Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, in maternal and fetal circulation.

Pronounced dilation of the maternal vasculature occurs during normal pregnancy. Likewise, low resistance characterizes the fetoplacental circulation. Nitric oxide released by endothelial cells is a potent vasodilator known to be a key modulator of both maternal and fetal vascular tone. However, the mechanisms underlying the maternal circulatory adaptations and the low resistance of the fetal circulation remain unknown. The aim of the present study was to compare levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, in the maternal and fetal circulations. High performance liquid chromatography was used to measure asymmetric ADMA in the maternal and umbilical venous plasma. Plasma ADMA levels during the first trimester were 0.29 +/- 0.05, the third trimester before term 0.29 +/- 0.05, and at term 0.32 +/- 0.05 nmol/mL, which were significantly (P <.05) lower than the levels measured in nonpregnant women (0.41 +/- 0.06 nmol/mL). By contrast, ADMA levels in umbilical venous plasma averaged 1.02 +/- 0.18 nmol/mL, significantly (P <.005) higher than maternal levels. Unlike ADMA, levels of plasma L-arginine, the nitric oxide precursor, did not significantly differ among nonpregnant and pregnant women and the fetus.During pregnancy, maternal hemodynamics are modulated, at least in part, by a reduction in ADMA. Conversely, the low resistance to umbilical blood flow is maintained despite substantially higher fetal ADMA levels. Thus, the predominant mechanisms regulating the maternal and fetal circulation apparently differ.