Brain Natriuretic Peptide in Term Pregnancy



To determine the normal range of serum brain natriuretic peptide (BNP) in uncomplicated, singleton term pregnant patients.

Study Design

Serum for analysis of BNP was drawn at admission to labor and delivery (= 104), prior to administration of intravenous fluid.


Median BNP was 20 pg/mL, with an interquartile range of 20 pg/mL (range 5–70 pg/mL; or a mean ± standard deviation [SD] of 23 ± 16 pg/mL). Brain natriuretic peptide negatively correlated with prepregnant (r = −.24, P < .05) and pregnant weight (r = −26, P < .01) and with heart rate (r = −.35, P < 0.001); heart rate was also positively correlated with BMI (r = .32). Brain natriuretic peptide levels were higher in Hispanic than African American women, independent of body mass index (BMI) and heart rate.


Brain natriuretic peptide values found in term pregnant patients are similar to those of prepregnant women of reproductive age. Brain natriuretic peptide levels appear to be set by conditions present in the prepregnant condition and maintained, despite changes in plasma volume, systemic vascular resistance, and cardiac output.

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  1. 1.

    Carpenter C, Griggs R, Loscalzo J. Heart Failure and Cardiomyopathy. Cecil Essentials of Medicine. 6th ed. Philapdelphia, WB: Saunders; 2004:63–65.

  2. 2.

    Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American college of cardiology foundation/American heart association task force on practice guidelines: developed in collaboration with the international society for heart and lung transplantation. Circulation. 2009;119(14):1977–2016.

  3. 3.

    Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161–167.

  4. 4.

    McCullough PA, Nowak RM, McCord J, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) multinational study. Circulation. 2002;106(4):416–422.

  5. 5.

    Mueller C, Laule-Kilian K, Scholer A, et al. Use of B-type natriuretic peptide for the management of women with dyspnea. Am J Cardiol. 2004;94(12):1510–1514.

  6. 6.

    Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med. 2004;350(7):647–654.

  7. 7.

    Cunningham G, Leveno K, Bloom SL, Hauth JC, Rouse DW, Spong CY. Maternal Physiology. Williams Obstetrics. 23rd ed. New Yortk, NY: McGraw-Hill Medical Publising Divison; 2005:129–135.

  8. 8.

    Cruz MO, Briller J, Hibbard JU. Update on peripartum cardiomyopathy. Obstet Gynecol Clin North Am. 2010;37(2):283–303.

  9. 9.

    Kuklina EV, Callaghan WM. Cardiomyopathy and other myocardial disorders among hospitalizations for pregnancy in the United States: 2004–2006. Obstet Gynecol. 2010;115(1):93–100.

  10. 10.

    ACOG practice bulletin. Management of preterm labor. Number 43, May 2003. Int J Gynaecol Obstet. 2003;82(1):127–135.

  11. 11.

    Mehra MR, Uber PA, Park MH, et al. Obesity and suppressed B-type natriuretic peptide levels in heart failure. J Am Coll Cardiol. 2004;43(9):1590–1595.

  12. 12.

    Das SR, Drazner MH, Dries DL, et al. Impact of body mass and body composition on circulating levels of natriuretic peptides: results from the Dallas heart study. Circulation. 2005;112(14):2163–2168.

  13. 13.

    Wang TJ, Larson MG, Levy D, et al. Impact of obesity on plasma natriuretic peptide levels. Circulation. 2004;109(5):594–600.

  14. 14.

    St Peter JV, Hartley GG, Murakami MM, Apple FS. B-type natriuretic peptide (BNP) and N-terminal pro-BNP in obese patients without heart failure: relationship to body mass index and gastric bypass surgery. Clin Chem. 2006;52(4):680–685.

  15. 15.

    Iwanaga Y, Kihara Y, Niizuma S, et al. BNP in overweight and obese patients with heart failure: an analysis based on the BNP-LV diastolic wall stress relationship. J Card Fail. 2007;13(8):663–667.

  16. 16.

    Balion C, Santaguida P, Hill S, et al. Testing for BNP and NT-proBNP in the Diagnosis and Prognosis of Heart Failure. Rockville, MD: Agency for Healthcare Research and Quality Evidence Report/Technology Assessment No. 142, 06-E014 2006.

  17. 17.

    Franz MB, Andreas M, Schiessl B, et al. NT-proBNP is increased in healthy pregnancies compared to non-pregnant controls. Acta Obstet Gynecol Scand. 2009;88(2):234–237.

  18. 18.

    Bernstein IM, Ziegler W, Badger GJ. Plasma volume expansion in early pregnancy. Obstet Gynecol. 2001;97(5 pt 1):669–672.

  19. 19.

    Chapman AB, Abraham WT, Zamudio S, et al. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int. 1998;54(6):2056–2063.

  20. 20.

    Chapman AB, Zamudio S, Woodmansee W, et al. Systemic and renal hemodynamic changes in the luteal phase of the menstrual cycle mimic early pregnancy. Am J Physiol. 1997;273(5 pt 2):F777–F782.

  21. 21.

    Fleming SM, O’Byrne L, Grimes H, Daly KM, Morrison JJ. Amino-terminal pro-brain natriuretic peptide in normal and hypertensive pregnancy. Hypertens pregnancy. 2001;20(2):169–175.

  22. 22.

    Hameed AB, Chan K, Ghamsary M, Elkayam U. Longitudinal changes in the B-type natriuretic peptide levels in normal pregnancy and postpartum. Clin Cardiol. 2009;32(8):E60–E62.

  23. 23.

    Folk JJ, Lipari CW, Nosovitch JT, Silverman RK, Carlson RJ, Navone AJ. Evaluating ventricular function with B-type natriuretic peptide in obstetric patients. J Reprod Med. 2005;50(3):147–154.

  24. 24.

    Resnik JL, Hong C, Resnik R, et al. Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women. Am J Obstet Gynecol. 2005;193(2):450–454.

  25. 25.

    de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet. 2003;362(9380):316–322.

  26. 26.

    Schrier RW, Durr JA. Pregnancy: an overfill or underfill state. Am J Kidney Dis. 1987;9(4):284–289.

  27. 27.

    Borghi C, Esposti DD, Immordino V, et al. Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia. Am J Obstet Gynecol. 2000;183(1):140–147.

  28. 28.

    Okuno S, Hamada H, Yasuoka M, et al. Brain natriuretic peptide (BNP) and cyclic guanosine monophosphate (cGMP) levels in normal pregnancy and preeclampsia. J Obstet Gynaecol Res. 1999;25(6):407–410.

  29. 29.

    Easterling TR, Benedetti TJ, Schmucker BC, Millard SP. Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study. Obstet Gynecol. 1990;76(6):1061–1069.

  30. 30.

    Howie-Esquivel J, Dracup K. Effect of gender, ethnicity, pulmonary disease, and symptom stability on rehospitalization in patients with heart failure. Am J Cardiol. 2007;100(7):1139–1144.

  31. 31.

    Abdulle AM, Nagelkerke NJ, Adem A, et al. Plasma N terminal pro-brain natriuretic peptide levels and its determinants in a multi-ethnic population. J Hum Hypertens. 2007;21(8):647–653.

  32. 32.

    Daniels LB, Clopton P, Bhalla V, et al. How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the breathing not properly multinational study. Am Heart J. 2006;151(5):999–1005.

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Correspondence to Ladin Yurteri-Kaplan MD.

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Yurteri-Kaplan, L., Saber, S., Zamudio, S. et al. Brain Natriuretic Peptide in Term Pregnancy. Reprod. Sci. 19, 520–525 (2012) doi:10.1177/1933719111426598

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  • body mass index
  • brain natriuretic peptide
  • pregnancy