Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta‐analysis

ABSTRACT Objective To describe the physiological pattern of gestational plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy‐induced hypertension, pre‐eclampsia or fetal growth restriction. Methods We performed a meta‐analy...

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Bibliographic Details
Published in:Ultrasound in obstetrics & gynecology 2017-02, Vol.49 (2), p.177-187
Main Authors: de Haas, S., Ghossein‐Doha, C., van Kuijk, S. M. J., van Drongelen, J., Spaanderman, M. E. A.
Format: Article
Language:English
Subjects:
blood volume
complicated pregnancy
Female
Fetal Growth Retardation - physiopathology
Humans
Hypertension, Pregnancy-Induced - physiopathology
physiology
Plasma Volume
Pre-Eclampsia - physiopathology
Pregnancy
Pregnancy Trimester, Third
pre‐eclampsia
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Summary:ABSTRACT Objective To describe the physiological pattern of gestational plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy‐induced hypertension, pre‐eclampsia or fetal growth restriction. Methods We performed a meta‐analysis of the current literature on plasma volume adjustments during physiological and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies reported both reference plasma volume measurements (non‐pregnant, prepregnancy or postpartum) and measurements obtained during predetermined gestational ages. Mean differences bet ween the reference and pregnancy plasma volume measurements were calculated for predefined intervals of gestational age using a random‐effects model described by DerSimonian and Laird. Results Thirty studies were included in the meta‐analysis with publication dates ranging from 1934 to 2007. Plasma volume increased in the first weeks of pregnancy, with the steepest increase occurring during the second trimester. Plasma volume continued to increase in the third trimester with a pooled maximum increase of 1.13 L (95% CI, 1.07–1.19 L), an increase of 45.6% (95% CI, 43.0–48.1%) in physiological pregnancies compared with the reference value. The plasma volume expansion in gestational hypertensive and growth‐restricted pregnancies was 0.80 L (95% CI, 0.59–1.02 L), an increase of 32.3% (95% CI, 23.6–41.1%) in the third trimester, a smaller increase than in physiological pregnancies (P 
ISSN:0960-7692
1469-0705
DOI:10.1002/uog.17360