PLASMA-LEVELS OF ATRIAL-NATRIURETIC-PEPTIDE IN NORMAL AND HYPERTENSIVE PREGNANCIES - A METAANALYSIS

被引:59
作者
CASTRO, LC [1 ]
HOBEL, CJ [1 ]
GORNBEIN, J [1 ]
机构
[1] UNIV CALIF LOS ANGELES, SCH MED, DEPT BIOMATH, LOS ANGELES, CA 90024 USA
关键词
ATRIAL NATRIURETIC PEPTIDE; PREGNANCY; PREECLAMPSIA; HYPERTENSION; BLOOD VOLUME;
D O I
10.1016/0002-9378(94)90416-2
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: Our goals were (1) to use meta-analysis to determine whether pregnancy and the puerperium are accompanied by alterations in plasma atrial natriuretic peptide levels when compared with the nonpregnant state and (2) to evaluate the additional effects of hypertensive disease during pregnancy on plasma atrial natriuretic peptide levels. STUDY DESIGN: Articles measuring atrial natriuretic peptide levels during pregnancy were reviewed. Data from articles meeting inclusion criteria were abstracted, and a meta-analysis was performed with the use of the maximum likelihood methods of Jennrich and Schluchter (Biometrics 1986;42:805-20). RESULTS: The mean atrial natriuretic peptide level in nonpregnant control subjects was 28.7 pg/ml (95% confidence interval 22.5 to 36.7). The mean plasma atrial natriuretic peptide level rose 41% to 40.5 pg/ml (95% confidence interval 31.7 to 51.8) in the third trimester (p < 0.0001). It was 71.1 pg/ml (95% confidence interval 51.2 to 98.7) or 148% greater than the mean nonpregnant level during the first week post partum (p < 0.0001). Compared with levels in pregnant control subjects, plasma atrial natriuretic peptide levels increased 52% to 52.1 pg/ml (95% confidence interval 32.9 to 82.5) in women with gestational hypertension (p < 0.005) and 130% to 78.8 pg/ml (95% confidence interval 52.3 to 118.8) in women with preeclampsia (p < 0.0001). Chronic hypertension did not significantly alter atrial natriuretic peptide levels. CONCLUSIONS: The 41% increase in atrial natriuretic peptide levels in the third trimester suggests that atrial stretch receptors sense the expanded blood volume as normal to moderately increased. The rise in atrial natriuretic peptide during the first week post partum is consistent with known hemodynamic changes and suggests that atrial natriuretic peptide may be involved in the postpartum diuresis. The marked increase in plasma atrial natriuretic peptide levels observed in preeclampsia is not likely to result from elevated arterial pressures alone but may reflect underlying factors unique to this disease process.
引用
收藏
页码:1642 / 1651
页数:10
相关论文
共 90 条
  • [1] ATRIAL NATRIURETIC FACTOR IN NORMAL AND HYPERTENSIVE PREGNANCY
    BOND, AL
    AUGUST, P
    DRUZIN, ML
    ATLAS, SA
    SEALEY, JE
    LARAGH, JH
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1989, 160 (05) : 1112 - 1116
  • [2] ATRIAL-NATRIURETIC-PEPTIDE IN HEART-FAILURE
    BRANDT, RR
    WRIGHT, RS
    REDFIELD, MM
    BURNETT, JC
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 22 (04) : A86 - A92
  • [3] EFFECT OF PREGNANCY ON THE VASODEPRESSOR RESPONSE TO ATRIAL-NATRIURETIC-FACTOR
    CASTRO, LC
    ALLEN, RJ
    ARORA, CP
    HOBEL, CJ
    PLATT, LD
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1993, 168 (03) : 979 - 984
  • [4] ATRIAL-NATRIURETIC-PEPTIDE METABOLISM DURING PREGNANCY IN THE RAT
    CASTRO, LC
    ARORA, CP
    KRAKOW, DE
    ALLEN, R
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1994, 170 (04) : 1184 - 1188
  • [5] PLASMA AND RED-CELL VOLUMES DURING PREGNANCY
    CHESLEY, LC
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1972, 112 (03) : 440 - +
  • [6] PLASMA ENDOTHELIN LEVELS IN PREECLAMPSIA - ELEVATION AND CORRELATION WITH URIC-ACID LEVELS AND RENAL IMPAIRMENT
    CLARK, BA
    HALVORSON, L
    SACHS, B
    EPSTEIN, FH
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1992, 166 (03) : 962 - 968
  • [7] CENTRAL HEMODYNAMIC ASSESSMENT OF NORMAL TERM PREGNANCY
    CLARK, SL
    COTTON, DB
    LEE, W
    BISHOP, C
    HILL, T
    SOUTHWICK, J
    PIVARNIK, J
    SPILLMAN, T
    DEVORE, GR
    PHELAN, J
    HANKINS, GDV
    BENEDETTI, TJ
    TOLLEY, D
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1989, 161 (06) : 1439 - 1442
  • [8] MATERNAL AND FETAL PLASMA ATRIAL-NATRIURETIC-PEPTIDE CONCENTRATIONS DURING ELECTIVE CESAREAN-SECTION
    DATTA, S
    MURPHY, MT
    CARR, DB
    BADER, AM
    JOHNSON, MD
    [J]. ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1991, 35 (02) : 93 - 96
  • [9] DAVISON JM, 1984, SEMIN NEPHROL, V4, P198
  • [10] A RAPID AND POTENT NATRIURETIC RESPONSE TO INTRAVENOUS-INJECTION OF ATRIAL MYOCARDIAL EXTRACT IN RATS
    DEBOLD, AJ
    BORENSTEIN, HB
    VERESS, AT
    SONNENBERG, H
    [J]. LIFE SCIENCES, 1981, 28 (01) : 89 - 94