ASSOCIATION BETWEEN AUTONOMIC REACTIVITY INDICES AND SERUM NT-PROBNP LEVELS, ENDOTHELIAL DYSFUNCTION MARKERS, AND 25-HYDROXYVITAMIN D (25(OH)D) LEVEL IN PREGNANT WOMEN WITH HYPERTENSIVE DISORDERS OF PREGNANCY

Authors:

Abstract:

Hypertensive disorders of pregnancy are increasingly recognized as multifactorial conditions involving autonomic imbalance, endothelial dysfunction, and vitamin D deficiency. This study evaluated the effects of a comprehensive multidisciplinary intervention – including psychological support, autonomic regulation strategies, and targeted supplementation – on heart rate variability, endothelial markers, and vitamin D status in pregnant women with hypertensive disorders of pregnancy. A total of 124 patients with hypertensive disorders of pregnancy and 35 healthy controls were enrolled. Compared to controls, women with hypertensive disorders of pregnancy exhibited significantly lower heart rate variability parameters, higher levels of N-terminal pro-brain natriuretic peptide and endothelin-1, reduced nitric oxide, and lower 25-hydroxyvitamin D concentrations. The intervention group demonstrated significant improvements in autonomic function and endothelial biomarkers after treatment, with increased standard deviation of NN intervals, root mean square of successive differences, percentage of successive NN intervals differing by more than 50 milliseconds, and decreased low-frequency to high-frequency ratio. These findings support the effectiveness of a multidisciplinary approach in mitigating autonomic and vascular dysfunction in hypertensive disorders of pregnancy.

Keywords:

hypertensive disorders of pregnancy autonomic nervous system endothelial dysfunction vitamin D heart rate variability

References:

1. Ahenkorah B, Sakyi SA, Fondjo LA, Helegbe G, Owiredu EW, Der EM, et al. Evaluating circulating soluble markers of endothelial dysfunction and risk factors associated with PE: A multicentre longitudinal case control study in northern Ghana. Heliyon. 2023 Sep;9(9):e19096. DOI:10.1016/j.heliyon.2023.e19096.
2. Cameron NA, Everitt I, Seegmiller LE, Yee LM, Grobman WA, Khan SS. Trends in the Incidence of New‐Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019. J Am Heart Assoc. 2022 Jan 18;11(2). DOI:10.1161/JAHA.121.023791.
3. Caplan M, Keenan-Devlin LS, Freedman A, Grobman W, Wadhwa PD, Buss C, et al. Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy. Am J Perinatol. 2021 Nov 2;38(13):1412–9. DOI:10.1055/s-0040-1713368.
4. Giourga C, Papadopoulou SK, Voulgaridou G, Karastogiannidou C, Giaginis C, Pritsa A. Vitamin D Deficiency as a Risk Factor of Preeclampsia during Pregnancy. Diseases. 2023 Nov 2;11(4):158. DOI:10.3390/diseases11040158.
5. Hauspurg A, Marsh DJ, McNeil RB, Bairey Merz CN, Greenland P, Straub AC, et al. Association of N-Terminal Pro–Brain Natriuretic Peptide Concentration in Early Pregnancy With Development of Hypertensive Disorders of Pregnancy and Future Hypertension. JAMA Cardiol. 2022 Mar 1;7(3):268. DOI:10.1001/jamacardio.2021.5617.
6. Jagodzinska A, Wsol A, Gondek A, Cudnoch-Jedrzejewska A. High Serum Adrenomedullin and Mid-Regional Pro-Atrial Natriuretic Peptide Concentrations in Early Pregnancy Predict the Development of Gestational Hypertension. Diagnostics. 2024 Nov 27;14(23):2670. DOI:10.3390/diagnostics14232670.
7. Kabuyanga RK, Tugirimana PL, Sifa B, Balezi M, Dikete ME, Mitangala PN, et al. Effect of early vitamin D supplementation on the incidence of preeclampsia in primigravid women: a randomised clinical trial in Eastern Democratic Republic of the Congo. BMC Pregnancy Childbirth. 2024 Feb 3;24(1):107. DOI:10.1186/s12884-024-06277-6.
8. Maksymenko LR, Perkhulyn OM, Drohomyretska NV, Henyk NI. The significance of assessment the relationship between the level of 25-(OH) vitamin D and excessive body weight in women on preconceptional period and during pregnancy. Medicni perspektivi. 2023 Mar 30;28(1):110–8. DOI:10.26641/2307-0404.2023.1.276031.
9. Nardin M, Verdoia M, Nardin S, Cao D, Chiarito M, Kedhi E, et al. Vitamin D and Cardiovascular Diseases: From Physiology to Pathophysiology and Outcomes. Biomedicines. 2024 Mar 30;12(4):768. DOI:10.3390/biomedicines12040768.
10. Pichardo-Carmona EY, Reyes-Lagos JJ, Ceballos-Juárez RG, Ledesma-Ramírez CI, Mendieta-Zerón H, Peña-Castillo MÁ, et al. Changes in the autonomic cardiorespiratory activity in parturient women with severe and moderate features of preeclampsia. Front Immunol. 2023 Sep 1;14. DOI:10.3389/fimmu.2023.1190699.
11. Slusher AL, Acevedo EO. Stress induced proinflammatory adaptations: Plausible mechanisms for the link between stress and cardiovascular disease. Front Physiol. 2023 Mar 17;14. DOI:10.3389/fphys.2023.1124121.
12. Wang W, Xie X, Yuan T, Wang Y, Zhao F, Zhou Z, et al. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study. BMC Pregnancy Childbirth. 2021 Dec 8;21(1):364. DOI:10.1186/s12884-021-03809-2.
13. Yousif D, Bellos I, Penzlin AI, Hijazi MM, Illigens BMW, Pinter A, et al. Autonomic Dysfunction in Preeclampsia: A Systematic Review. Front Neurol. 2019 Aug 6;10. DOI:10.3389/fneur.2019.00816.
14. Yuan Y, Tai W, Xu P, Fu Z, Wang X, Long W, et al. Association of maternal serum 25-hydroxyvitamin D concentrations with risk of preeclampsia: a nested case-control study and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2021 May 19;34(10):1576–85. DOI:10.1080/14767058.2019.1640675.

Publication:

«World of Medicine and Biology» Vol. 21 No. 94 (2025) , с. 72-77
УДК 618.3-06:616.12-008.331.1

DOI:

https://doi.org/10.26724/2079-8334-2025-4-94-72-77