Abstract
Normal levels of B‐type natriuretic peptide (BNP) are not well established in pregnancy. We obtained longitudinal BNP levels in 29 healthy pregnant women in each trimester and postpartum period, and compared these levels to the 25 nonpregnant controls. There were no significant differences among the cases and controls with respect to weight, diastolic blood pressure, and ethnicity. A total of 116 BNP values were obtained during pregnancy. The median (and range) BNP level during pregnancy was 19 (10–143) pg/ml versus 10 (10–37) pg/ml in the nonpregnant controls (p = 0.003). However, there were no statistically significant differences in the median BNP levels at various stages of pregnancy: first trimester 20 (10–115) pg/ml versus the second trimester 18 (10–112) pg/ml (p = 0.8), second trimester 18 pg/ml versus third trimester 26 (10–143) pg/ml (p = 0.06), and third trimester 26 pg/ml versus postpartum18 (10–62) pg/ml (p = 0.08). There were no significant differences between the BNP levels throughout the trimesters and postpartum period. Pregnant BNP levels were approximately twice as high as the nonpregnant BNP levels. Our study is unique in evaluating longitudinal changes in BNP levels in normal pregnancies and the postpartum period in comparison with healthy, nonpregnant controls. It demonstrates that pregnant BNP levels are approximately 2‐fold higher than their nonpregnant counterparts, and do not significantly fluctuate during pregnancy. In conclusion, pregnancy is associated with a significant, but small increase in the BNP levels compared with nonpregnant women. Copyright © 2009 Wiley Periodicals, Inc.
Full Text
The Full Text of this article is available as a PDF (153.9 KB).
References
- 1. Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature 1988; 332: 78–81. [DOI] [PubMed] [Google Scholar]
- 2. Wieczorek SJ, Wu AH, Christenson R, et al. A rapid B‐type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: A multicenter evaluation. Am Heart J 2002; 144: 834–839. [DOI] [PubMed] [Google Scholar]
- 3. McCullough PA, Nowak RM, McCord J, et al. B‐type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: Analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 2002; 106: 416–422. [DOI] [PubMed] [Google Scholar]
- 4. Morrison LK, Harrison A, Krishnaswamy P, et al. Utility of a rapid B‐natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol 2002; 39: 202–209. [DOI] [PubMed] [Google Scholar]
- 5. Altintop L, Yardan T, Cander B, Findik S, Yilmaz O. An increase of BNP levels in massive pulmonary embolism and the reduction in response to the acute treatment. Resuscitation 2005; 65: 225–229. [DOI] [PubMed] [Google Scholar]
- 6. Folk JJ, Lipari CW, Nosovitch JT, et al. Evaluating ventricular function with B‐type natriuretic peptide in obstetric patients. J Reprod Med 2005; 50: 147–154. [PubMed] [Google Scholar]
- 7. Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation 1978; 58: 434–441. [DOI] [PubMed] [Google Scholar]
- 8. Cabanes L, Richaud‐Thiriez B, Fulla Y, et al. Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea. Chest 2001; 120: 2047–2050. [DOI] [PubMed] [Google Scholar]
- 9. Resnik JL, Hong C, Resnik R, et al. Evaluation of B‐type natriuretic peptide (BNP) levels in normal and preeclamptic women. Am J Obstet Gynecol 2005; 193: 450–454. [DOI] [PubMed] [Google Scholar]
- 10. Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B‐type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161–167. [DOI] [PubMed] [Google Scholar]
- 11. Cheng V, Kazanagra R, Garcia A, et al. A rapid bedside test for B‐type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: A pilot study. J Am Coll Cardiol 2001; 37: 386–391. [DOI] [PubMed] [Google Scholar]
- 12. Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol 1989; 256: H1060–H1065. [DOI] [PubMed] [Google Scholar]
- 13. Robson SC, Dunlop W, Hunter S. Haemodynamic changes during the early puerperium. BMJ (Clin Res Ed) 1987; 294: 1065. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Robson SC, Hunter S, Moore M, Dunlop W. Haemodynamic changes during the puerperium: A Doppler and M‐mode echocardiographic study. Br J Obstet Gynaecol 1987; 94: 1028–1039. [DOI] [PubMed] [Google Scholar]
- 15. Furuhashi N, Kimura H, Nagae H, et al. Brain natriuretic peptide and atrial natriuretic peptide levels in normal pregnancy and preeclampsia. Gynecol Obstet Invest 1994; 38: 73–77. [DOI] [PubMed] [Google Scholar]
- 16. Itoh H, Sagawa N, Mori T, et al. Plasma brain natriuretic peptide level in pregnant women with pregnancy‐induced hypertension. Obstet Gynecol 1993; 82: 71–77. [PubMed] [Google Scholar]