Cerebral vascular adaptation to pregnancy and its role in the neurological complications of eclampsia

The cerebral circulation has a central role in mediating the neurological complications of eclampsia, yet our understanding of how pregnancy and preeclampsia affect this circulation is severely limited. Here, we show that pregnancy causes outward remodeling of penetrating arterioles and increased capillary density in the brain due to activation of peroxisome proliferator-activated receptor-gamma (PPAR gamma), a transcription factor involved in cerebrovascular remodeling and highly activated in pregnancy. Pregnancy-induced PPAR gamma activation also significantly affected cerebral hemodynamics, decreasing vascular resistance and increasing cerebral blood flow by similar to 40% in response to acute hypertension that caused breakthrough of autoregulation. These structural and hemodynamic changes in the brain during pregnancy were associated with substantially increased blood-brain barrier permeability, an effect that could promote passage of damaging proteins into the brain and cause the neurological complications of eclampsia, including seizure.