Medical Faculty of Hasanuddin University

INCIDENCE OF PREECLAMPSIA AND LOW BIRTH WEIGHT IN SYMPATHETIC

HYPERACTIVITY PREGNANT WOMEN
Last Updated Sunday, 11 June 2006

Irfan Idris, Irawan Yusuf, Wardihan Sinrang, Agnes Batmomolin

Physiology Department, School of Medicine, Hasanuddin University, Makassar
RINGKASAN
Latar belakang : Preeklampsia dan bayi berat badan lahir rendah (BBLR) merupakan komplikasi utama pada ibu-ibu
hamil di Indonesia. Kesulitan untuk memprediksi dan mengenali tanda-tanda dini penyakit ini menyebabkan peningkatan
angka morbiditas dan mortalitas. Tujuan penelitian ini untuk membuktikan bahwa hiperaktifitas simpatis berhubungan
dengan insiden terjadinya preeklampsia dan BBLR. Metode dan Cara Kerja : 79 orang ibu hamil ikut dalam penelitian ini
dan mereka difollow-up sampai bersalin. Hiperaktifitas simpatis diukur sewaktu datang pertama kalinya ke RS Bersalin
untuk pemeriksaa antenatal dengan teknik Cold Pressure Test (satu tangan direndam pada air dingin 3o-5oC selama 30
detik dan 60 detik, sambil dilakukan pengukuran tekanan darah) Hasil : Sampel terdiri atas 47 ibu hamil dengan
hiperaktifitas simpatis (hipereaktor) dan 32 yang tidak mengalami hiperaktifitas simpatis (hiporeaktor). Dari 47 ibu hamil
yang mengalami hiperaktifitas simpatis, 7 orang yang preeklampsia dan 40 orang yang normal. Dua orang preeklampsia
juga didapatkan pada 32 sample yang tidak mengalami hiperaktifitas simpatis. Insiden BBLR dijumpai hanya pada 8
orang dari 79 sample ibu hamil yang bersalin, 5 orang ibu hamil dengan hiperaktifitas simpatis dan 3 orang dari ibu
normal. Kami mendapatkan bahwa ibu dengan hiperaktifitas simpatis mempunyai resiko 2.3 kali menderita preeklampsia
dan 1.1 kali beresiko melahirkan bayi dengan BBLR.
Kesimpulan : Insidens preeklampsia dan BBLR pada sampel kami nampaknya membutuhkan faktor resiko lain (disfungsi
endotel, genetic, immunologic) selain faktor resiko hiperaktifitas simpatis. (J Med Nus. 2004; 25:121-124)
SUMMARY
Background : Preeclampsia and low birth weight were the common complication in pregnant woman in Indonesia. The
difficulty to predict and recognize the sign and symptoms increase the morbidity and mortality rate. In present study we
examined the appearance of sympathetic hyperactivity with cold pressure test to predict and recognize preeclampsia and
low birth weight. The aims of this study were to prove that sympathetic hiperactivity associated with incidence of
preeclampsia and low birth weigh Material and method : 79 pregnant woman were involved in this study, and follow up
until delivery. Sympathetic hyperactivity was examined when admitted to the hospital for antenatal care by cold pressure
test (the hand was immersed in the cold water 3-5oC for 30 second and 60 second and measuring blood pressure at 30
and 60 second). Results : Our sample consist of 47 sympathetic hiperactivity and 32 sympathetic non-hiperactivity. Of 47
sympathetic hiperactivity samples, 7 samples were preeclampsia and 40 samples were normal. Two preeclampsia
subjects also occurred in normal sample. Incidence of low birth weight only 8 (<2500 gr) from 79 sample, 5 from
sympathetic hyperactivity and 3 from normal sample. Sympathetic hyperactivity sample have a risk 2.3 times (RR = 2.3)
to suffered preeclampsia and 1.1 (RR=1.1) times to have low birth weight.
Conclusion : Incidence of preeclampsia and low weight birth in our sample appear required another risk factors (endothel
dysfunction, genetic, immunologic), beside sympathetic hyperactivity alone. (J Med Nus. 2004; 25:121-124)

Introduction
Preeclampsia and low birth weight were the common complication in pregnant woman in Indonesia. The difficulty to
predict these conditions and the complexity of the management had a significance effect to increase morbidity and
mortality rate.6,9 Preeclampsia affect 5-7% pregnant woman and from many studies tend to produce low birth weight
with small gestational age4,6. Although pathophysiologic mechanisms that underlie reversible form of human
hypertension still unclear, it is accepted that preeclampsia is characterized by a marked increase in peripheral vascular
resistance, which is causes hypertension.4
Since vascular tone is largely determined by sympathetic nerve activity, sympathetic hyperactivity was one factor that to
be considered to create these symptoms (peripheral resistance, hypertension) beside another factors such as endothelial
dysfunction, oxidative stress and autoimmunity.5 We hypothesized that sympathetic hiperactivity had association with
incidence of preeclampsia and low birth weight and the severity of these symptoms depend on involvement amount of
factors in the pathophysiological pathways.
In order to predict preeclampsia symptoms with considering restricted laboratory facilities in health center of small
villages, sympathetic hyperactivity more feasible to measure (by cold pressure test) for controlling preeclampsia and low
birth weight incidence. The objectives of this study were to prove that sympathetic hiperactivity associated with incidence
of preeclampsia and low birth weight
Method
Subjects
79 pregnant woman were involved in this study, and follow up until delivery. They have no history of hypertension or
another cardiovascular diseases and had gestational age e 20 weeks. When admission for antenatal care in the hospital,
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subject were requested to involved if they were meet the requirement of the study. After fulfilled the informed consent,
the sympathetic hyperactivity was examined by cold pressure test (by immersion the hand in the cold water 3-5oC for 30
second and 60 second and measuring blood pressure at 30 and 60 second). The subjects were followed up until delivery
and the outcome was recorded. The low birth weight baby was performed if the weight < 2500 gram with small
gestational age. Preeclampsia was defined according to diagnosis made by gynecologist in the hospital, this criteria
include no history of hypertension, cardiovascular, or renal diseases and blood pressure values more than 140/90 mmHg
after the 20th week of gestation, and the blood pressure return to normal after delivery5.
Cold pressure test protocol
After taking blood pressure in resting condition, subject asked for immersion one of their hand up to the wrist for 1 minute
in the cold water 3 5oC. Blood pressure was recorded every 30 second and 60 second. Hypereactor was performed if
systolic and or diastolic pressure increase e 15 mmHg, compared to resting blood pressure, and hyporeactor if not2,3.
Statistical Analysis
Relative risk with 95% confidence interval was performed for incidence preeclampsia and low birth weight in hypereactor
subjects. Blood pressure at rest condition and when immersion the hand underwater calculated with paired t test.
Spearmans correlation also performed for examined relation between preeclampsia subject against age and hypereactor
condition. All data calculated based on SPSS 11.5 for windows programs.
Result and Discussion
Subject characteristic can be seen in table 1
Table.1. Characteristic of subjects

Incidence of preclampsia in our sample occurred 11%, and it was the same with many reports that the diseases affected
7 12% people.4,6 Our cohort data shown that preeclampsia occurrence higher in sympathetic hyperactivity
(hypereactor) subject than hyporeactor. Hypereactor subject tended 2.3 times (RR : 2.3) to suffered preeclampsia
compared with hyporeactor subject (Figure 1). These data suggested that sympathetic hyperactivity may play a role in
pathomechanisms of preeclampsia.
Schobel et al 1996 proposed that preeclampsia occurred due to the increase in peripheral resistance was mediated
partly by sympathetic vasoconstrictor activity. Increasing blood pressure in preeclampsia due to increased of plasma
cathecolamine concentration, and lead to overstimulated in sympathetic neuron.5,9 Although effect of sympathetic
hyperactivity was partly and still need another factors to produce preeclampsia symptoms, as our data suggested.5
Our results obtained that only 17.5 % hypereactor subject suffering preeclampsia, and suggested that preeclampsia had
multifactor risk. Endothelial dysfunction, immunologic profile and genetic factor were accepted as the risk factors, and the
severity of preeclampsia symptoms could be occurred if these multifactor risk emerged in one subject.8
Preeclampsia in our sample (figure 3) also had weak related to the subjects age (R=0.07, Spearmans correlation),
compare to sympathetic hyperactivity (hypereactor) (R=0.13, Spearmans correlation). Many studies obtained that
womans age unrelated to incidence of preeclampsia, because this sympathetic hyperactivity seems to be specific to the
diseases and probably not a secondary finding caused by high blood pressure. Also from our data, we found that
preeclampsia tended to occurred in the first and second pregnancy (Figure 4), as many studies reported.4,9
As shown in our data, incidence of low birth weight only had relative risk 1.1 times to produced low birth weight baby.
Many studies had conflict result of effect of preeclampsia on birth weight. Xiong and Fraser 2004, proposed that most
babies born to mothers with severe preeclampsia or preeclampsia and gestational hypertension had similar fetal growth
to those born to normotensive mothers.10 Another researcher concluded that preeclampsia increased the risk of
intrauterine growth restriction and low birth weight due to decreased uteroplacental blood flow, and this would
responsible for lower birth weights outcome.1,7
Preeclampsia in our sample (figure 3) also had weak related to the subjects age (R=0.07, Spearmans correlation),
compare to sympathetic hyperactivity (hypereactor) (R=0.13, Spearmans correlation). Many studies obtained that
womans age unrelated to incidence of preeclampsia, because this sympathetic hyperactivity seems to be specific to the
diseases and probably not a secondary finding caused by high blood pressure. Also from our data, we found that
preeclampsia tended to occurred in the first and second pregnancy (Figure 4), as many studies reported.4,9
As shown in our data, incidence of low birth weight only had relative risk 1.1 times to produced low birth weight baby.
Many studies had conflict result of effect of preeclampsia on birth weight. Xiong and Fraser 2004, proposed that most
babies born to mothers with severe preeclampsia or preeclampsia and gestational hypertension had similar fetal growth
to those born to normotensive mothers.10 Another researcher concluded that preeclampsia increased the risk of
intrauterine growth restriction and low birth weight due to decreased uteroplacental blood flow, and this would
responsible for lower birth weights outcome.1,7
Conclusion
Incidence of preeclampsia in our sample appeared required another risk factors (endothelial dysfunction, immunologic,
genetic), beside sympathetic hyperactivity alone. Hypereactor as a sign of sympathetic hyperactivity was a risk factor for
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incidence of preeclampsia, and can be examined with simple techniques (cold pressure test). Incidence of low birth
weight in our sample appeared have no association to preeclampsia mother
References
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5. Hans P Schobel et al. Preeclampsia A State of Sympathetic overactivity. N Engl J Med 1996; 335 : 148085
6. Joey P. Granger et al. Pathophysiology of hypertension during preeclampsia linking placental ischemia with
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9. Woisetschlager C. et al. Inceased blood pressure respons to the cold pressure test in pregnant woman developing preeclampsia. J Hypertens, April1, 2000: 18 (4) : 399-403
10. Xiong X, Fraser WD. Impact of pregnancy-induced hypertension on birthweight by gestational age, Paediatr Perinat
Epidemiol. 2004 May;18(3):186-91

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