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Recent data indicate an increased vascular reactivity due to an overactivity of the sympathetic nervous system in women with pre-eclampsia. We therefore evaluated whether this increased vascular reactivity can be detected prior to the clinical manifestation of preeclampsia by the use of a physiological stimulus.Prospective data collection.Clinic of Obstetrics and Gynecology in a 2000 bed tertiary care hospital.One hundred and twenty-three pregnant women between the16th to 20th week of gestation.A cold pressor test was performed by positioning an ice-bag on the forehead of the woman for 3 min. Blood pressure and heart rate were monitored by a continuous, noninvasive blood pressure measurement device during the stimulus and after removal of the icebag. A clinical follow-up was carried out by review of the charts after delivery to identify those women who have developed pre-eclampsia.Ten (8%) out of 123 pregnant women developed pre-eclampsia. During the cold pressor test systolic as well as diastolic blood pressure increased significantly and was more pronounced in women developing pre-eclampsia compared with healthy pregnant women (systolic blood pressure: 14.2 ± 5.5 versus 8.5 ± 7.2 mmHg, P = 0.02; diastolic blood pressure: 7.3 ± 4.9 versus 3.9 ± 4.7 mmHg, P = 0.03). The change in heart rate was similiar between both groups (8 ± 2.6 versus 10.4 ± 6.4 beats/min, not significant).An increased vasoconstrictive response to a physiological stimulus is present in women with preeclampsia as a sign of an increased vascular reactivity prior to clinical manifestation of the disease. The cold pressor test may be a suitable diagnostic tool to identify women, who will develop pre-eclampsia. However, future studies in larger cohorts are required to establish the final value of this test.