Abstract
Objective: An association between the renin-angiotensin system and the pathogenesis of pregnancy-induced hypertension has been reported. The prorenin receptor was discovered in 2002, and Wanatabe et al. reported that women with plasma soluble prorenin receptor concentrations above the 75th percentile at delivery had a significantly increased risk of preeclampsia. We evaluated serum prorenin concentrations during pregnancy, and we assessed the incidence of pregnancy-induced hypertension. Methods: We measured serum prorenin concentrations in 430 pregnant women (565 samples). Regression analysis was performed to determine the associations between the serum prorenin level and maternal/neonatal complications. Results: The serum prorenin concentration and gestational age had a positive correlation in non-pregnancyinduced hypertension in women with singleton pregnancies (Spearman rank-correlation coefficient, -0.215: p<0.0001). The serum prorenin concentration in women with multiple pregnancies was significantly higher than that in women with singleton pregnancies (multiple linear regression analysis, p<0.0001). Low prorenin levels in the third trimester (≤20.1 percentile) were significantly associated with pregnancy-induced hypertension (adjusted odds ratio, 18.16: 95% confidential interval, 1.95-412.41: p=0.0107). Conclusion: The serum prorenin levels during pregnancy may be adversely correlated with the prorenin receptor, and low prorenin levels during late pregnancy were significantly associated with pregnancy-induced hypertension.
Highlights
Pregnancy-Induced Hypertension (PIH), which includes preeclampsia and gestational hypertension, occurs in 3-5% of pregnant women, and it can cause maternal death, premature delivery, and fetal growth restrictions [1]
The Renin Angiotensin System (RAS) has an important role in hypertension: it maintains the constancy of Blood Pressure (BP) during pregnancy, which increases the cardiac output and circulating plasma volume [2]
Patients with PIH are sensitive to the pressor effects of Angiotensin 2 (AT2) compared to normotensive pregnant women [3,4], and Gant et al reported that an AT2 infusion test may predict the onset of preeclampsia [2], suggesting that the RAS is associated with the pathogenesis of PIH
Summary
Pregnancy-Induced Hypertension (PIH), which includes preeclampsia and gestational hypertension, occurs in 3-5% of pregnant women, and it can cause maternal death, premature delivery, and fetal growth restrictions [1]. The Renin Angiotensin System (RAS) has an important role in hypertension: it maintains the constancy of Blood Pressure (BP) during pregnancy, which increases the cardiac output and circulating plasma volume [2]. Patients with PIH are sensitive to the pressor effects of Angiotensin 2 (AT2) compared to normotensive pregnant women [3,4], and Gant et al reported that an AT2 infusion test may predict the onset of preeclampsia [2], suggesting that the RAS is associated with the pathogenesis of PIH. Wanatabe et al reported that pregnant women with Plasma-Soluble (P) Rr [s(P)RR] concentrations above the 75th percentile at delivery had a significantly increased risk of preeclampsia [6]. Since Prorenin (PR) combined with (P) RR activates the tissue RAS, we evaluated the serum PR concentration during pregnancy to determine whether PR is associated with PIH
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