Important Role of Renin–Angiotensin System and Vasopressin System in Cardiovascular, Metabolic and Psychogenic Disorders in Pregnancy and Early Postnatal Life: A Narrative Review

The renin–angiotensin system (RAS) and vasopressin system (VAS) play an essential role in the regulation of multiple vital body functions. A survey of the literature provides evidence that the central and systemic RAS and VAS are activated during pregnancy and cooperate in the regulation of blood circulation and in the exchange of substrates and metabolites between the mother and fetus. The present review is focused on the engagement of the RAS and VAS in the regulation of blood circulation in healthy pregnant women and fetuses and in gestations complicated by cardiovascular, metabolic and psychogenic diseases. The presence of several components of the RAS and VAS, such as renin, angiotensin-converting enzymes (ACE1, ACE2), angiotensins [Ang II, Ang-(1–7)], angiotensin receptors (AT1R, AT2R), and AVP receptors (V1aR), in the placenta and the myometrium allows us to assume that the RAS and VAS play a prominent role in function of the maternal–placental–fetal unit. Gestation is also associated with the activation of components of the RAS and VAS in appropriate regions of the central nervous system that are involved in the regulation of blood pressure. Experimental studies suggest that the RAS and VAS participate in the autonomic control of blood circulation and in the regulation of emotional aspects of pregnancy and maternity. Abnormal functioning of the RAS and/or VAS was found in eclampsia, metabolic diseases (diabetes mellitus) and psychogenic disorders (anxiety, stress, and depression). Some of these abnormalities may have an immunological or genetic background. In eclampsia, the presence of specific agonistic angiotensin receptor autoantibodies (AT1-AA) and altered genotypes of AGT, ACE2, AT1R, and AT2R were reported. Polymorphism of the AVP promoter was also described. Inappropriate pharmacotherapy or toxic environmental pollution may disturb the regulation of the cardiovascular system of the mother and fetus by the RAS and VAS during gestation. Further studies are necessary to better recognize the mechanisms of action of the RAS and VAS in healthy and pathological pregnancies.