Vasopressin in Pregnancy and Breastfeeding

Risk Factor: B
Class: Hormones / Pituitary agents

Read about Vasopressin in "Herbs And Mind Enhancing Foods Drugs" section

Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

No reports linking the use of vasopressin with congenital defects have been located. Vasopressin and the structurally related synthetic polypeptides, desmopressin and lypressin, have been used during pregnancy to treat diabetes insipidus, a rare disorder (1,2,3,4,5,6,7,8,9 and 10). Desmopressin has also been used at delivery in three women for the management of von Willebrand disease (11). No adverse effects on the newborns were reported.

A 3-fold increase of circulating levels of endogenous vasopressin has been reported for women in the last trimester and in labor as compared with nonpregnant women (12). Although infrequent, the induction of uterine activity in the 3rd trimester has been reported after IM and intranasal vasopressin (13). The IV use of desmopressin, which is normally given intranasally, has also been reported to cause uterine contractions (4).

Two investigators speculated that raised levels of vasopressin resulted from hypoxemia and acidosis and could produce signs of fetal distress (bradycardia and meconium staining) (14).

A 1995 Reference described the use of desmopressin during pregnancy in 42 women with diabetes insipidus, 29 of whom received the drug throughout the whole pregnancy (15). One patient, treated with vasopressin during the first 6 months and then changed to desmopressin, delivered an infant who had a ventricular septal defect, a patent ductus arteriosus, and simian lines. The child died at age 14 years because of hypophyseal disease. Three of the infants exposed throughout gestation to desmopressin had birth weights close to or outside of the 99% confidence interval (two low and one high). The authors concluded that the use of desmopressin throughout pregnancy did not constitute a major fetal risk (15).

Diabetes insipidus developed in a 14-year-old girl at 33 weeks' gestation with resulting oligohydramnios and an amniotic fluid index of 0 (16). She was treated with intranasal desmopressin, 10 g twice daily, with rapid resolution of the oligohydramnios and eventual, spontaneous delivery of a healthy, 2700-g male infant at 38 weeks.

Breast Feeding Summary

Patients receiving vasopressin, desmopressin, or lypressin for diabetes insipidus have been reported to breast-feed without apparent problems in the infant (1,2). Experimental work in lactating women suggests that suckling almost doubles the maternal blood concentration of vasopressin (12).

References

  1. Hime MC, Richardson JA. Diabetes insipidus and pregnancy. Obstet Gynecol Surv 1978;33:3759.
  2. Hadi HA, Mashini IS, Devoe LD. Diabetes insipidus during pregnancy complicated by preeclampsia. A case report. J Reprod Med 1985;30:2068.
  3. Phelan JP, Guay AT, Newman C. Diabetes insipidus in pregnancy: a case review. Am J Obstet Gynecol 1978;130:3656.
  4. van der Wildt B, Drayer JIM, Eske TKAB. Diabetes insipidus in pregnancy as a first sign of a craniopharyngioma. Eur J Obstet Gynecol Reprod Biol 1980;10:26974.
  5. Ford SM Jr. Transient vasopressin-resistant diabetes insipidus of pregnancy. Obstet Gynecol 1986;68:2889.
  6. Ford SM Jr, Lumpkin HL III. Transient vasopressin-resistant diabetes insipidus of pregnancy. Obstet Gynecol 1986;68:7268.
  7. Rubens R, Thiery M. Case report: diabetes insipidus and pregnancy. Eur J Obstet Gynecol Reprod Biol 1987;26:26570.
  8. Hughes JM, Barron WM, Vance ML. Recurrent diabetes insipidus associated with pregnancy: pathophysiology and therapy. Obstet Gynecol 1989;73:4624.
  9. Goolsby L, Harlass F. Central diabetes insipidus: a complication of ventriculoperitoneal shunt malfunction during pregnancy. Am J Obstet Gynecol 1996;174:16557.
  10. Stubbe E. Pregnancies in diabetes insipidus. Geburtsh und Frauenheilk 1994;54:1113.
  11. Swanbeck J, Baxi L, Hurlet AM. DDAVP in the management of Von Willebrand's disease in pregnancy (abstract). Am J Obstet Gynecol 1992;166:427.
  12. Robinson KW, Hawker RW, Robertson PA. Antidiuretic hormone (ADH) in the human female. J Clin Endocrinol Metab 1957;17:3202.
  13. Oravec D, Lichardus B. Management of diabetes insipidus in pregnancy. Br Med J 1972;4:1145.
  14. Gaffney PR, Jenkins DM. Vasopressin: mediator of the clinical signs of fetal distress. Br J Obstet Gynaecol 1983;90:987.
  15. Kallen BA, Carlsson SS, Bengtsson BKA. Diabetes insipidus and use of desmopressin (Minirin) during pregnancy. Eur J Endocrinol 1995;132:1446.
  16. Hanson RS, Powrie RO, Larson L. Diabetes insipidus in pregnancy: a treatable cause of oligohydramnios. Obstet Gynecol 1997;89:8167.

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Questions and Answers

What's the difference between vasopressin and desmopressin?,

Desmopressin is chemically related to a natural hormone, vasopressin, which is produced in the body by the pituitary gland It is used to supplement vasopressin which is produced in insufficient quantities by patients with diabetes insipidus. Desmopressin mimics the action of vasopressin on the kidneys which results in concentration of the urine and hence normal urine volume and flow. Desmopressin is relatively specific in its action on the kidney so that it has little or no vasopressin-like activity elsewhere in the body. This medicine can also be delivered into the nostril (and therefore close to the pituitary gland) from where it is well absorbed into the circulation. When taken in tablet form, a relatively large amount of Desmopressin is destroyed in the stomach and before it is absorbed into the circulation. For this reason, you will note that there is a substantial difference in dosage between Desmopressin tablets and the intranasal forms

WOW a great answer. Don't you think?

Could a lack of vasopressin be the cause of insomnia and excessive thirst?, There is no evidence of diabetes after many tests and there is not excessive urination at night. The sleep disturbances have not been helped with "sleep hygiene" methods. There is very vivid dreaming and recall. The thirst is high-moderate at all times with bouts of sudden great thrist, which if not eleviated quickly cause dizziness. There is also a history of brain trauma.

Vasopressin is an anti-diuretic hormone, have a look at this site for more information:
http://www.vivo.colostate.edu/hbooks/pat...

A lack of vasopressin should cause polyuria (excessive urination) which is required to avoid brain damage during to the excess of water ingested because of the bursts of thirsts. You say you have an history of brain damage, which might suggest that this regulation is missing in your body.
While there is evidence that a lack of vasopressin can cause excessive nocturnal urination, nothing suggests that this hormone can cause similar symptoms "per-se". I would rather think that your insomnia is of a nervous origin. Try seeking for help with psycotherapy or hipnosis. Yoga and herbal remedies could also help a bit.

I suffer from insomnia too and, although if I lay awake in my bed I tend to visit the bathroom often, I donĀ“t really "need" to empy the bladder, it is just an anxiety-related response.

Good luck

What happens to plasma and urine osmolarity in a patient with a lung tumor that secretes vasopressin (ADH)?,

This results in a condition called SIADH (Syndrome of Inappropriate ADH) - most commonly caused by a small cell lung cancer.

This will unnecessarily retain water, and unnecessarily concentrate your urine. The result will be a DECREASE in plasma osmolarity (more water relative to solute) and an INCREASE in urine osmolarity (more solute relative to water).

Normally the body would dilute urine in the presence of a low osmolarity (it wants to bring it back to normal) and it would accomplish this by inhibiting ADH action and reducing its secretion. In an ADH secreting tumor, this stream of ADH cannot be turned off so the urine remains concentrated.

If you were stranded in the desert, would you expect your body;s production of vasopressin to increase?, or decrease?

Yes

"One of the most important roles of AVP is to regulate the body's retention of water, being released when the body is dehydrated; it causes the kidneys to conserve water, concentrating the urine, and reducing urine volume. It also raises blood pressure by inducing moderate vasoconstriction. In addition, it has a variety of neurological effects on the brain, having been found, for example, to influence pair-bonding in voles.
A very similar substance, lysine vasopressin (LVP) or lypressin, has the same function in pigs and is often used in human therapy."

When there's an increase in BP due to vasopressin, what other mechanisms occur to compensate for this increase?,

Your blood pressure would continually increase until your body reaches its desirable blood pressure.
To lower blood pressure your body would adjust by

1) Decreasing ADH (vasopressin) therefore you will increase your urine output
2) Decrease in Renin-Angiotensin system; decreasing aldosterone dilates your vessels as well eliminate more sodium in your body
3) Your central nervous system would adjust by dilating your vessels in your body
4) Your heart will release atrial naturietic peptide which inibits the Renin angiotensin system.

What do dopamine, serotonin, oxytocin, and vasopressin have in common?,

all of them are nurotransmitters...oxytocin and vasopressin are hormones too
serotonin and dopamine are amines....while oxytocin and vasopressin are peptide,
serotonin and dopamine are synthesized in the cytoplasm of locus ceruleus and substantia nigra repectively....while oxytocin and vasopressin are synthesied only the hypothalamus( para ventriculara nmd supra optic nuclei respectively)
so u see there is much in common of oxytocin and vasopressin. serotonin and doapmine have few things in common themselves

The vasopressin mechanism has what effect on blood volume and blood pressure?,

The vasopressin mechanism increases blood volume and blood pressure.

Have suffered insomnia & great thirst since 14, could low vasopressin be why?, I don't have diabetes or anything that accounts for the thirst: I drink plenty of water but occasionally get "overcome" with thirst. Every way you can describe insomnia I experience and "sleep hygiene" tricks have not helped much. Melatonin gives me a headache. I am NOT looking for a diagnosis, I am just curious if there are any connections.

I know you said you're not looking for a diagnosis, but check out this article about someone who had similar symptoms.

http://abcnews.go.com/Primetime/Story?id...

Have you ever had a head injury that could have caused the same condition this girl has?