Mea. Spaanderman et al., Changes in hemodynamic parameters and volume homeostasis with the menstrual cycle among women with a history of preeclampsia, AM J OBST G, 182(5), 2000, pp. 1127-1134
OBJECTIVE: Among women with a history of preeclampsia the prevalence of hem
odynamic and clotting disorders is elevated. In this study we tested the hy
pothesis that the normal cyclic variation in hemodynamic and renal function
parameters with the menstrual cycle that is seen among healthy women would
be preserved in women with a history of preeclampsia irrespective of wheth
er they had an underlying hemodynamic or clotting disorder.
STUDY DESIGN: We compared the hemodynamic and volume cyclic variations duri
ng the menstrual cycle among women with a history of preeclampsia (n = 39)
with those among healthy parous control women (control group, n = 10). The
participants with a history of preeclampsia were subdivided into groups of
women with hypertension with or without thrombophilia (hypertension group,
n = 10), women with a normotension and a thrombophilic disorder (thrombophi
lia group, n = 17), and women without either of these abnormalities (sympto
m-free group, n = 12). We measured greater than or equal to 5 months post p
artum, once during the follicular phase of the menstrual cycle (day 5 +/- 2
) and once during the luteal phase (day 22 +/- 2), the following variables:
body weight and length, mean arterial pressure, heart rate, cardiac output
, plasma volume, glomerular filtration rate, effective renal plasma flow, a
nd concentrations of renal volume homeostatic hormones, reproductive hormon
es, and catecholamines. From the measured data we calculated body mass inde
x, cardiac index, left ventricular work, total peripheral and renal vascula
r resistances, effective renal blood flow, and renal filtration fraction.
RESULTS: The hypertension group differed from the control group in having h
igher baseline (follicular phase) values for cardiac output, cardiac output
, left ventricular work, renal vascular resistance, and atrial natriuretic
peptide and norepinephrine levels. The symptom-free group differed from the
control group in having a lower baseline plasma volume and higher baseline
cardiac output and left ventricular work values. Women in the thrombophili
a group were comparable to those in the control group with respect to basel
ine hemodynamic and renal function variables except for a higher renal vasc
ular work value. In the control group heart rate, plasma volume, effective
renal plasma volume, effective renal blood flow, and concentrations of reni
n-angiotensin-aldosterone system hormones and norepinephrine were increased
during the luteal phase with respect to values during the follicular phase
, whereas the renal vascular resistance and atrial natriuretic peptide valu
es were decreased. In the three subgroups of women with a history of preecl
ampsia this cyclic pattern with the menstrual cycle was preserved for most
of these parameters.
CONCLUSION: Although baseline hemodynamic and volume status among women wit
h a history of preeclampsia differed from that among healthy parous control
subjects, the cyclic variation with the menstrual cycle was largely preser
ved.