B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy

Janet M. Burlingame; Kelly Yamasato; Hyeong Jun Ahn; Todd Seto; W. H. Wilson Tang

doi:10.1515/jpm-2016-0266

Article

B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy

Janet M. Burlingame , Kelly Yamasato , Hyeong Jun Ahn , Todd Seto and W. H. Wilson Tang

Published/Copyright: February 14, 2017

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From the journal Journal of Perinatal Medicine Volume 45 Issue 5

Abstract

Objective:

To evaluate B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac structure and function in normal women through pregnancy and the postpartum.

Methods:

In this prospective observational study, we obtained serial transthoracic echocardiograms, BNP, and NT-proBNP at seven intervals from 6 weeks’ gestation through 12 months postpartum. Women with hypertension or cardiac disease were excluded. Using 6–12 months postpartum as reference for non-pregnant levels, echocardiogram measurements and BNP/NT-proBNP were compared over time using linear mixed models with Tukey-Kramer adjustment for multiple comparisons.

Results:

Of 116 patients, data was available for 78–114 healthy pregnant or postpartum women within each time interval, and 102 patients provided data for ≥4 intervals. Compared to 6–12 months postpartum, BNP and NT-proBNP remained stable through pregnancy and delivery, increased within 48 h postpartum (P<0.0001), then returned to baseline. Left ventricular volume increased within 48 h postpartum (P=0.021) while left atrial volume increased at 18–24 weeks (P=0.0002), 30–36 weeks (P<0.0001) and within 48 h postpartum (P=0.002). The transmitral early/late diastolic velocity (E/A) ratio, transmitral early/peak mitral annulus diastolic velocity (E/E′) ratio, isovolumic relaxation times, and mitral valve deceleration times were similar within 48 h and 6–12 months postpartum.

Conclusion:

In normal women, BNP/NT-proBNP, left atrial, and left ventricular volumes increase within 48 h postpartum without indications of altered diastolic function.

Keywords: Brain; echocardiography; natriuretic peptide, pregnancy; postpartum period

Corresponding author: Kelly Yamasato, MD, University of Hawaii, John A Burns School of Medicine, Department of Obstetrics, Gynecology and Women’s Health, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA, Tel.: +808-203-6508

Acknowledgments

The research described was supported in part by the NIH grants U54MD007584, G12MD007601, R01HL103931, and P20GM103466. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or The Queen’s Medical Center.

Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has been complied with all the relevant national regulations, and institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

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Received: 2016-8-9

Accepted: 2017-1-10

Published Online: 2017-2-14

Published in Print: 2017-7-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2016-0266

Keywords for this article

Brain; echocardiography; natriuretic peptide, pregnancy; postpartum period