Maternale Endothelfunktion in Schwangerschaft und Wochenbett – ultraschallgestützte longitudinale Erfassung mittels Flow Mediated Dilatation (FMD)

Zusammenfassung

Ziel: Die Verminderung des peripheren Gefäßwiderstands in der Schwangerschaft wird durch eine NO-getriggerte Gefäßdilatation vermittelt. Diese physiologische Änderung der Endothelfunktion während des Schwangerschaftsverlaufs und im Wochenbett wurde mittels der noninvasiven Erfassung der flussabhängigen Gefäßdilatation durch hochauflösende Ultraschallmessung ermittelt. Material und Methoden: In einer prospektiven Beobachtungsstudie wurde longitudinal an 16 schwangeren Frauen im 1. Trimenon (T1) < 14. Schwangerschaftswochen (SSW), 2. Trimenon (T2) ≥ 14. – 27. SSW, 3. Trimenon (T3) ≥ 28. SSW und > 6 Wochen postpartal (pp) sonografisch die FMD der A. brachialis ermittelt. 19 nicht schwangere Frauen (NS) wurden als Vergleichsgruppe in die Studie eingeschlossen. Ergebnisse: Die FMD (%) stieg vom 1. zum 2. Trimenon (T1 8,0 ± 5,58 vs. T 2 15,2 ± 5,19, p < 0,003) signifikant an und erreichte ihr Maximum in der Mitte der Schwangerschaft. Zum 3. Trimenon fiel die FMD wieder signifikant ab (T2 vs. T 3 9,15 ± 3,61, p < 0,004). Die Mittelwerte der FMD waren im 2. und 3. Trimenon verglichen mit den nicht schwangeren Kontrollen signifikant erhöht (T2 vs. NS 6,17 ± 4,39, p < 0,0001; T 3 vs. NS, p < 0,047). Postpartal fiel die FMD auf das Niveau der in der Frühschwangerschaft bestimmten Werte zurück. Schlussfolgerung: Im Schwangerschaftsverlauf ändert sich die maternale Endothelfunktion mit einer Zunahme der flussabhängigen Gefäßerweiterung, die im Wochenbett wieder verschwindet. Mittels der FMD-Messung lassen sich diese physiologischen Veränderungen im Schwangerschaftsverlauf zuverlässig erfassen.

Abstract

Purpose: NO-triggered vasodilatation decreases peripheral vascular resistance in pregnancy. Using a noninvasive ultrasound technique, flow-mediated vasodilatation can be quantified. We used this technique to detect changes in endothelial function during pregnancy and postpartum. Materials and Methods: In a prospective longitudinal study 16 healthy pregnant women were assessed for flow-mediated dilatation of the brachial artery during pregnancy (first trimester T 1 < 14th gestational week, second trimester T 2 ≥ 14th – 27th gestational week, third trimester T 3 ≥  28th gestational week) and postpartum (> 6 weeks postpartum). As a control group, flow-mediated dilatation was determined in 19 healthy non-pregnant women. Results: Flow-mediated dilatation (%) increased significantly in normal human pregnancy from the first trimester (T1 8.0 ± 5.58 vs. T 2 15.2 ± 5.19, p < 0.003) to the second trimester and reached its maximum in mid-trimester. Towards the end of pregnancy, flow-mediated dilatation decreased significantly (T2 vs. T 3 9.15 ± 3.61, p < 0.004). Mean values of flow-mediated dilatation are significantly higher during the second and third trimester of pregnancy compared to non-pregnant controls (T2 vs. NP 6.17 ± 4.39, p < 0.001; T 3 vs. NP, p < 0.047). Postpartum flow-mediated dilatation decreased to values of early pregnancy. Conclusion: During pregnancy maternal endothelial function shows an increase in flow-mediated dilatation and then reverts postpartum. Using ultrasound-based measurement of flow-mediated dilatation, these physiological changes in pregnancy can be reliably detected.

Key words

endothelial function - pregnancy - flow-mediated dilatation

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