Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia

TY - JOUR

T1 - Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia

AU - Janzarik, Wibke G

AU - Ehlers, Elena

AU - Ehmann, Renata

AU - Gerds, Thomas A

AU - Schork, Joscha

AU - Mayer, Sebastian

AU - Gabriel, Boris

AU - Weiller, Cornelius

AU - Prömpeler, Heinrich

AU - Reinhard, Matthias

PY - 2014/1

Y1 - 2014/1

N2 - Preeclampsia may affect severely the cerebral circulation leading to impairment of cerebral autoregulation, edema, and ischemia. It is not known whether impaired autoregulation occurs before the clinical onset of preeclampsia, and whether this can predict the occurrence of preeclampsia. Seventy-two women at 25 to 28 weeks of gestation were studied. Control values were derived from 26 nonpregnant women. Dynamic properties of cerebral autoregulation (DCA) were measured in the middle and posterior cerebral artery using transcranial Doppler and transfer function analysis (phase and gain) of respiratory-induced 0.1 Hz hemodynamic oscillations. Uterine artery ultrasound was performed to search for a notch sign as an early marker of general endothelial dysfunction. All women were followed up until 6 weeks after delivery for the occurrence of preeclampsia. The autoregulation parameter gain did not differ between pregnant and nonpregnant women. Phase was slightly but significantly higher in pregnant women, indicating better DCA. Women with a notch sign did not show altered DCA. A history of preeclampsia during a previous pregnancy was associated with lower phase in middle cerebral artery and posterior cerebral artery (P<0.05 each). During follow-up, 9 women developed preeclampsia. None of the DCA parameters were associated with the occurrence of preeclampsia. In conclusion, DCA is well preserved during late midterm pregnancy, even in women with disturbed uterine blood flow. Yet, pregnant women with preeclampsia in a previous pregnancy seem to have poorer DCA. Although limited in statistical power, this study does not support DCA as a strong early risk marker of preeclampsia.

AB - Preeclampsia may affect severely the cerebral circulation leading to impairment of cerebral autoregulation, edema, and ischemia. It is not known whether impaired autoregulation occurs before the clinical onset of preeclampsia, and whether this can predict the occurrence of preeclampsia. Seventy-two women at 25 to 28 weeks of gestation were studied. Control values were derived from 26 nonpregnant women. Dynamic properties of cerebral autoregulation (DCA) were measured in the middle and posterior cerebral artery using transcranial Doppler and transfer function analysis (phase and gain) of respiratory-induced 0.1 Hz hemodynamic oscillations. Uterine artery ultrasound was performed to search for a notch sign as an early marker of general endothelial dysfunction. All women were followed up until 6 weeks after delivery for the occurrence of preeclampsia. The autoregulation parameter gain did not differ between pregnant and nonpregnant women. Phase was slightly but significantly higher in pregnant women, indicating better DCA. Women with a notch sign did not show altered DCA. A history of preeclampsia during a previous pregnancy was associated with lower phase in middle cerebral artery and posterior cerebral artery (P<0.05 each). During follow-up, 9 women developed preeclampsia. None of the DCA parameters were associated with the occurrence of preeclampsia. In conclusion, DCA is well preserved during late midterm pregnancy, even in women with disturbed uterine blood flow. Yet, pregnant women with preeclampsia in a previous pregnancy seem to have poorer DCA. Although limited in statistical power, this study does not support DCA as a strong early risk marker of preeclampsia.

KW - Adult

KW - Cerebral Arteries

KW - Cerebrovascular Circulation

KW - Female

KW - Homeostasis

KW - Humans

KW - Pre-Eclampsia

KW - Predictive Value of Tests

KW - Pregnancy

KW - Pregnancy Trimester, Second

KW - Risk Factors

KW - Ultrasonography, Doppler

KW - Uterine Artery

U2 - 10.1161/HYPERTENSIONAHA.113.01667

DO - 10.1161/HYPERTENSIONAHA.113.01667

M3 - Journal article

C2 - 24101668

SN - 0194-911X

VL - 63

SP - 161

EP - 166

JO - Hypertension

JF - Hypertension

ER -