Baroreceptor reflex sensitivity (assessed using sequence technique), time and frequency domain heart rate variability measures, as SDNN, RMSSD, LFRRI, HFRRI and LF/HFRRI of R-R intervals, were compared between groups (p<0.05 significant).Results24 women with preeclampsia (10 with early-onset and 14 with late-onset preeclampsia) and 72 controls were included in the study. SDNN, RMSSD and HFRRI were significantly higher in the late-onset preeclampsia group compared to gestational age matched controls (p = 0.033, p = 0.002 and p = 0.018, respectively). No significant differences in SDNN RMSSD and HFRRI between early-onset preeclampsia group and gestational age matched controls were observed (p = 0.304, p = 0.325 and p = 0.824, respectively). Similarly, baroreceptor reflex sensitivity was higher in late-onset preeclampsia compared to controls at ≥ 34 weeks (p = 0.037), but not different between early-onset preeclampsia compared to controls at < 34 weeks (p = 0.50).ConclusionsHeart rate variability and baroreceptor reflex sensitivity are increased in late- but not early-onset preeclampsia compared to healthy pregnancies. This indicates a better autonomic nervous system mediated adaptation to preeclampsia related cardiovascular changes in late-onset disease.
Highlights
Preeclampsia, a multisystem disorder characterized by new-onset hypertension and proteinuria or end-organ dysfunction after 20 weeks of gestation, affects 2 to 8% of pregnancies [1,2,3,4,5,6,7]
standard deviation of normal-to-normal beat (SDNN), root mean squared successive differences (RMSSD) and HFRRI were significantly higher in the late-onset preeclampsia group compared to gestational age matched controls (p = 0.033, p = 0.002 and p = 0.018, respectively)
Reflex sensitivity was higher in late-onset preeclampsia compared to controls at ! 34 weeks (p = 0.037), but not different between early-onset preeclampsia compared to controls at < 34 weeks (p = 0.50)
Summary
Preeclampsia, a multisystem disorder characterized by new-onset hypertension and proteinuria or end-organ dysfunction after 20 weeks of gestation, affects 2 to 8% of pregnancies [1,2,3,4,5,6,7]. Our group and others have shown that autonomic nervous system functioning can be non-invasively assessed during pregnancy by analyzing heart rate variability and baroreceptor reflex sensitivity (BRS) [18,22,23] These measurements could, be of great clinical value in the prediction, diagnosis and management of preeclampsia. It is still not clear whether changes in autonomic nervous system function differ between normal pregnancies and those complicated by early- as well as late-onset preeclampsia
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