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Alon T, Rosov A, Lifshitz L, Moallem U. Male fetuses negatively affect the vitality of the litter and the dam's metabolic and physiological state in multifetal pregnant ewe. PLoS One 2023; 18:e0285338. [PMID: 37159474 PMCID: PMC10168572 DOI: 10.1371/journal.pone.0285338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/19/2023] [Indexed: 05/11/2023] Open
Abstract
In sheep, ~30% of fetuses do not survive till parturition, and 17.7% of the multifetal pregnancies experience partial litter loss (PLL). In humans, multifetal pregnancies are associated with a higher risk of perinatal mortality. Therefore, the objectives were to examine the association between partial litter loss, fetal sex, dam's metabolic and physiological state, and pregnancy outcome in multifetal pregnant ewes. The study includes two parts. The first was a retrospective study, in which we analyzed data of 675 lambings and examined the PLL incidence according to male ratio (MR) for all litter sizes (range 2-6). Lambings were categorized as having a low male ratio (LMR; <50% males) or a high male ratio (LMR; >50% males). In the second part, we monitored 24 ewes from 80 to 138 days in pregnancy every 10 days, and then daily until lambing, by ultrasound scanning for maternal heart rate (HR), and Doppler ultrasound for litter vitality. Blood samples were taken from dams on the days of scanning. Male ratio strongly affected PLL, where the general survival rate (for all lambings) was reduced from 90% in LMR lambings to 85% in HMR lambings. The odds ratio for PLL in HMR vs. LMR litters was 1.82. Birth body weight and the survival rate of female was higher in LMR than HMR lambings, with no differences for male lambs in both parameters. In the second part, dams' HR during the last trimester was 9.4% higher in LMR than in HMR pregnancies, with no differences in fetuses' HR. The plasma glucose and insulin concentrations were not significantly different between groups, but plasma β-hydroxybutyrate and nonesterified fatty acid concentrations were, respectively, 31% and 20% lower in HMR vs. LMR ewes. In conclusion, male fetuses negatively affect pregnancy outcomes and influence dams' metabolic and physiological state in sheep.
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Affiliation(s)
- Tamir Alon
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, Rishon LeZion, Israel
- Department of Animal Science, the Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Alexander Rosov
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, Rishon LeZion, Israel
| | - Lila Lifshitz
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, Rishon LeZion, Israel
| | - Uzi Moallem
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, Rishon LeZion, Israel
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2
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Widatalla N, Khandoker A, Alkhodari M, Koide K, Yoshida C, Kasahara Y, Kimura Y, Saito M. Similarities between maternal and fetal RR interval tachograms and their association with fetal development. Front Physiol 2022; 13:964755. [PMID: 36479345 PMCID: PMC9721082 DOI: 10.3389/fphys.2022.964755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/02/2022] [Indexed: 12/26/2023] Open
Abstract
An association between maternal and fetal heart rate (HR) has been reported but, so far, little is known about its physiological implication and importance relative to fetal development. Associations between both HRs were investigated previously by performing beat-by-beat coupling analysis and correlation analysis between average maternal and fetal HRs. However, studies reporting on the presence of similarities between maternal and fetal HRs or RR intervals (RRIs) over the short term (e.g., 5-min) at different gestational ages (GAs) are scarce. Here, we demonstrate the presence of similarities in the variations exhibited by maternal and fetal RRl tachograms (RRITs). To quantify the same similarities, a cross-correlation (CC) analysis between resampled maternal and fetal RRITs was conducted; RRITs were obtained from non-invasive electrocardiogram (ECG). The degree of similarity between maternal and fetal RRITs (bmfRRITs) was quantified by calculating four CC coefficients. CC analysis was performed for a total of 330 segments (two 5-min segments from 158 subjects and one 5-min from 14 subjects). To investigate the association of the similarity bmfRRITs with fetal development, the linear correlation between the calculated CC coefficients and GA was calculated. The results from the latter analysis showed that similarities bmfRRITs are common occurrences, they can be negative or positive, and they increase with GA suggesting the presence of a regulation that is associated with proper fetal development. To get an insight into the physiological mechanisms involved in the similarity bmfRRITs, the association of the same similarity with maternal and fetal HR variability (HRV) was investigated by comparing the means of two groups in which one of them had higher CC values compared to the other. The two groups were created by using the data from the 158 subjects where fetal RRI (fRRI) calculation from two 5-min ECG segments was feasible. The results of the comparison showed that the maternal very low frequency (VLF) HRV parameter is potentially associated with the similarity bmfRRITs implying that maternal hormones could be linked to the regulations involved in the similarity bmfRRITs. Our findings in this study reinforce the role of the maternal intrauterine environment on fetal development.
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Affiliation(s)
- Namareq Widatalla
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Ahsan Khandoker
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mohanad Alkhodari
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
- Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kunihiro Koide
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chihiro Yoshida
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kasahara
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Kimura
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masatoshi Saito
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
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Montenegro de Andrade Lima Bernardes JF, da Silva Lobo Maia Gonçalves HM. Risk of postpartum hemorrhage and fetal gender. Arch Gynecol Obstet 2022; 308:313-314. [PMID: 36214889 DOI: 10.1007/s00404-022-06723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/26/2022] [Indexed: 11/02/2022]
Affiliation(s)
- João Francisco Montenegro de Andrade Lima Bernardes
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450, Porto, Portugal.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal
| | - Hernâni Manuel da Silva Lobo Maia Gonçalves
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n, 4200-450, Porto, Portugal. .,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
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4
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da Silva Lobo Maia Gonçalves HM, Montenegro de Andrade Lima Bernardes JF. Measuring fetal heart rate and variability: Fetal cardiotocography versus electrocardiography. Dev Psychobiol 2022; 64:e22266. [DOI: 10.1002/dev.22266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Hernâni Manuel da Silva Lobo Maia Gonçalves
- Center for Health Technology and Services Research (CINTESIS@RISE) Faculty of Medicine University of Porto Porto Portugal
- Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal
| | - João Francisco Montenegro de Andrade Lima Bernardes
- Center for Health Technology and Services Research (CINTESIS@RISE) Faculty of Medicine University of Porto Porto Portugal
- Department of Obstetrics and Gynecology Faculty of Medicine University of Porto Porto Portugal
- Department of Obstetrics and Gynecology São João Hospital Porto Portugal
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Ribeiro M, Monteiro-Santos J, Castro L, Antunes L, Costa-Santos C, Teixeira A, Henriques TS. Non-linear Methods Predominant in Fetal Heart Rate Analysis: A Systematic Review. Front Med (Lausanne) 2021; 8:661226. [PMID: 34917624 PMCID: PMC8669823 DOI: 10.3389/fmed.2021.661226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022] Open
Abstract
The analysis of fetal heart rate variability has served as a scientific and diagnostic tool to quantify cardiac activity fluctuations, being good indicators of fetal well-being. Many mathematical analyses were proposed to evaluate fetal heart rate variability. We focused on non-linear analysis based on concepts of chaos, fractality, and complexity: entropies, compression, fractal analysis, and wavelets. These methods have been successfully applied in the signal processing phase and increase knowledge about cardiovascular dynamics in healthy and pathological fetuses. This review summarizes those methods and investigates how non-linear measures are related to each paper's research objectives. Of the 388 articles obtained in the PubMed/Medline database and of the 421 articles in the Web of Science database, 270 articles were included in the review after all exclusion criteria were applied. While approximate entropy is the most used method in classification papers, in signal processing, the most used non-linear method was Daubechies wavelets. The top five primary research objectives covered by the selected papers were detection of signal processing, hypoxia, maturation or gestational age, intrauterine growth restriction, and fetal distress. This review shows that non-linear indices can be used to assess numerous prenatal conditions. However, they are not yet applied in clinical practice due to some critical concerns. Some studies show that the combination of several linear and non-linear indices would be ideal for improving the analysis of the fetus's well-being. Future studies should narrow the research question so a meta-analysis could be performed, probing the indices' performance.
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Affiliation(s)
- Maria Ribeiro
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - João Monteiro-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luísa Castro
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Luís Antunes
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - Cristina Costa-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreia Teixeira
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
| | - Teresa S Henriques
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Sarkar P, Lobmaier S, Fabre B, González D, Mueller A, Frasch MG, Antonelli MC, Etemad A. Detection of maternal and fetal stress from the electrocardiogram with self-supervised representation learning. Sci Rep 2021; 11:24146. [PMID: 34921162 PMCID: PMC8683397 DOI: 10.1038/s41598-021-03376-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
In the pregnant mother and her fetus, chronic prenatal stress results in entrainment of the fetal heartbeat by the maternal heartbeat, quantified by the fetal stress index (FSI). Deep learning (DL) is capable of pattern detection in complex medical data with high accuracy in noisy real-life environments, but little is known about DL's utility in non-invasive biometric monitoring during pregnancy. A recently established self-supervised learning (SSL) approach to DL provides emotional recognition from electrocardiogram (ECG). We hypothesized that SSL will identify chronically stressed mother-fetus dyads from the raw maternal abdominal electrocardiograms (aECG), containing fetal and maternal ECG. Chronically stressed mothers and controls matched at enrolment at 32 weeks of gestation were studied. We validated the chronic stress exposure by psychological inventory, maternal hair cortisol and FSI. We tested two variants of SSL architecture, one trained on the generic ECG features for emotional recognition obtained from public datasets and another transfer-learned on a subset of our data. Our DL models accurately detect the chronic stress exposure group (AUROC = 0.982 ± 0.002), the individual psychological stress score (R2 = 0.943 ± 0.009) and FSI at 34 weeks of gestation (R2 = 0.946 ± 0.013), as well as the maternal hair cortisol at birth reflecting chronic stress exposure (0.931 ± 0.006). The best performance was achieved with the DL model trained on the public dataset and using maternal ECG alone. The present DL approach provides a novel source of physiological insights into complex multi-modal relationships between different regulatory systems exposed to chronic stress. The final DL model can be deployed in low-cost regular ECG biosensors as a simple, ubiquitous early stress detection and monitoring tool during pregnancy. This discovery should enable early behavioral interventions.
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Affiliation(s)
- Pritam Sarkar
- Department of ECE and Ingenuity Labs Research Institute, Queen's University, Kingston, ON, Canada
| | - Silvia Lobmaier
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany.
| | - Bibiana Fabre
- Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Diego González
- Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alexander Mueller
- Department of Cardiology, Technical University of Munich, Munich, Germany
| | - Martin G Frasch
- Department of Obstetrics and Gynaecology, University of Washington, Seattle, WA, USA.
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA.
| | - Marta C Antonelli
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany.
- IBCN, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Ali Etemad
- Department of ECE and Ingenuity Labs Research Institute, Queen's University, Kingston, ON, Canada.
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7
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Castro L, Loureiro M, Henriques TS, Nunes I. Systematic Review of Intrapartum Fetal Heart Rate Spectral Analysis and an Application in the Detection of Fetal Acidemia. Front Pediatr 2021; 9:661400. [PMID: 34408993 PMCID: PMC8364976 DOI: 10.3389/fped.2021.661400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical interventions to prevent brain damage or perinatal death. The visual analysis of cardiotocography traces has been complemented by computerized methods in order to overcome some of its limitations in the screening of fetal hypoxia/acidemia. Spectral analysis has been proposed by several studies exploring fetal heart rate recordings while referring to a great variety of frequency bands for integrating the power spectrum. In this paper, the main goal was to systematically review the spectral bands reported in intrapartum fetal heart rate studies and to evaluate their performance in detecting fetal acidemia/hypoxia. A total of 176 articles were reviewed, from MEDLINE, and 26 were included for the extraction of frequency bands and other relevant methodological information. An open-access fetal heart rate database was used, with recordings of the last half an hour of labor of 246 fetuses. Four different umbilical artery pH cutoffs were considered for fetuses' classification into acidemic or non-acidemic: 7.05, 7.10, 7.15, and 7.20. The area under the receiver operating characteristic curve (AUROC) was used to quantify the frequency bands' ability to distinguish acidemic fetuses. Bands referring to low frequencies, mainly associated with neural sympathetic activity, were the best at detecting acidemic fetuses, with the more severe definition (pH ≤ 7.05) attaining the highest values for the AUROC. This study shows that the power spectrum analysis of the fetal heart rate is a simple and powerful tool that may become an adjunctive method to CTG, helping healthcare professionals to accurately identify fetuses at risk of intrapartum hypoxia and to implement timely obstetrical interventions to reduce the incidence of related adverse perinatal outcomes.
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Affiliation(s)
- Luísa Castro
- Faculty of Medicine, Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,Health Information and Decision Sciences Department - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,School of Health of the Polytechnic of Porto, Porto, Portugal
| | - Maria Loureiro
- Faculty of Engineering, University of Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Teresa S Henriques
- Faculty of Medicine, Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,Health Information and Decision Sciences Department - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Nunes
- Faculty of Medicine, Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,Centro Materno-Infantil do Norte - Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Comparison of Computerized Cardiotocography Parameters between Male and Female Fetuses. Med Sci (Basel) 2019; 7:medsci7030050. [PMID: 30901854 PMCID: PMC6473323 DOI: 10.3390/medsci7030050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
Fetal sex has been identified as an important factor influencing pregnancy outcomes, but its impact on fetal heart rate (FHR) variability in uncomplicated pregnancies is still unclear. The objective of the study was to assess short-term variability (STV) and other computerized cardiotocography (cCTG) parameters in relation to fetal sex during fetal antepartum surveillance. We retrospective compared cCTG parameters of male and female fetuses in uncomplicated singleton pregnancies at term. In addition to univariate analysis, a multivariate analysis was performed taking into account maternal characteristics. A total of 689 cCTG recordings were analyzed: 335 from male fetuses and 354 from female fetuses. Analysis of cCTG results by fetal sex showed no significant difference in percentage of signal loss, number of contractions, movements, accelerations and decelerations, long-term variability (LTV), and STV at both uni-and multivariate analysis. There was a statistically significant difference for baseline FHR at the univariate analysis, which was not confirmed by a multivariate analysis. Our results suggest that fetal sex did not affect cCTG parameters in uncomplicated term singleton pregnancies, and therefore it does not need to be taken into account when interpreting cCTG in physiological conditions.
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