Study of autonomic sympatho-vagal modulation in different trimesters of pregnancy

  • Dr. Sonia Kochhar Professor, Department of Physiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, (Haryana) India
  • Dr. Swaran Jit Associate Professor, Department of Physiology, Govt. Medical College, Amritsar (Punjab) India
  • Dr. Ashwani Ummat Associate Professor, Orthopedic Department, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, (Haryana) India
Keywords: Pregnancy trimesters, sympatho-vagal modulation, ANS activity, orthostatic hypotension, cardiovascular regulation

Abstract

Introduction: Various physiological conditions are known to influence functional activity of ANS and one such state is pregnancy. Pregnancy is associated with profound but temporary and reversible hemo-dynamic changes in mother to support fetal development and growth but without permanent deleterious effects in the mother.

Material & Methods: Functional status of Autonomic Nervous System during 1st, 2nd and 3rd trimester of pregnancy was studied in 75 pregnant women in all three trimesters of pregnancy (25 each) and results were compared among them and with another 25 non-pregnant women taken as control. Parasympathetic activity was assessed by Standing to Lying down ratio, 30:15 ratio, Valsalva ratio and Tachycardia ratio. The assessment of sympathetic activity was done by tests viz. CPT, HGT and GSR.

Results: Parasympathetic activity was significantly reduced in 3rd trimester of pregnancy in comparison to non-pregnant controls as well as 1st and 2nd trimesters. The sympathetic activity showed significant rise in sympathetic nervous system activity during 3rd trimester of pregnancy in comparison with the changes in non-pregnant controls as well as 1st & 2nd trimester of pregnancy.

Conclusion: Although ANS play a central role in the adaptation of hemodynamic to various demands of pregnancy yet its failure to achieve the required goal during different trimesters of pregnancy is poorly understood and needs to be investigated. This havoc of sympatho-vagal modulation in pregnancy can be attributed to orthostatic dys-regulation occurring due to deficiency of autonomic nervous control mechanisms in pregnancy and we have tried to prove this in our study.

Downloads

Download data is not yet available.

References

1. Low PA. Clinical autonomic disorders: evaluation and management, Second Edition ed. Philadelphia: Lippincott – Raven (1997).

2. Benarroch EE. The Central autonomic network in Clinical Autonomic Disorders 2nd ed. Low P (ed) Lippincott-Raven Publishers, Philadelphia (1997).:17-22

3. Thornburg KL, Jacobson SL et al. Hemodynamic changes in pregnancy. Semin Perinatol. 2000 ; Feb;24(1): 11-4.

4. Neeta Bachlaus Measurement of Baroreflex & Sympathetic Control of Haemodynamics in Mid Pregnancy by Orthostatic Test, People’s Journal of Scientific Research. 2010. 3 (1) :1-4

5. Hytten FE, Leitch I. The Physiology of human pregnancy. 2nd Ed. 1971; Blackwell Scientific Publications, Oxford : 69-131.

6. Barnea ER, Tal J.. Stress related reproductive failure, J IVF ET 1991; 8:15-23.

7. Frohlich E D, Dustan H P, Tarazi R C.. Hyperdynamic beta‐adrenergic circulatory state- an overview. Arch Intern Med 1970,1261068–1069.1069

8. Muenter Swift N, Charkoudian N, Dotson R M. et al . Baroreflex control of muscle sympathetic nerve activity in postural orthostatic tachycardia syndrome. Am J Physiol Heart Circ Physiol 2005, 289H1226–H1233.H1233

9. Bhatia SG, Sainani GS, Nayak NJ, Diwate PG. Valsalva maneuver as a test of autonomic neuropathy in diabetes mellitus. JAPI 1976; 24:89

10. Mathias CJ, Bannister R. Autonomic Failure., 4 ed. 1999 Oxford: Oxford University Press.

11. Christopher H. Gibbons, MD, et al Autonomic Testing Model Coverage Policy September, American Academy of Neurology 2, 2014; https://www.aan.com/

12. Low PA, Benarroch EE.. Clinical autonomic disorders, 3rd ed. 2008; Philadelphia: Lippincott Williams & Wilkins.

13. Smit AA, Wieling W, Karemaker JM.. Clinical approach to cardiovascular reflex testing. Clin. Sci. (Colch.) 1996; 91 Suppl:108-112.

14. Wieling W, Karemaker JM : C.J.Mathias and Sir Roger Bannister (ed.) Autonomic Failure, A textbook of Clinical Disorders of the Autonomic Nervous System ed. 1999. Oxford: Oxford University Press;, pp. 196-210

15. R.Banister, C.Mathias : Sir Roger Bannister (ed.): (1988). Autonomic Failure; A textbook of Clinical Disorders of the Autonomic Nervous System, 1999; Oxford: Oxford University Press: 289-307.

16. Pagani M, Furlan R, Pizzinelli P, Crivellaro W, Cerutti S, Malliani A: Spectral analysis of R-R and arterial pressure variabilities to assess sympatho-vagal interaction during mental stress in humans. J Hypertens 1989;7 (suppl 6):S14-S15

17. Barron W, Mujais S, Zinaman M, Bravo E, Lindheimer M. Plasma catecholamine responses to physiologic stimuli in normal human pregnancy. American Journal of Obstetrics and Gynecology.1986;154:80–84.

18. Ekholm E, Piha S, Antila K, Erkkola R. Cardiovascular autonomic reflexes in mid-pregnancy. British Journal of Obstetrics and Gynaecology. 1993;100:177–182.

19. Matthews KA, Rodin J. Pregnancy alters blood pressure responses to psychological and physical challenge. Psychophysiology. 1992;29:232–240.

20. Rodrigues EA, Ewing DJ.. Immediate heart rate response to lying down: simple test for cardiac parasympathetic damage in diabetics. Br Med J (Clin Res Ed) 1982 Oct 2;285(6346):916–918.

21. Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed). 1982 Oct 2;285(6346):916-8.

22. Lewin AB . A simple test of Cardiac function based upon the heart rate changes induced by the Valsalva maneuver. Am J Cardiol 1966;18:90-99

23. Baldwa VS, Ewingg DJ.. Heart rate response to valsalva maneuver, reproducibility in normal and relation to variation in resting heart rate in diabetics.Br. Heart J. 1977; 37: 641-644.

21. Hines EA, Brown GE.. The cold pressor test for measuring the reactibility of blood pressure. Am Heart J. 1936; 11(1): 1-9

22. Ewing DJ, Irwing JB, Ken F, Wildsmith JAW, Clarke RF. Cardiovascular response to sustained handgrip in normal subjects and in patients with diabetes mellitus- A test of autonomic function. Clin Sci Mol Med. 1974; 46: 295-306

23. Heard GE. The psychogalvanic response in the study of sympathetic activity. Br J Surg. 1964; 51 (8): 629-631

24. Kuo CD, Chen GY, Yang MJ, Lo HM, Tsai YS.. Biphasic changes in autonomic nervous activity during pregnancy. Br. J. Anaesth 2000.; 84 (3): 323-329

25. Matsuo H, Inoue K, Hapsari ED, Kitano K, Shiotani H. Change of autonomic nervous activity during pregnancy and its modulation of labor assessed by spectral heart rate variability analysis. Clin Exp Obstet Gynecol. 2007; 34(2):73-9.

26. Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy. Br.Heart J (1992)..; 68 (6): 540-543

27. Perini R, Veicsteinas A. Heart rate variability and autonomic activity at rest and during exercise in various physiological conditions. Eur J Appl Physiol 2003 Oct;90 (3-4):317-25. Epub 2003 Sep 12.

28. Vybiral T, Bryg RJ, Maddens ME, Boden WE. Effect of passive upright on sympathetic and parasympathetic components of heart rate variability in normal subjects. American Journal of Cardiology 1989; 63: 1117–20

29. Neeta Bachlaus Measurement of Baroreflex & Sympathetic Control of Haemodynamics in Mid Pregnancy by Orthostatic Test, People’s Journal of Scientific Research 2010; 3 Vol.3(1) :1-4
CITATION
DOI: 10.17511/ijmrr.2016.i05.15
Published: 2016-05-31
How to Cite
1.
Kochhar S, Swaran J, Ummat A. Study of autonomic sympatho-vagal modulation in different trimesters of pregnancy. Int J Med Res Rev [Internet]. 2016May31 [cited 2024Nov.8];4(5):751-7. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/552
Section
Original Article