Plasticity of the Maternal Vasculature During Pregnancy

Annu Rev Physiol. 2019 Feb 10:81:89-111. doi: 10.1146/annurev-physiol-020518-114435.


Maternal cardiovascular changes during pregnancy include an expansion of plasma volume, increased cardiac output, decreased peripheral resistance, and increased uteroplacental blood flow. These adaptations facilitate the progressive increase in uteroplacental perfusion that is required for normal fetal growth and development, prevent the development of hypertension, and provide a reserve of blood in anticipation of the significant blood loss associated with parturition. Each woman's genotype and phenotype determine her ability to adapt in response to molecular signals that emanate from the fetoplacental unit. Here, we provide an overview of the major hemodynamic and cardiac changes and then consider regional changes in the splanchnic, renal, cerebral, and uterine circulations in terms of endothelial and vascular smooth muscle cell plasticity. Although consideration of gestational disease is beyond the scope of this review, aberrant signaling and/or maternal responsiveness contribute to the etiology of several common gestational diseases such as preeclampsia, intrauterine growth restriction, and gestational diabetes.

Keywords: adaptability; cardiac output; endothelium; peripheral resistance; remodeling; vasodilation.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Cardiovascular System / physiopathology*
  • Cell Plasticity / physiology*
  • Endothelium, Vascular / physiology*
  • Female
  • Humans
  • Muscle, Smooth, Vascular / physiology*
  • Myocytes, Smooth Muscle / physiology
  • Pregnancy