Mechanisms regulating angiotensin II responsiveness by the uteroplacental circulation

Am J Physiol Regul Integr Comp Physiol. 2001 Oct;281(4):R1025-40. doi: 10.1152/ajpregu.2001.281.4.R1025.

Abstract

Pregnancy is associated with increases in cardiac output and uterine blood flow (UBF) and a fall in systemic vascular resistance. In ovine pregnancy, UBF rises from approximately 3% of cardiac output to approximately 25% at term gestation, reflecting a >30-fold rise in UBF by term. This increase in UBF supports exponential fetal growth during the last trimester and maintains fetal well-being by providing excess oxygen and nutrient delivery. These hemodynamic changes are associated with numerous hormonal changes, including increases in placental steroid hormones and enhanced activation of the renin-angiotensin and sympathetic nervous systems, all of which are believed to modulate systemic and uterine vascular adaptation and vascular reactivity. Systemic pressor responses to infused ANG II are attenuated in normotensive pregnancies and the uteroplacental vasculature is even less sensitive, suggesting development of mechanisms to maintain basal UBF and permit the rise in UBF necessary for fetal growth and well-being. The effects of ANG II on the uteroplacental vasculature are reviewed, and the mechanisms that may account for attenuated vascular sensitivity are examined, including ANG II metabolism, vascular production of antagonists, ANG II-receptor subtype expression, and the role of indirect mechanisms.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Angiotensin II / pharmacology
  • Angiotensin II / physiology*
  • Animals
  • Blood Flow Velocity / drug effects
  • Blood Flow Velocity / physiology
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Dose-Response Relationship, Drug
  • Female
  • Placental Circulation / drug effects
  • Placental Circulation / physiology*
  • Pregnancy
  • Sheep
  • Vascular Resistance / drug effects
  • Vascular Resistance / physiology
  • Vasomotor System / drug effects
  • Vasomotor System / physiology

Substances

  • Angiotensin II