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Meta-Analysis
. 2024 Mar 7;22(1):29.
doi: 10.1186/s12958-024-01200-2.

Active plasma renin concentration throughout healthy and complicated pregnancy: a systematic review and meta-analysis

Wisal El Fathi #  1 , Maaike van Ochten #  2 , Munieb Rehman  3 , Sander M J van Kuijk  4 , Joanna IntHout  5 , Chahinda Ghossein-Doha  6 , Sander de Haas  7 , Marc E A Spaanderman  1   7 , Joris van Drongelen  1
Affiliations
Meta-Analysis

Active plasma renin concentration throughout healthy and complicated pregnancy: a systematic review and meta-analysis

Wisal El Fathi et al. Reprod Biol Endocrinol. .

Abstract

Background: Pregnancy is characterized by profound circulatory changes and compensatory adjustments in the renin-angiotensin-aldosterone system (RAAS). Differences in regulatory response may antedate or accompany vascular complicated pregnancy. We performed a systematic review and meta-analysis to delineate the trajectory of active plasma renin concentration (APRC) in healthy pregnancy and compare this to complicated pregnancy.

Methods: We performed a systematic review and meta-analysis on APRC during normotensive and hypertensive pregnancies, using PubMed (NCBI) and Embase (Ovid) databases. We included only studies reporting measurements during pregnancy together with a nonpregnant reference group measurement. Risk of bias was assessed with QUIPS. Ratio of the mean (ROM) and 95% confidence intervals (CI) of APRC values between pregnant and nonpregnant women were estimated for predefined intervals of gestational age using a random-effects model. Meta-regression was used to analyze APRC over time.

Results: In total, we included 18 studies. As compared to nonpregnant, APRC significantly increased as early as the first weeks of healthy pregnancy and stayed increased throughout the whole pregnancy (ROM 2.77; 95% CI 2.26-3.39). APRC in hypertensive complicated pregnancy was not significantly different from nonpregnancy (ROM 1.32; 95% CI 0.97-1.80).

Conclusion: Healthy pregnancy is accompanied by a profound rise in APRC in the first trimester that is maintained until term. In hypertensive complicated pregnancy, this increase in APRC is not observed.

Keywords: Complicated pregnancy; Hypertension; Pregnancy; Renin; Renin-angiotensin system.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the study selection
Fig. 2
Fig. 2
Forest plot of the ratio of means (ROM) of the active plasma renin concentrations (APRC) during healthy pregnancy at < 14 weeks, 15–21 weeks, 22–28 weeks, 29–35 weeks and 36–41 weeks of gestation compared to reference values in non-pregnancy, preconception or postpartum. Only studies with more than 4 subjects are included. Studies that are reported more than once provide data for different gestational weeks within the same study. Only the first author of each study is given. GA = gestational age in weeks, SD = standard deviation, CI = confidence interval
Fig. 3
Fig. 3
Forest plot of the ratio of means (ROM) of the active plasma renin concentrations (APRC) during hypertensive complicated pregnancy at 29–35 weeks and 36–41 weeks of gestation compared to reference values in non-pregnancy, preconception or postpartum. Studies that are reported more than once provide data for different gestational weeks within the same study. Only the first author of each study is given. GA = gestational age in weeks, SD = standard deviation, CI = confidence interval, PE = preeclampsia, PIH = pregnancy induced hypertension
Fig. 4
Fig. 4
The ratio of means (ROM) of active plasma renin concentration (APRC) during pregnancy compared to nonpregnant women by gestational age. Shaded area represents the 95% confidence interval. The green data points represent healthy pregnancy; the red data points represent complicated pregnancy. Nonpregnant values were standardized as 1 and are represented by the dashed line
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