Blood Pressure and Heart Rate Variability Complexity Analysis in Pregnant Women with Hypertension

Background. In this work, we perform a comparative analysis of blood pressure and heart rate variability complexity during pregnancy between normal, hypertensive, and preeclamptic women. Methods and Results. A total of 563 short electrocardiographic (10 min) records were obtained from 217 pregnant women (135 normal, 55 hypertensive, and 27 preeclamptic) during several gestational ages in sitting position. We used a mixed unbalanced model for the longitudinal statistical analysis and besides the conventional spectral analysis, we applied Lempel–Ziv complexity, sample entropy, approximated entropy, and detrended fluctuation analysis in the complexity measurement. Conclusions. The obtained results revealed significant differences between pathological and normal states with important considerations related to pregnancy adaptability and evolution as well as the relationship of complexity and blood pressure with factors such as maternal age, familial history of diabetes or hypertension, and parity.

[1]  M. Thompson,et al.  Modelling the association of blood pressure during pregnancy with gestational age and body mass index. , 2009, Paediatric and perinatal epidemiology.

[2]  E. Ekholm,et al.  Autonomic cardiovascular control in pregnancy. , 1996, European journal of obstetrics, gynecology, and reproductive biology.

[3]  J. Nieto-Villar,et al.  Non-linear Analysis Approach of Maternal Heart Rate Patterns in Normal and Pre-eclamptic Pregnancies , 2003 .

[4]  Amir Peleg,et al.  Power spectral analysis of heart rate variability during the 100-g oral glucose tolerance test in pregnant women. , 2006, Diabetes care.

[5]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[6]  U. Nater,et al.  Heart rate variability changes in pregnant and non‐pregnant women during standardized psychosocial stress 1 , 2009, Acta obstetricia et gynecologica Scandinavica.

[7]  G. Ohel,et al.  Modulation of heart rate variability by estrogen in young women undergoing induction of ovulation , 2009, European Journal of Applied Physiology.

[8]  A Voss,et al.  Baroreflex sensitivity, heart rate, and blood pressure variability in normal pregnancy. , 2000, American journal of hypertension.

[9]  M. Ericson,et al.  Autonomic cardiovascular control in normal and pre‐eclamptic pregnancy , 1994, Acta obstetricia et gynecologica Scandinavica.

[10]  G. Parati,et al.  Task Force II: Blood pressure measurement and cardiovacular outcome , 2001, Blood pressure monitoring.

[11]  Cheryl C. H. Yang,et al.  Preeclamptic pregnancy is associated with increased sympathetic and decreased parasympathetic control of HR. , 2000, American journal of physiology. Heart and circulatory physiology.

[12]  F. Lang,et al.  Fetal sex determines the impact of maternal PROGINS progesterone receptor polymorphism on maternal physiology during pregnancy , 2009, Pharmacogenetics and genomics.

[13]  M. Thompson,et al.  Trimester-specific blood pressure levels in relation to maternal pre-pregnancy body mass index. , 2007, Paediatric and perinatal epidemiology.

[14]  W. Fraser,et al.  History of abortion, preterm, term birth, and risk of preeclampsia: a population-based study. , 2002, American journal of obstetrics and gynecology.

[15]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[16]  N. Amador-Licona,et al.  Heart sympathetic activity and pulmonary function in obese pregnant women , 2009, Acta obstetricia et gynecologica Scandinavica.

[17]  J. Langhoff‐Roos,et al.  Blood pressure patterns through consecutive pregnancies are influenced by body mass index. , 2002, American journal of obstetrics and gynecology.

[18]  G. Bahadur,et al.  Pregnancy and miscarriage rates in 3978 donor insemination cycles: Effect of age, parity and partner's infertility status on pregnancy outcome , 2000, Human fertility.

[19]  Ana Paula Rocha,et al.  Linear and complex heart rate dynamics vary with sex in relation to fetal behavioural states. , 2008, Early human development.

[20]  Jing Hu,et al.  Analysis of Biomedical Signals by the Lempel-Ziv Complexity: the Effect of Finite Data Size , 2006, IEEE Transactions on Biomedical Engineering.

[21]  Henning Cammann,et al.  How to avoid misinterpretation of heart rate variability power spectra? , 2002, Comput. Methods Programs Biomed..

[22]  L. Peeters,et al.  Cardiac Adaptation to Pregnancy in Women with a History of Preeclampsia and a Subnormal Plasma Volume , 2008, Reproductive Sciences.

[23]  J. Berry,et al.  Analyzing Longitudinal Data with Multilevel Models: An Example with Individuals Living with Lower Extremity Intra-articular Fractures. , 2008, Rehabilitation psychology.

[24]  Madalena Costa,et al.  Multiscale entropy analysis of biological signals. , 2005, Physical review. E, Statistical, nonlinear, and soft matter physics.

[25]  Maria G. Signorini,et al.  Complexity analysis of the fetal heart rate variability: early identification of severe intrauterine growth-restricted fetuses , 2009, Medical & Biological Engineering & Computing.

[26]  Chung-Kang Peng,et al.  A new method to determine a fractal dimension of non-stationary biological time-serial data , 2000, Comput. Biol. Medicine.

[27]  S M Pincus,et al.  Approximate entropy as a measure of system complexity. , 1991, Proceedings of the National Academy of Sciences of the United States of America.

[28]  Abraham Lempel,et al.  On the Complexity of Finite Sequences , 1976, IEEE Trans. Inf. Theory.

[29]  Brady T. West,et al.  Linear Mixed Models: A Practical Guide Using Statistical Software , 2006 .

[30]  E. Eneroth,et al.  Preeclampsia and Maternal Heart Rate Variability , 1998, Gynecologic and Obstetric Investigation.

[31]  E. D. Hapsari,et al.  Change of autonomic nervous activity during pregnancy and its modulation of labor assessed by spectral heart rate variability analysis. , 2007, Clinical and experimental obstetrics & gynecology.

[32]  M. Fujishima,et al.  Chaos and spectral analyses of heart rate variability during head-up tilting in essential hypertension. , 1999, Journal of the autonomic nervous system.

[33]  J. Shieh,et al.  Detrended fluctuation analysis of short-term heart rate variability in late pregnant women , 2009, Autonomic Neuroscience.

[34]  Eduardo Tejera,et al.  Heart Rate Variability Complexity in the Aging Process , 2007 .

[35]  G. Liakos,et al.  Inverse relation of C-reactive protein levels to heart rate variability in patients after acute myocardial infarction. , 2007, Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese.

[36]  Mathias Baumert,et al.  HERZFREQUENZ- UND BLUTDRUCKINTERAKTION BEI NORMOTENSIVER UND CHRONISCH HYPERTENSIVER SCHWANGERSCHAFT , 2002 .

[37]  G. Pal,et al.  Spectral analysis of heart rate variability (HRV) may predict the future development of essential hypertension. , 2009, Medical hypotheses.

[38]  A L Goldberger,et al.  Physiological time-series analysis: what does regularity quantify? , 1994, The American journal of physiology.

[39]  A. Malliani,et al.  Power spectrum analysis of heart rate variability: a tool to explore neural regulatory mechanisms. , 1994, British heart journal.

[40]  R. Dyer,et al.  Cardiovascular responses to the change from the left lateral to the upright position in pregnant hypertensives , 2004, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.