Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 May;300(5):R1221-9.
doi: 10.1152/ajpregu.91046.2008. Epub 2011 Feb 16.

High-end arteriolar resistance limits uterine artery blood flow and restricts fetal growth in preeclampsia and gestational hypertension at high altitude

Vaughn A Browne  1 , Lilian Toledo-Jaldin, R Daniela Davila, Luis P Lopez, Henry Yamashiro, Darleen Cioffi-Ragan, Colleen G Julian, Megan J Wilson, Abigail W Bigham, Mark D Shriver, Benjamin Honigman, Enrique Vargas, Robert Roach, Lorna G Moore
Affiliations

High-end arteriolar resistance limits uterine artery blood flow and restricts fetal growth in preeclampsia and gestational hypertension at high altitude

Vaughn A Browne et al. Am J Physiol Regul Integr Comp Physiol. 2011 May.

Abstract

The reduction in infant birth weight and increased frequency of preeclampsia (PE) in high-altitude residents have been attributed to greater placental hypoxia, smaller uterine artery (UA) diameter, and lower UA blood flow (Q(UA)). This cross-sectional case-control study determined UA, common iliac (CI), and external iliac (EI) arterial blood flow in Andeans residing at 3,600-4,100 m, who were either nonpregnant (NP, n = 23), or experiencing normotensive pregnancies (NORM; n = 155), preeclampsia (PE, n = 20), or gestational hypertension (GH, n = 12). Pregnancy enlarged UA diameter to ~0.62 cm in all groups, but indices of end-arteriolar vascular resistance were higher in PE or GH than in NORM. Q(UA) was lower in early-onset (≤34 wk) PE or GH than in NORM, but was normal in late-onset (>34 wk) illness. Left Q(UA) was consistently greater than right in NORM, but the pattern reversed in PE. Although Q(CI) and Q(EI) were higher in PE and GH than NORM, the fraction of Q(CI) distributed to the UA was reduced 2- to 3-fold. Women with early-onset PE delivered preterm, and 43% had stillborn small for gestational age (SGA) babies. Those with GH and late-onset PE delivered at term but had higher frequencies of SGA babies (GH=50%, PE=46% vs. NORM=15%, both P < 0.01). Birth weight was strongly associated with reduced Q(UA) (R(2) = 0.80, P < 0.01), as were disease severity and adverse fetal outcomes. We concluded that high end-arteriolar resistance, not smaller UA diameter, limited Q(UA) and restricted fetal growth in PE and GH. These are, to our knowledge, the first quantitative measurements of Q(UA) and pelvic blood flow in early- vs. late-onset PE in high-altitude residents.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Shown are representative Doppler flow-velocity waveforms from uterine (UA), common iliac (CI), and external iliac (EI) arteries. UA blood flow (QUA) is continuous throughout the cardiac cycle and demonstrates a low-resistance pattern characterized by high peak systolic (PSV), end-diastolic (EDV), and mean flow (MFV) velocities. QCI and QEI demonstrate a high-resistance triphasic, pulsatile pattern with an antegrade midsystolic peak (PSV) followed rapidly by a retrograde minimum early-diastolic velocity (MDV), and then by resumption of forward flow that tapers off in late diastole.
Fig. 2.
Fig. 2.
Blood flow in the UA, CI, and EI arteries in nonpregnant controls (Non Preg), normotensive pregnant women who delivered at term (NT) or preterm (NPT), and women with gestational hypertension (GH) or preeclampsia (PE) who were ≤34 wk or >34 wk of pregnancy at the time of ultrasound study. A: compared with NT, uterine artery blood flow (QUA) was lower in NPT and markedly reduced in early-onset but not in late-onset GH and PE. B and C: women who developed PE and GH had greater pregnancy-associated increases in QCI and QEI than NT. P < 0.01 in *NT vs. NPT, GH, or PE; †≤34 wk vs. >34 wk; ‡Nonpregnant vs. pregnant; and §GH vs. PE.
Fig. 3.
Fig. 3.
Left and right QUA were equal in nonpregnant women but dissimilar during pregnancy. Left QUA (A) was consistently higher than the right (B) in normotensive women who delivered at NT and in late-onset GH. The reverse occurred in normotensive women who delivered NPT and in women with PE, with left QUA being much lower than the right QUA. P < 0.01 in *NT vs. NPT, GH, or PE; †≤34 wk vs. >34 wk; ‡Nonpregnant vs. pregnant; and §GH vs. PE.
Fig. 4.
Fig. 4.
CI artery blood flow is redistributed to favor the UA during pregnancy. A: compared with normotensive women who delivered at NT, UA relative to CI blood flow (UA/CI ratio) was reduced in normotensive women who delivered NPT and in women with GH or PE. B: EI relative to CI blood flow (EI/CI ratio) decreased during pregnancy and was lowest in GH, early-onset PE, and NT >34 wk. P < 0.05 in *NT vs. NPT, GH, or PE; †≤34 wk vs. >34 wk; ‡Nonpregnant vs. pregnant; and §GH vs. PE.
Fig. 5.
Fig. 5.
Uterine artery (UA) artery blood flow (QUA) at the time of ultrasound study are strongly related to average birth weight when comparing women who remained normotensive and delivered at term (NT) or preterm (NPT), and those who developed GH or PE. Reduced QUA before 34 wk was associated with lower birth weight and an increased risk of premature delivery. The solid line with dotted 95% CI shows the overall correlation, and the R2 value of 0.80 indicates that 80% of the variation in birth weight can be explained by QUA across all groups. P < 0.05 in *NT vs. NPT, GH, or PE; †≤34 wk vs. >34 wk; and §GH vs. PE.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bigham A, Bauchet M, Pinto D, Mao X, Akey JM, Mei R, Scherer SW, Julian CG, Wilson MJ, Lopez Herraez D, Brutsaert T, Parra EJ, Moore LG, Shriver MD. Identifying signatures of natural selection in Tibetan and Andean populations using dense genome scan data. PLoS Genet 6: 2010 - PMC - PubMed
    1. Bigham AW, Mao X, Mei R, Brutsaert T, Wilson MJ, Julian CG, Parra EJ, Akey JM, Moore LG, Shriver MD. Identifying positive selection candidate loci for high-altitude adaptation in Andean populations. Hum Genomics 4: 79–90, 2009 - PMC - PubMed
    1. Bosio P, McKenna P, Conroy R, O'Herlihy C. Maternal cental hemodynamics in hypertensive disorders of pregnancy. Obstet Gynecol 94: 978–984, 1999 - PubMed
    1. Bower S, Bewley S, Campbell S. Improved prediction of preecalmpsia by two-stage screeening of uterine arteries using the early diastolic notch and color Doppler imaging. Obstet Gynecol 82: 78–83, 1993 - PubMed
    1. Brosens IA, Robertson WB, Dixon HG. The role of the spiral arteries in the pathogenesis of preeclampsia. Obstet Gynecol Annu 1: 177–191, 1972 - PubMed

Publication types

MeSH terms