Differential regulation of sympathetic neural burst frequency and amplitude throughout normal pregnancy: A longitudinal study

Sympathetic activation is a hallmark of pregnancy. However, longitudinal assessments of muscle sympathetic nerve activity (MSNA) in pregnancy are scarce and have primarily focused on burst occurrence (frequency) at rest, despite burst strength (amplitude) representing distinct characteristics of sympathetic outflow. Thus, we assessed MSNA burst amplitude distributions in healthy women to determine the impact of normal pregnancy on neural discharge patterns in response to orthostatic stress. Twenty-six women were studied longitudinally during pre-, early- (4-8 weeks of gestation) and late (32-36 weeks) pregnancy, as well as postpartum (6-10 weeks after delivery). MSNA, blood pressure (BP), and heart rate (HR) were measured in the supine posture and during graded head-up tilt (30˚ and 60˚HUT). Mean and median MSNA burst amplitudes were used to characterize burst amplitude distribution. In late pregnancy, women demonstrated smaller increases in HR (P<0.001) during 60˚HUT and larger increases in systolic BP (P=0.043) throughout orthostasis, compared to pre-pregnancy. The increase in MSNA burst frequency during late- relative to pre-pregnancy (Late: ∆14[10] vs. Pre: ∆21[9] bursts/min; P=0.001) was smaller during 60˚HUT, whereas increases in burst incidence were smaller in late- relative to pre-pregnancy throughout orthostasis (P=0.009). Nonetheless, median burst amplitude was smaller throughout orthostasis in late compared to pre-pregnancy (P=0.038). Thus, while supine MSNA burst frequency was greater in late pregnancy, increases in burst frequency and strength during orthostasis were attenuated. These smaller, orthostatically-induced MSNA increases may reflect natural adaptions of pregnancy serving to prevent sympathetic hyper-reactivity that is common in pathological states.