[Hypotension in pregnancy, a sequela of adrenal cortex insufficiency?]

Because of certain similarities in the symptoms of hypotension and adrenal cortical insufficiency, etiological connections have long been postulated. In the prospective study reported here the behavior of plasma renin activity, angiotensin II, aldosterone and cortisol values were therefore investigated in 10 normotensive and 20 hypotensive women during pregnancy. Blood samples were taken from all women at the start of the study and 10-14 days later, in each case following orthostatic loading. Following randomization between taking blood samples, the hypotensive gravidae were given either 2 X 1 placebo tablets (n = 10) or 2 X 2.5 mg dihydroergotamine (DETMS retard) (n = 10) daily on a double-blind basis and continued to take the tablets until their children were born. Among the hypotensive gravidae there were no low aldosterone or cortisol values typical of Addison's disease, nor any severely increased PRA and angiotensin II values. Therefore, adrenal cortex insufficiency can be ruled out as a cause of their hypotension. While no differences were found between the hypotensives treated with DHE and the normotensive women as regards gestation period, birth weight and body length of the newborn, statistically significant abnormalities were found among the hypotensive patients: the mean gestation period was two weeks shorter, birth weight was around 400 g lower and body length approx. 2 cm shorter. The cause of these obstetrically undesirable results among untreated hypotensive patients cannot be explained by adrenal cortical insufficiency. Rather, a prime etiologic factor seems to be a disorder of venous hemodynamics.