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Hypertension. 2019 Aug;74(2):391-398. doi: 10.1161/HYPERTENSIONAHA.119.12924. Epub 2019 Jun 10.

Aldosterone, Salt, and Potassium Intakes as Predictors of Pregnancy Outcome, Including Preeclampsia.

Birukov A1,2,3,4,5, Andersen LB6,7,5, Herse F1,2,3, Rakova N1,2,3, Kitlen G8, Kyhl HB9,10, Golic M1,2,3,4, Haase N1,2,3,4, Kräker K1,2,3,4, Müller DN1,2,3,4, Jørgensen JS6,9,10,5, Andersen MS11, Dechend R1,2,3,4,5,12, Jensen BL8.

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From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).
Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).
German Centre for Cardiovascular Research, Partner Site Berlin, Germany (A.B., M.G., N.H., K.K., D.N.M., R.D.).
Department of Obstetrics and Gynecology (A.B., L.B.A., J.S.J., R.D.), Odense University Hospital, Denmark.
Institute of Clinical Research (L.B.A., J.S.J.), University of Southern Denmark, Odense.
Department of Obstetrics and Gynecology, Herlev Hospital, Denmark (L.B.A.).
Institute for Molecular Medicine (G.K., B.L.J.), University of Southern Denmark, Odense.
Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents (H.B.K., J.S.J.), Odense University Hospital, Denmark.
Odense Patient Data Explorative Network (H.B.K., J.S.J.), Odense University Hospital, Denmark.
Department of Endocrinology (M.S.A.), Odense University Hospital, Denmark.
Department of Cardiology and Nephrology, HELIOS-Klinikum, Berlin, Germany (R.D.).


The mineralocorticoid aldosterone increases in plasma in healthy pregnancy along with renin and angiotensin II and plays a key role in the physiological plasma volume expansion. In mice, aldosterone contributes to an optimal fetal development by enhancing PlGF (placental growth factor) expression and trophoblast cell proliferation. In preeclampsia, there is coincident suppression of aldosterone and impaired placental development. We hypothesized that aldosterone independently contributes to placental and birth weight in humans, and high dietary sodium and low potassium intakes affect this relationship adversely. We analyzed 24-hour urine collections and plasma samples from gestational week 29 in a subsample of 569 pregnant women from the Odense Child Cohort-a Danish population-based longitudinal cohort study. Plasma and urinary aldosterone were measured by ELISA, sodium and potassium excretions by flame photometer. Predictive values of aldosterone levels and sodium and potassium intakes were assessed by multiple and Cox regression analyses. Primary outcomes were placental weight and birth weight. Secondary outcome was preeclampsia. Urinary aldosterone excretion at gestational week 29 independently contributed to placental and birth weights (adjusted β-coefficients [95% CI], 24.50 [9.66-39.35] and 9.59 [4.57-14.61], respectively). Aldosterone levels were not associated to preeclampsia incidence. Salt intake >6 g/d was associated with development of preeclampsia (hazard ratio [95% CI], 5.68 [1.51-21.36]). At gestational week 29, urinary aldosterone excretion is an independent predictor of placental and birth weights. High salt intake is a risk factor for preeclampsia. In perspective, suppression of aldosterone in pregnancy has adverse trophic effects.


aldosterone; birth weight; potassium; preeclampsia; sodium

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