Heart rate variability in hypertensive pregnancy disorders: A systematic review

• Published in: Pregnancy hypertension 2020-04, Vol.20, p.56-68
• Main Authors: Moors, S., Staaks, K.J.J., Westerhuis, M.E.M.H., Dekker, L.R.C., Verdurmen, K.M.J., Oei, S.G., van Laar, J.O.E.H.
• Format: Article
• Language: English
• Subjects: Autonomic nervous system; Gestational hypertension; Heart rate variability; Hypertensive pregnancy disorders; Preeclampsia
• ISSN: 2210-7789; 2210-7797
• DOI: 10.1016/j.preghy.2020.03.003

•HPD are associated with dysfunction of the autonomic nervous system.•Cardiac autonomic functions can be assessed by HRV measurements.•A systematic review was performed to study HRV in hypertensive pregnancy disorders.•A decreased overall HRV was found in preeclampsia compared to normotensive controls.•A trend is seen towards increased LF/HF-ratio in women with preeclampsia.•Sympathetic overdrive is found in HPD, associated with parasympathetic withdrawal. Hypertensive pregnancy disorders (HPD) are associated with dysfunction of the autonomic nervous system. Cardiac autonomic functions can be assessed by heart rate variability (HRV) measurements. To study whether HRV detects differences in the function of the autonomic nervous system between pregnant women with HPD compared to normotensive pregnant women and between women with a history of a pregnancy complicated by HPD compared to women with a history of an uncomplicated pregnancy. A systematic search was performed in Medline, EMBASE, and CENTRAL to identify studies comparing HRV between pregnant women with HPD or women with a history of HPD to women with (a history of) normotensive pregnancies. The search identified 523 articles of which 24 were included in this review, including 850 women with (a history of) HPD and 1205 normotensive controls. The included studies showed a large heterogenicity. A decrease in overall HRV was found in preeclampsia (PE), compared to normotensive pregnant controls. A trend is seen towards increased low frequency/high frequency-ratio in women with PE compared to normotensive pregnant controls. Our systematic review supports the hypothesis a sympathetic overdrive is found in HPD which is associated with a parasympathetic withdrawal. However, the included studies in our review showed a large diversity in the methods applied and their results.