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Impaired neurovascular reactivity in the microvasculature of pregnant women with preeclampsia. INTRODUCTION: PE is associated with maternal vascular dysfunction, leading to serious cardiovascular risk both during and following pregnancy. OBJECTIVE: To assess microvascular reactivity in pregnant women with PE. METHODS: A cross-sectional study was performed in 36 pregnant women with PE and 36 normotensive pregnant women (C) in the third trimester. Skin microvascular blood flow was measured using LDF at rest (RF), during the maximum hyperemic response to brief arterial occlusion (MF) and during the sympathetically mediated constrictor response to deep IBH. RESULTS: In pregnant women with PE, RF was higher [C, 8.1 (4.6); PE, 12.0 (7.6), P<.001; PU perfusion units; median (IQR)] and MF/RF [C, 6.1 (3.7); PE, 3. 9 (4.9) P<.001] and peak CVC lower (P=.009) compared to normotensive controls. The constrictor response to IBH [C, 62.4% (27.9); PE, 33.0% (50.6), P=.008] was reduced in women with PE. In univariate analysis, MF/RF was associated with PE status (r=-.417, P=.0001), systolic (r=-.385, P=.001), and diastolic (r=-.388, P=.001) blood pressure, but not BMI (r=.077, P=.536). CONCLUSIONS: Women with PE are more than three times more likely to exhibit a reduced microvascular reactivity in the third trimester of pregnancy than normotensive pregnant controls. These differences may be attributable in part to an altered sympathetic neural microvascular tone in PE.