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Escalona-Vargas D, Siegel ER, Bolin EH, Eswaran H. Fetal magnetocardiographic recordings with a prototype bed-based array system of optically-pumped magnetometers. Med Eng Phys 2024; 128:104175. [PMID: 38789219 PMCID: PMC11307323 DOI: 10.1016/j.medengphy.2024.104175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To record and extract features of fetal cardiac activities with a semi-rigid prototype optically-pumped magnetometers (OPM) sensor array. METHODS Fetal magnetocardiography (fMCG) data were collected from 15 pregnant women between 28 and 40 weeks gestation. Mothers were lying flat in a customized bed with sensors touching their abdomen from below using a prototype grid. fMCG was extracted to perform standard fetal heart rate variability (FHRV) analysis. RESULTS fMCG was observed in 13 of the 15 pregnant women. OPM FHRV indicators were in the range of previous SQUID studies. CONCLUSION Semi-rigid prototype OPM system has the ability to record quality fMCG. fMCG is capable of identifying lethal cardiac rhythm disturbances in the fetus. Our novel application of OPM technology may lower costs and increase maternal comfort, thus expanding fMCG's generalizability.
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Affiliation(s)
- Diana Escalona-Vargas
- Department of Pediatrics, Division of Neurology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA; Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Elijah H Bolin
- Department of Pediatrics, Division of Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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2
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Mercado L, Escalona-Vargas D, Blossom S, Siegel ER, Whittington JR, Preissl H, Walden K, Eswaran H. The effect of maternal pregestational diabetes on fetal autonomic nervous system. Physiol Rep 2023; 11:e15680. [PMID: 37144450 PMCID: PMC10161040 DOI: 10.14814/phy2.15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
Heart rate variability assessment of neonates of pregestational diabetic mothers have shown alterations in the autonomic nervous system (ANS). The objective was to study the effect of maternal pregestational diabetes on ANS at the fetal stage by combining cardiac and movement parameters using a non-invasive fetal magnetocardiography (fMCG) technique. This is an observational study with 40 participants where fetuses from a group of 9 Type 1, 19 Type 2 diabetic, and 12 non-diabetic pregnant women were included. Time and frequency domain fetal heart rate variability (fHRV) and coupling of movement and heart rate acceleration parameters related to fetal ANS were analyzed. Group differences were investigated using analysis of covariance to adjust for gestational age (GA). When compared to non-diabetics, the Type 1 diabetics had a 65% increase in average ratio of very low-frequency (VLF) to low-frequency (LF) bands and 63% average decrease in coupling index after adjusting for GA. Comparing Type 2 diabetics to non-diabetics, there was an average decrease in the VLF (50%) and LF bands (63%). Diabetics with poor glycemic control had a higher average VLF/LF (49%) than diabetics with good glycemic control. No significant changes at p < 0.05 were observed in high-frequency (HF) frequency domain parameters or their ratios, or in the time domain. Fetuses of pregestational diabetic mothers exhibited some differences in fHRV frequency domain and heart rate-movement coupling when compared to non-diabetics but the effect of fHRV related to fetal ANS and sympathovagal balance were not as conclusive as observed in the neonates of pregestational diabetic mothers.
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Affiliation(s)
- Luis Mercado
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Diana Escalona-Vargas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Sarah Blossom
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Julie R Whittington
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Kaitlyn Walden
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Rahbek Zizzo A, Kirkegaard I, From Reese C, Hansen J, Uldbjerg N, Mølgaard H. Fetal respiratory movements improve reliability of heart rate variability and suggest a coupling between fetal respiratory arrhythmia and vagal activity. Physiol Rep 2022; 10:e15224. [PMID: 35307959 PMCID: PMC8935276 DOI: 10.14814/phy2.15224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 04/21/2023] Open
Abstract
Fetal heart rate variability (FHRV) reflects autonomic cardiac regulation. The autonomic nervous system constantly adjusts the heart rate to maintain homeostasis. By providing insight into the fetal autonomic state, FHRV has the potential to become an investigational and clinical instrument. However, the method needs standardization and the influence of fetal movements, including fetal respiratory movements, is not well explored. Therefore, in a highly standardized setting, the aim was to evaluate the association between fetal movements and fetal heart rate variability (FHRV) including their impact on reliability. Fetal heart rate was obtained by noninvasive fetal electrocardiography (NI-FECG) and fetal movements by simultaneous ultrasound scanning in 30 healthy singleton pregnant women on two occasions with a maximum interval of 7 days. The standard deviation of normal-to-normal RR-intervals (SDNN), root mean square of successive RR-interval differences (RMDDS), high-frequency power (HF-power), low-frequency power (LF-power), and LF/HF were measured. A multivariate mixed model was used and reliability was defined as acceptable by a coefficient of variance (CV) ≤15% and an intraclass correlation coefficient (ICC) ≥0.80. During time periods with fetal respiratory movements, the highest reliability was achieved. Intra- and inter-observer reliability measurements were very high (CV: 0-9%; ICC ≧ 0.86). Within the same recording, SDNN and RMSSD achieved acceptable reliability (CV: 14-15%; ICC ≧ 0.80). However, day-to-day reliability displayed high CV's. In time periods with fetal respiratory movements, as compared to periods with quiescence RMSSD and HF-power were higher (Ratio: 1.33-2.03) and LF/HF power lower (Ratio: 0.54). In periods with fetal body movements SDNN, RMSSD and HF-power were higher (Ratio: 1.27-1.65). In conclusion, time periods with fetal respiratory movements were associated with high reliability of FHRV analyses and the highest values of parameters supposed to represent vagal activity.
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Affiliation(s)
- Anne Rahbek Zizzo
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Ida Kirkegaard
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Camille From Reese
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - John Hansen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Niels Uldbjerg
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Henning Mølgaard
- Department of CardiologyAarhus University HospitalAarhus NDenmark
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4
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Khandoker AH, Wahbah M, Yoshida C, Kasahara Y, Funamoto K, Niizeki K, Kimura Y. Investigating the effect of cholinergic and adrenergic blocking agents on maternal-fetal heart rates and their interactions in mice fetuses. Biol Open 2022; 11:274473. [PMID: 35188546 PMCID: PMC9019529 DOI: 10.1242/bio.058999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/15/2022] [Indexed: 11/20/2022] Open
Abstract
This study examines the role of autonomic control of maternal and fetal heart rate variability (MHRV and FHRV) and their heartbeats phase coupling prevalence (CPheartbeat) in mice. The subjects are divided into three groups: control with saline, cholinergic blockade with atropine, and β-adrenergic blockade with propranolol. Electrocardiogram signals of 27 anesthetized pregnant mice and 48 fetuses were measured for 20 min (drugs were administered after 10 min). For the coupling analysis, different maternal heartbeats were considered for one fetal beat. Results show that saline infusion did not produce any significant changes in MHRV and FHRV, as well as CPheartbeat. Atropine increased maternal HR (MHR) and decreased MHRV significantly without any considerable effect on fetal HR (FHR) and FHRV. Propranolol infusion did not produce any significant changes in MHR and MHRV, but significantly decreased FHR and increased FHRV. Moreover, atropine had led to a decrease in CPheartbeat when considering two and three maternal beats, and an increase for four beats; while propranolol resulted in a decrease for two heartbeats, but an increase for four and five beats. The proposed approach is useful for assessing the impact of maternal autonomic modulation activity on fetal distress and obstetric complications prevalent in pregnant mothers. Summary: Autonomic development of fetal mice is analyzed through electrocardiography. Saline infusion does not alter maternal and fetal heart rate variation and coupling significantly. Atropine increases maternal heart rate, while propranolol lowers fetal heart rate.
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Affiliation(s)
- Ahsan H Khandoker
- Health Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates
| | - Maisam Wahbah
- Health Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates
| | - Chihiro Yoshida
- Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Kiyoe Funamoto
- Health Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates
| | - Kyuichi Niizeki
- Graduate School of Bio-System Engineering, Yamagata University, Yamagata, Japan
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5
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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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Joint symbolic dynamics identifies differences in the maternal-fetal cardiac coupling between nonlaboring and laboring women. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Zwanenburg F, Jongbloed MRM, van Geloven N, Ten Harkel ADJ, van Lith JMM, Haak MC. Assessment of human fetal cardiac autonomic nervous system development using color tissue Doppler imaging. Echocardiography 2021; 38:974-981. [PMID: 34018638 PMCID: PMC8252470 DOI: 10.1111/echo.15094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Functional development of the fetal cardiac autonomic nervous system (cANS) plays a key role in fetal maturation and can be assessed through fetal heart rate variability (fHRV)‐analysis, with each HRV parameter representing different aspects of cANS activity. Current available techniques, however, are unable to assess the fHRV parameters accurately throughout the whole pregnancy. This study aims to test the feasibility of color tissue Doppler imaging (cTDI) as a new ultrasound technique for HRV analysis. Secondly, we explored time trends of fHRV parameters using this technique. Methods 18 healthy singleton fetuses were examined sequentially every 8 weeks from 10 weeks GA onwards. From each examination, 3 cTDI recordings of the four‐chamber view of 10 seconds were retrieved to determine accurate beat‐to‐beat intervals. The fHRV parameters SDNN, RMSSD, SDNN/RMSSD, and pNN10, each representing different functional aspects of the cANS, were measured, and time trends during pregnancy were explored using spline functions within a linear mixed‐effects model. Results In total, 77% (95% Cl 66–87%) of examinations were feasible for fHRV analysis from the first trimester onwards, which is a great improvement compared to other techniques. The technique is able to determine different maturation rates of the fHRV parameters, showing that cANS function, presumably parasympathetic activity, establishes around 20 weeks GA and matures rapidly until 30 weeks GA. Conclusions This is the first study able to assess cANS function through fHRV analysis from the first trimester onwards. The use of cTDI to determine beat‐to‐beat intervals seems feasible in just 3 clips of 10 seconds, which holds promise for future clinical use in assessing fetal well‐being.
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Affiliation(s)
- Fleur Zwanenburg
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
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8
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Vasavan T, Deepak S, Jayawardane IA, Lucchini M, Martin C, Geenes V, Yang J, Lövgren-Sandblom A, Seed PT, Chambers J, Stone S, Kurlak L, Dixon PH, Marschall HU, Gorelik J, Chappell L, Loughna P, Thornton J, Pipkin FB, Hayes-Gill B, Fifer WP, Williamson C. Fetal cardiac dysfunction in intrahepatic cholestasis of pregnancy is associated with elevated serum bile acid concentrations. J Hepatol 2021; 74:1087-1096. [PMID: 33276032 PMCID: PMC8062912 DOI: 10.1016/j.jhep.2020.11.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND & AIMS Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of stillbirth. This study aimed to assess the relationship between bile acid concentrations and fetal cardiac dysfunction in patients with ICP who were or were not treated with ursodeoxycholic acid (UDCA). METHODS Bile acid profiles and NT-proBNP, a marker of ventricular dysfunction, were assayed in umbilical venous serum from 15 controls and 76 ICP cases (36 untreated, 40 UDCA-treated). Fetal electrocardiogram traces were obtained from 43 controls and 48 ICP cases (26 untreated, 22 UDCA-treated). PR interval length and heart rate variability (HRV) parameters were measured in 2 behavioral states (quiet and active sleep). RESULTS In untreated ICP, fetal total serum bile acid (TSBA) concentrations (r = 0.49, p = 0.019), hydrophobicity index (r = 0.20, p = 0.039), glycocholate concentrations (r = 0.56, p = 0.007) and taurocholate concentrations (r = 0.44, p = 0.039) positively correlated with fetal NT-proBNP. Maternal TSBA (r = 0.40, p = 0.026) and alanine aminotransferase (r = 0.40, p = 0.046) also positively correlated with fetal NT-proBNP. There were no significant correlations between maternal or fetal serum bile acid concentrations and fetal HRV parameters or NT-proBNP concentrations in the UDCA-treated cohort. Fetal PR interval length positively correlated with maternal TSBA in untreated (r = 0.46, p = 0.027) and UDCA-treated ICP (r = 0.54, p = 0.026). Measures of HRV in active sleep and quiet sleep were significantly higher in untreated ICP cases than controls. HRV values in UDCA-treated cases did not differ from controls. CONCLUSIONS Elevated fetal and maternal serum bile acid concentrations in untreated ICP are associated with an abnormal fetal cardiac phenotype characterized by increased NT-proBNP concentration, PR interval length and HRV. UDCA treatment partially attenuates this phenotype. LAY SUMMARY The risk of stillbirth in intrahepatic cholestasis of pregnancy (ICP) is linked to the level of bile acids in the mother which are thought to disrupt the baby's heart rhythm. We found that babies of women with untreated ICP have abnormally functioning hearts compared to those without ICP, and the degree of abnormality is closely linked to the level of harmful bile acids in the mother and baby's blood. Babies of women with ICP who received treatment with the drug UDCA do not have the same level of abnormality in their hearts, suggesting that UDCA could be a beneficial treatment in some ICP cases, although further clinical trials are needed to confirm this.
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Affiliation(s)
- Tharni Vasavan
- Department of Women and Children’s Health, King's College London, London, UK
| | - Sahil Deepak
- Department of Women and Children’s Health, King's College London, London, UK
| | - Indu Asanka Jayawardane
- University Department of Obstetrics and Gynaecology, Nottingham City Hospital, University of Nottingham, Nottingham, UK,Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Maristella Lucchini
- Departments of Psychiatry and Pediatrics, Columbia University, New York, USA
| | - Catherine Martin
- Department of Women and Children’s Health, King's College London, London, UK
| | - Victoria Geenes
- Department of Women and Children’s Health, King's College London, London, UK
| | - Joel Yang
- Departments of Psychiatry and Pediatrics, Columbia University, New York, USA
| | | | - Paul Townsend Seed
- Department of Women and Children’s Health, King's College London, London, UK
| | - Jenny Chambers
- Women’s Health Research Centre, Imperial College London, London, UK
| | - Sophia Stone
- Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
| | - Lesia Kurlak
- University Department of Obstetrics and Gynaecology, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Peter Hendy Dixon
- Department of Women and Children’s Health, King's College London, London, UK
| | - Hanns-Ulrich Marschall
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Julia Gorelik
- Imperial College London, National Heart and Lung Institute, Imperial Centre for Experimental and Translational Medicine, London, UK
| | - Lucy Chappell
- Department of Women and Children’s Health, King's College London, London, UK
| | - Pam Loughna
- University Department of Obstetrics and Gynaecology, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Jim Thornton
- University Department of Obstetrics and Gynaecology, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Fiona Broughton Pipkin
- University Department of Obstetrics and Gynaecology, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | | | - William Paul Fifer
- Departments of Psychiatry and Pediatrics, Columbia University, New York, USA
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DiPietro JA, Raghunathan RS, Wu HT, Bai J, Watson H, Sgambati FP, Henderson JL, Pien GW. Fetal heart rate during maternal sleep. Dev Psychobiol 2021; 63:945-959. [PMID: 33764539 DOI: 10.1002/dev.22118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/07/2021] [Accepted: 02/22/2021] [Indexed: 11/09/2022]
Abstract
Despite prolonged and cumulative exposure during gestation, little is known about the fetal response to maternal sleep. Eighty-four pregnant women with obesity (based on pre-pregnancy BMI) participated in laboratory-based polysomnography (PSG) with continuous fetal electrocardiogram monitoring at 36 weeks gestation. Multilevel modeling revealed both correspondence and lack of it in maternal and fetal heart rate patterns. Fetal heart rate (fHR) and variability (fHRV), and maternal heart rate (mHR) and variability (mHRV), all declined during the night, with steeper rates of decline prior to 01:00. fHR declined upon maternal sleep onset but was not otherwise associated with maternal sleep stage; fHRV differed during maternal REM and NREM. There was frequent maternal waking after sleep onset (WASO) and fHRV and mHRV were elevated during these episodes. Cross-correlation analyses revealed little temporal coupling between maternal and fetal heart rate, except during WASO, suggesting that any observed associations in maternal and fetal heart rates during sleep are the result of other physiological processes. Implications of the maternal sleep context for the developing fetus are discussed, including the potential consequences of the typical sleep fragmentation that accompanies pregnancy.
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Affiliation(s)
- Janet A DiPietro
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Radhika S Raghunathan
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hau-Tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, USA
| | - Jiawei Bai
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heather Watson
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Francis P Sgambati
- Center for Interdisciplinary Sleep Research and Education, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Janice L Henderson
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Grace W Pien
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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10
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Zizzo AR, Kirkegaard I, Hansen J, Uldbjerg N, Mølgaard H. Fetal Heart Rate Variability Is Affected by Fetal Movements: A Systematic Review. Front Physiol 2020; 11:578898. [PMID: 33101059 PMCID: PMC7554531 DOI: 10.3389/fphys.2020.578898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Fetal heart rate variability (FHRV) evaluates the fetal neurological state, which is poorly assessed by conventional prenatal surveillance including cardiotocography (CTG). Accurate FHRV on a beat-to-beat basis, assessed by time domain and spectral domain analyses, has shown promising results in the scope of fetal surveillance. However, accepted standards for these techniques are lacking, and the influence of fetal breathing movements and gross movements may be especially challenging. Thus, current standards for equivalent assessments in adults prescribe rest and controlled respiration. The aim of this review is to clarify the importance of fetal movements on FHRV. Methods: A systematic review in accordance with the PRISMA guidelines based on publications in the EMBASE, the MEDLINE, and the Cochrane Library databases was performed. Studies describing the impact of fetal movements on time domain, spectral domain and entropy analyses in healthy human fetuses were reviewed. Only studies based on fetal electrocardiography or fetal magnetocardiography were included. PROSPERO registration number: CRD42018068806. Results: In total, 14 observational studies were included. Fetal movement detection, signal processing, length, and selection of appropriate time series varied across studies. Despite these divergences, all studies showed an increase in overall FHRV in the moving fetus compared to the resting fetus. Especially short-term, vagal mediated indexes showed an increase during fetal breathing movements including an increase in Root Mean Square of the Successive Differences (RMSSD) and High Frequency power (HF) and a decrease in Low Frequency power/High Frequency power (LF/HF). These findings were present even in analyses restricted to one specific fetal behavioral state defined by Nijhuis. On the other hand, fetal body movements seemed to increase parameters supposed to represent the sympathetic response [LF and Standard Deviation of RR-intervals from normal sinus beats (SDNN)] proportionally more than parameters representing the parasympathetic response (RMSSD, HF). Results regarding entropy analyses were inconclusive. Conclusion: Time domain analyses as well as spectral domain analyses are affected by fetal movements. Fetal movements and especially breathing movements should be considered in these analyses of FHRV.
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Affiliation(s)
- Anne Rahbek Zizzo
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Kirkegaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - John Hansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Mølgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Escalona-Vargas D, Eswaran H. Adaptable Sensor Arrays for Fetal Magnetocardiographic Measurements Using Optically-Pumped Magnetometers: A Pilot Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1803-1806. [PMID: 33018349 PMCID: PMC8547318 DOI: 10.1109/embc44109.2020.9175691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fetal magnetocardiography (fMCG) is a noninvasive method of measuring magnetic signals generated by the depolarizing heart. fMCG has proved to have superior signal-to-noise ratio characteristics and enables precise detection of the R-R intervals for fetal heart rate variability (FHRV) analysis. FHRV is one of the most useful clinical indicators for investigating fetal neurodevelopment. Currently, fMCG recordings rely on superconducting quantum interference devices (SQUIDs) which require cryogenics leading to a high cost device. New cryogenic-free sensors called optical pump magnetometers (OPMs) have emerged as alternative to SQUIDs. To take advantage of the flexibility of the OPM sensors, we explored the ability of OPM sensors to measure the fMCG at different maternal positions and sensor locations. Data were collected with a 14-channel OPM array using different sitting positions (mother leaning forward, backward, and prone). Projection operator algorithm based on minimum norm (POMN) was applied to extracted fMCG. R peaks were obtained to perform standard FHRV analysis. We were able to configure a standalone array of the OPMs that conforms to the shape of the maternal abdomen to obtain signals with sufficient quality. We extracted and quantified FHRV parameters in three low-risk fetuses. Results showed that FHRV values are in the range of previous SQUID studies.
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12
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Bauer I, Hartkopf J, Kullmann S, Schleger F, Hallschmid M, Pauluschke-Fröhlich J, Fritsche A, Preissl H. Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review. BMJ Open Sport Exerc Med 2020; 6:e000658. [PMID: 32206341 PMCID: PMC7078670 DOI: 10.1136/bmjsem-2019-000658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 12/16/2022] Open
Abstract
Before and during pregnancy, women often aim to improve their lifestyle so as to provide a healthier environment for their developing child. It remains unresolved, however, as to whether physical activity (PA) during pregnancy poses a possible risk or whether it might even have beneficial effects on the developing child. There is increasing evidence that PA during pregnancy is indeed beneficial to maternal physiological and psychological health and that it is generally not detrimental to the fetal cardiovascular system and neuronal function in the developing child. This also led to international recommendations for PAs during pregnancy. In the current review, we aimed to comprehensively assess the evidence of beneficial and harmful effects of maternal PA, including high-performance sports, on fetal development. The different mental and body-based relaxation techniques presented here are frequently performed during pregnancy. We found a considerable number of studies addressing these issues. In general, neither low key, moderate maternal PA nor relaxation techniques were observed to have a harmful effect on the developing child. However, we identified some forms of PA which could have at least a transient unfavourable effect. Notably, the literature currently available does not provide enough evidence to enable us to make a general conclusive statement on this subject. This is due to the lack of longitudinal studies on the metabolic and cognitive effects of regular PA during pregnancy and the wide diversity of methods used. In particular, the kind of PA investigated in each study differed from study to study.
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Affiliation(s)
- Ilena Bauer
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Julia Hartkopf
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Schleger
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Manfred Hallschmid
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, Institute of Pharmaceutical Sciences; Interfaculty Centre for Pharmacogenomics and Pharma Research, Eberhard Karls University Tübingen, Tübingen, Germany
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13
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Comparison of fetal heart rate variability by symbolic dynamics at the third trimester of pregnancy and low-risk parturition. Heliyon 2020; 6:e03485. [PMID: 32195385 PMCID: PMC7075801 DOI: 10.1016/j.heliyon.2020.e03485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/26/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Fetal heart rate variability (fHRV) is an essential source of information to monitor fetal well-being during pregnancy. This study aimed to apply a nonlinear approach, known as symbolic dynamics (SD), for comparing human fHRV in the third trimester of pregnancy during active fetal state (TT) and active labor at term (P). We performed a longitudinal, prospective, descriptive, and comparative study composed of 42 longitudinal recordings of 5-minutes of fetal heartbeat interval series. Recordings were collected from 21 low-risk, healthy, pregnant women attending the Maternal and Child Research Center (CIMIGen), Mexico City. We calculated relevant linear parameters of fHRV between TT and P stages, such as the percentage of differences between adjacent RR intervals >5 ms (PRR5, related to vagal modulations) and other SD parameters such as the percentage of no variations between three successive symbols (%0V, reflects sympathetic modulations) and the probability of low variability with a threshold of 4 ms (POLVAR4, associated with a low variability). We identified statistical differences for PRR5 between TT and P (37.13% [28.47-47.60%] vs. 28.84% [19.36-36.76%], p = 0.03), respectively. Also, for 0V% (65.66% [59.01-71.80%] vs. 71.14% [65.94-75.87%], p = 0.03) and for POLVAR4 values (0.06 [0.04-0.11] vs. 0.15 [0.09-0.24], p = 0.002), respectively. Our results indicate that during parturition, the short-term fetal fHRV is decreased, showing a decreased vagal modulations and higher adrenergic response of the heart. These autonomic modifications may result from the fetal response to the stressful inflammatory challenge of labor. We thus confirmed that the analysis of the SD applied to fHRV time series could be a potential clinical biomarker to differentiate the fetal autonomic cardiac condition at different stages of pregnancy.
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14
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Complexity of Cardiotocographic Signals as A Predictor of Labor. ENTROPY 2020; 22:e22010104. [PMID: 33285878 PMCID: PMC7516409 DOI: 10.3390/e22010104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/17/2022]
Abstract
Prediction of labor is of extreme importance in obstetric care to allow for preventive measures, assuring that both baby and mother have the best possible care. In this work, the authors studied how important nonlinear parameters (entropy and compression) can be as labor predictors. Linear features retrieved from the SisPorto system for cardiotocogram analysis and nonlinear measures were used to predict labor in a dataset of 1072 antepartum tracings, at between 30 and 35 weeks of gestation. Two groups were defined: Group A—fetuses whose traces date was less than one or two weeks before labor, and Group B—fetuses whose traces date was at least one or two weeks before labor. Results suggest that, compared with linear features such as decelerations and variability indices, compression improves labor prediction both within one (C-Statistics of 0.728) and two weeks (C-Statistics of 0.704). Moreover, the correlation between compression and long-term variability was significantly different in groups A and B, denoting that compression and heart rate variability look at different information associated with whether the fetus is closer to or further from labor onset. Nonlinear measures, compression in particular, may be useful in improving labor prediction as a complement to other fetal heart rate features.
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15
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Mat Husin H, Schleger F, Bauer I, Fehlert E, Kiefer-Schmidt I, Weiss M, Kagan KO, Brucker S, Pauluschke-Fröhlich J, Eswaran H, Häring HU, Fritsche A, Preissl H. Maternal Weight, Weight Gain, and Metabolism are Associated with Changes in Fetal Heart Rate and Variability. Obesity (Silver Spring) 2020; 28:114-121. [PMID: 31858736 DOI: 10.1002/oby.22664] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Prepregnancy obesity and extensive weight gain can lead to diseases in the offspring later in life. The aim of this study was to evaluate the effect of anthropometric and metabolic factors on the fetal autonomic nervous system (ANS) in uncomplicated pregnancies. METHODS A total of 184 pregnant women in the second or third trimester were included, and for 104 women, maternal insulin sensitivity (ISI) was determined. Fetal heart rate (HR) and heart rate variability (HRV) were determined by magnetic recording. Associations of maternal prepregnancy BMI, weight gain, and ISI with fetal HR and HRV were evaluated by ANCOVA, partial correlation, and mediation analysis. RESULTS HR was increased and HRV decreased in fetuses of mothers with overweight or obesity in comparison to normal-weight mothers. Fetal HR was negatively correlated with maternal weight gain. Maternal prepregnancy BMI was positively correlated with fetal high frequency and was negatively correlated with low frequency and low/high frequency ratio. Maternal ISI showed a negative correlation with fetal HR. CONCLUSIONS The results show that the fetal ANS is sensitive to alterations of prepregnancy BMI, weight changes, and glucose metabolism. These findings highlight the importance of the intrauterine environment on the developing ANS and the possible programming of obesity.
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Affiliation(s)
- Haliza Mat Husin
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany
| | - Franziska Schleger
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Ilena Bauer
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Ellen Fehlert
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Isabelle Kiefer-Schmidt
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Magdalene Weiss
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Jan Pauluschke-Fröhlich
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Hubert Preissl
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, Interfaculty Centre for Pharmacogenomics and Pharma Research, University of Tübingen, Tübingen, Germany
- Institute for Diabetes and Obesity, Helmholtz Diabetes Centre, Helmholtz Centre Munich, German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
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16
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Chen K, Zhao Y, Li S, Chen L, Wang N, Zhang K, Wang Y, Zhang J. Multiscale Coupling of Uterine Electromyography and Fetal Heart Rate as a Novel Indicator of Fetal Neural Development. Front Neurol 2019; 10:760. [PMID: 31379714 PMCID: PMC6651265 DOI: 10.3389/fneur.2019.00760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
Fetal nerve maturation is a dynamic process, which is reflected in fetal movement and fetal heart rate (FHR) patterns. Classical FHR variability (fHRV) indices cannot fully reflect their complex interrelationship. This study aims to provide an alternative insight for fetal neural development by using the coupling analysis of uterine electromyography (UEMG) and FHR acceleration. We investigated 39 normal pregnancies with appropriate for gestational age (AGA) and 19 high-risk pregnancies with small for gestational age (SGA) at 28-39 weeks. The UEMG and FHR were recorded simultaneously by a trans-abdominal device during the night (10 p.m.-8 a.m.). Cross-wavelet analysis was used to characterize the dynamic relationship between FHR and UEMG. Subsequently, a UEMG-FHR coupling index (UFCI) was extracted from the multiscale coupling power spectrum. We examined the gestational-age dependency of UFCI by linear/quadratic regression models, and the ability to screen for SGA using binary logistic regression. Also, the performances of classical fHRV indices, including short-term variation (STV), averaged acceleration capacity (AAC), and averaged deceleration capacity (ADC), time- and frequency- domain indices, and multiscale entropy (MSE), were compared as references on the same recordings. The results showed that UFCI provided a stronger age predicting value with R2 = 0.480, in contrast to the best value among other fHRV indices with R2 = 0.335, by univariate regression models. Also, UFCI achieved superior performance for predicting SGA with the area under the curve (AUC) of 0.88, compared with 0.79 for best performance of other fHRV indices. The present results indicate that UFCI provides new information for early detection and comprehensive interpretation of intrauterine growth restriction in prenatal diagnosis, and helps improve the screening of SGA.
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Affiliation(s)
- Kun Chen
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yangyu Zhao
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Shufang Li
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Lian Chen
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Nan Wang
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Kai Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yan Wang
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
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17
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Shuffrey LC, Myers MM, Odendaal HJ, Elliott AJ, du Plessis C, Groenewald C, Burd L, Angal J, Nugent JD, Isler JR, Fifer WP. Fetal heart rate, heart rate variability, and heart rate/movement coupling in the Safe Passage Study. J Perinatol 2019; 39:608-618. [PMID: 30833637 PMCID: PMC6483837 DOI: 10.1038/s41372-019-0342-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/19/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine normative values for heart rate patterns in healthy fetuses. METHODS This research is from the Safe Passage Study conducted by the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network. A standardized protocol assessed fetal heart rate (FHR), heart rate variability (HRV), and movement from 1655 fetuses at three-time points during gestation (20-24 weeks, 28-32 weeks, 34-38 weeks gestation). RESULTS FHR decreased while HRV increased over gestation. At the latter two ages, males had significantly lower FHR than females while there were no sex differences in FHR at 20-24 weeks. When accounting for the fetal state during late gestation (34-28 weeks), we found that males had significantly lower FHR than females in the active fetal state only. CONCLUSION Results demonstrate significant state, gestational age, and sex-related changes in cardiac activity, somatic activity, and autonomic function as the fetus approaches birth.
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Affiliation(s)
- Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Medical
Center, New York, NY 10032,Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Medical
Center, New York, NY 10032,Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032,Department of Pediatrics, Columbia University Medical
Center, New York, NY 10032
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South
Africa 7530
| | - Amy J. Elliott
- Center for Pediatric & Community Research, Avera
Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School
of Medicine, Sioux Falls, SD 57105
| | - Carlie du Plessis
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South
Africa 7530
| | - Coen Groenewald
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South
Africa 7530
| | - Larry Burd
- Department of Pediatrics, University of North Dakota
Medical School, Grand Forks, ND 58202
| | - Jyoti Angal
- Center for Pediatric & Community Research, Avera
Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School
of Medicine, Sioux Falls, SD 57105
| | - J. David Nugent
- Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032
| | - Joseph R. Isler
- Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032
| | - William P. Fifer
- Department of Psychiatry, Columbia University Medical
Center, New York, NY 10032,Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032,Department of Pediatrics, Columbia University Medical
Center, New York, NY 10032
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18
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Vincze B, Solymosi N, Debnár V, Kútvölgyi G, Krikó E, Wölfling A, Szenci O. Assessment of equine alpha-fetoprotein levels in mares and newborn foals in the periparturient period. Theriogenology 2018; 122:53-60. [PMID: 30237100 DOI: 10.1016/j.theriogenology.2018.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 12/24/2022]
Abstract
Alpha-fetoprotein (AFP) is best known in human obstetrics for its association with fetal anomalies recognized in the 1970s. Although this fetal protein had been shown to be present in the sera of many mammalian species, its possible diagnostic role in the detection of abnormalities was evaluated only later, when a research laboratory published variable levels of AFP in different groups of mares with pregnancy problems (twins, conception failure, placentitis, embryonic loss), and subsequently differences were demonstrated in its serum levels between aborted and healthy mares. In this study, peri- and intrapartal AFP levels were measured in maternal serum, amniotic fluid, neonatal blood, and umbilical blood samples. The mean levels of AFP were lower in umbilical blood and amniotic fluid samples than in foal and maternal blood. Older mares had lower AFP levels correlated with their age in years. The time remaining until foaling had a significant, non-linear effect on AFP levels: an elevation could be detected in the last two weeks of pregnancy, followed by a decline after foaling. Also, AFP levels were found to be elevated in the hot summer months. There was a significant individual variation in AFP levels in the population studied.
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Affiliation(s)
- Boglárka Vincze
- MTA-SZIE Large Animal Clinical Research Group, Üllő, Hungary; Department of Animal Breeding, Nutrition and Laboratory Animal Science, University of Veterinary Medicine, Budapest, Hungary.
| | - Norbert Solymosi
- Centre for Bioinformatics, University of Veterinary Medicine, Budapest, Hungary
| | - Viktória Debnár
- National Agricultural Research and Innovation Center (NARIC) Research Institute for Animal Breeding, Nutrition and Meat Science, Herceghalom, Hungary
| | - Gabriella Kútvölgyi
- National Agricultural Research and Innovation Center (NARIC) Research Institute for Animal Breeding, Nutrition and Meat Science, Herceghalom, Hungary
| | - Eszter Krikó
- Centre for Bioinformatics, University of Veterinary Medicine, Budapest, Hungary
| | - Anna Wölfling
- Department of Reproduction and Obstetrics, University of Veterinary Medicine, Budapest, Hungary
| | - Ottó Szenci
- MTA-SZIE Large Animal Clinical Research Group, Üllő, Hungary
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19
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Schmidt A, Schukat-Talamazzini EG, Zöllkau J, Pytlik A, Leibl S, Kumm K, Bode F, Kynass I, Witte OW, Schleussner E, Schneider U, Hoyer D. Universal characteristics of evolution and development are inherent in fetal autonomic brain maturation. Auton Neurosci 2018. [DOI: 10.1016/j.autneu.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Escalona-Vargas D, Wu HT, Frasch MG, Eswaran H. A Comparison of Five Algorithms for Fetal Magnetocardiography Signal Extraction. Cardiovasc Eng Technol 2018; 9:483-487. [PMID: 29582244 DOI: 10.1007/s13239-018-0351-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 03/20/2018] [Indexed: 12/24/2022]
Abstract
Fetal magnetocardiography (fMCG) provides accurate and reliable measurements of electrophysiological events in the fetal heart and is capable of studying fetuses with congenital heart diseases. A variety of techniques exist to extract the fMCG signal with the demand for non-invasively obtained fetal cardiac information. To the best of our knowledge, there is no comparative study published in the field as to how the various extraction algorithms perform. We perform a comparative study of the ability of five methods to extract the fMCG using real biomagnetic signals, two of those methods are applied to real fMCG data for the first time. Biomagnetic signals were recorded and processed with each of the five methods to obtain fMCG. The R peaks of the fMCG traces were obtained via a peak-detection algorithm. From whole recording for each method, the fetal heart rate (FHR) was calculated and used to perform FHR variability (FHRV) analysis. Additionally, we calculated durations from the PQRST complex from time-averaged data during sinus rhythm. The five methods recovered the fMCG signals, but two of them were able to extract cleaner fMCG and the morphology was observed from the continuous data. The time-averaged data showed very similar morphologies between methods, but two of them displayed a signal amplitude reduction on the R-waves and T-waves. Values of PQRST durations, FHR and FHRV were in the range of previous fetal cardiac studies. We have compared five methods for fMCG extraction and showed their ability to perform fMCG analysis.
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Affiliation(s)
- Diana Escalona-Vargas
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 West Markham St., #518, Little Rock, AR, 72205, USA.
| | - Hau-Tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, USA.,Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 West Markham St., #518, Little Rock, AR, 72205, USA
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21
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Gonçalves H, Amorim-Costa C, Ayres-de-Campos D, Bernardes J. Evolution of linear and nonlinear fetal heart rate indices throughout pregnancy in appropriate, small for gestational age and preterm fetuses: A cohort study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 153:191-199. [PMID: 29157452 DOI: 10.1016/j.cmpb.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 09/19/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES To assess the evolution of linear and nonlinear fetal heart rate (FHR) analysis throughout pregnancy in appropriate (AGA), small for gestational age (SGA) and preterm (PTB) fetuses. METHODS A prospective cohort study was carried out in 171 singleton pregnancies divided in three groups: AGA (n = 147), SGA (n = 13) fetuses and spontaneous PTB (n = 11). FHR was recorded with an external sensor from the 24th to the 40th week of gestation. Linear time- and frequency-domain and nonlinear FHR indices were computed on 10-min segments. Longitudinal analysis of indices throughout pregnancy was performed with generalized estimating equations, and receiver operating characteristic (ROC) curves were calculated for the prediction of SGA and PTB fetuses. RESULTS Increasing gestational age significantly affected most FHR indices, with a general increase in variability and entropy indices, and a decrease in mean FHR. The PTB group exhibited a significantly lower short-term variation, and no monotonic increase in the sympatho-vagal balance as observed in the AGA group. The SGA group exhibited higher long-term irregularity and lower short-term irregularity than the AGA group throughout gestation. In prediction of SGA and PTB, the largest areas under the ROC curves obtained were 0.76 and 0.78, respectively. CONCLUSIONS Linear and nonlinear FHR analysis provides useful information on the evolution of fetal autonomic nervous and complexity control systems throughout pregnancy, in relation with AGA, SGA and PTB fetuses, which may be helpful in clinical practice.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal.
| | - Célia Amorim-Costa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal; INEB - Institute of Biomedical Engineering, I3S - Institute for Research and Innovation in Health, University of Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal
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Gonçalves H, Amorim-Costa C, Ayres-de-Campos D, Bernardes J. Gender-specific evolution of fetal heart rate variability throughout gestation: A study of 8823 cases. Early Hum Dev 2017; 115:38-45. [PMID: 28889037 DOI: 10.1016/j.earlhumdev.2017.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal heart rate (FHR) variability throughout gestation reflects aspects of fetal development, and its analysis has been used for the assessment of fetal well-being. AIM The objective of this study was to provide a gender-specific analysis of the evolution of FHR variability indices throughout gestation, using linear time-domain, spectral and nonlinear FHR indices. STUDY DESIGN A large retrospective study was carried out using antepartum FHR recordings obtained from 4713 male and 4110 female fetuses, with normal pregnancy outcome, between 2004 and 2013, with gestational ages ranging between 25 and 40weeks. OUTCOME MEASURES FHR variability was analysed through linear time-domain methods, as well as using spectral analysis and entropy indices. Evolution of FHR indices throughout gestation was analysed through Spearman correlation coefficient. Comparison between male and female fetuses was performed using nonparametric bootstrap 95% confidence intervals for the median. RESULTS Mean FHR decreased significantly throughout gestation, whereas most variability indices increased. Sympatho-vagal balance measured by spectral analysis exhibited two local maxima at 29-30 and 34-35weeks and decreased afterwards. Entropy indices increased until around the 34th week, slightly decreasing after the 37th week. Female fetuses presented higher mean FHR and entropy from the 34th week afterwards, and lower short-term variability and sympatho-vagal balance in the same period. CONCLUSIONS Spectral and entropy analysis should be considered as a complement to conventional FHR variability analysis, aiming at a better characterization and follow-up of fetal development/maturation throughout gestation. Additionally, gestational age needs to be considered when defining reference ranges for FHR indices in systems of computerized analysis.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal.
| | - Célia Amorim-Costa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; INEB - Institute of Biomedical Engineering, I3S - Institute for Research and Innovation in Health, University of Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; INEB - Institute of Biomedical Engineering, I3S - Institute for Research and Innovation in Health, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal
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Drewery ML, Gaitán AV, Spedale SB, Monlezun CJ, Miketínas DC, Lammi-Keefe CJ. Maternal n-6 and n-3 fatty acid status during pregnancy is related to infant heart rate and heart rate variability: An exploratory study. Prostaglandins Leukot Essent Fatty Acids 2017; 126:117-125. [PMID: 29031389 DOI: 10.1016/j.plefa.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
Early life heart rate (HR) and heart rate variability (HRV) reflect autonomic system maturation. Intervention with n-3 long chain polyunsaturated fatty acids (LCPUFAs) during pregnancy favorably affects fetal HR and HRV, complementing previous observations for n-3 LCPUFA intervention during infancy. The relationship between maternal fatty acid status during pregnancy and infant HR/HRV has not previously been assessed. The aim of this study was to explore associations between maternal n-6 and n-3 fatty acid status during pregnancy and infant HR and HRV at 2 weeks, 4 months, and 6 months of age using linear regression models. Maternal n-3 fatty acids were inversely related to infant HR and positively related to HRV. Conversely, maternal n-6 fatty acids were positively related to infant HR and inversely related to HRV. These data build on existing literature evidencing a role for n-3 fatty acids in accelerating autonomic development and link n-6 fatty acids to HR/HRV.
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Affiliation(s)
- M L Drewery
- Louisiana State University, Baton Rouge, LA, United States.
| | - A V Gaitán
- Louisiana State University, Baton Rouge, LA, United States
| | | | - C J Monlezun
- Louisiana State University, Baton Rouge, LA, United States
| | - D C Miketínas
- Louisiana State University, Baton Rouge, LA, United States; Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - C J Lammi-Keefe
- Louisiana State University, Baton Rouge, LA, United States; Pennington Biomedical Research Center, Baton Rouge, LA, United States; Louisiana State Agricultural Center, Baton Rouge, LA, United States
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Drewery ML, Spedale SB, Lammi-Keefe CJ. Modulation of heart rate and heart rate variability by n-3 long chain polyunsaturated fatty acids: Speculation on mechanism(s). Med Hypotheses 2017; 107:29-34. [PMID: 28915957 DOI: 10.1016/j.mehy.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 11/28/2022]
Abstract
Heart rate (HR) and heart rate variability (HRV) are valuable markers of health. Although the underlying mechanism(s) are controversial, it is well documented that n-3 long chain polyunsaturated fatty acid (LCPUFA) intake improves HR and HRV in various populations. Autonomic modulation and/or alterations in cardiac electrophysiology are commonly cited as potential mechanisms responsible for these effects. This article reviews existing evidence for each and explores a separate mechanism which has not received much attention but has scientific merit. Based on presented evidence, it is proposed that n-3 LCPUFAs affect HR and HRV directly by autonomic modulation and indirectly by altering circulating factors, both dependently and independently of the autonomic nervous system. The evidence for changes in cardiac electrophysiology as the mechanism by which n-3 LCPUFAs affect HR and HRV needs strengthening.
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Affiliation(s)
- Merritt L Drewery
- School of Nutrition and Food Sciences, Louisiana State University, Baton Rouge, LA 70803, USA.
| | | | - Carol J Lammi-Keefe
- School of Nutrition and Food Sciences, Louisiana State University, Baton Rouge, LA 70803, USA; Louisiana State University Agricultural Center, Baton Rouge, LA 70803, USA
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Hoyer D, Żebrowski J, Cysarz D, Gonçalves H, Pytlik A, Amorim-Costa C, Bernardes J, Ayres-de-Campos D, Witte OW, Schleußner E, Stroux L, Redman C, Georgieva A, Payne S, Clifford G, Signorini MG, Magenes G, Andreotti F, Malberg H, Zaunseder S, Lakhno I, Schneider U. Monitoring fetal maturation-objectives, techniques and indices of autonomic function. Physiol Meas 2017; 38:R61-R88. [PMID: 28186000 PMCID: PMC5628752 DOI: 10.1088/1361-6579/aa5fca] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.
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Affiliation(s)
- Dirk Hoyer
- Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany
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Fehlert E, Willmann K, Fritsche L, Linder K, Mat-Husin H, Schleger F, Weiss M, Kiefer-Schmidt I, Brucker S, Häring HU, Preissl H, Fritsche A. Gestational diabetes alters the fetal heart rate variability during an oral glucose tolerance test: a fetal magnetocardiography study. BJOG 2016; 124:1891-1898. [PMID: 28029217 DOI: 10.1111/1471-0528.14474] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) potentially harms the child before birth. We previously found GDM to be associated with developmental changes in the central nervous system. We now hypothesise that GDM may also impact on the fetal autonomic nervous system under metabolic stress like an oral glucose tolerance test (OGTT). DESIGN We measured heart rate variability (HRV) of mothers and fetuses during a three-point OGTT using fetal magnetocardiography (fMCG). SETTING Measurements were performed in the fMEG Centre in Tübingen. POPULATION After exclusion of 23 participants, 13 pregnant women with GDM and 36 pregnant women with normal glucose tolerance were examined. METHODS All women underwent the same examination setting with OGTT during which fMCG was recorded three times. MAIN OUTCOME MEASURE(S) Parameters of heart rate variability were measured. RESULTS Compared with mothers with normal glucose regulation, mothers with GDM showed increased heart rate but no significant differences of maternal HRV. In contrast, HRV in fetuses of mothers with GDM differed from those in the metabolically healthy group regarding standard deviation normal to normal beat (SDNN) (P = 0.012), low-frequency band (P = 0.008) and high-frequency band (P = 0.031). These HRV parameters exhibit a decrease only in GDM fetuses during the second hour of the OGTT. CONCLUSIONS These results show an altered response of the fetal autonomic nervous system to metabolic stress in GDM-complicated pregnancies. Hence, disturbances in maternal glucose metabolism might not only impact on the central nervous system of the fetus but may also affect the fetal autonomic nervous system. TWEETABLE ABSTRACT Metabolic stress reveals a different response of fetal autonomic nervous system in GDM-complicated pregnancies.
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Affiliation(s)
- E Fehlert
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - K Willmann
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - L Fritsche
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - K Linder
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - H Mat-Husin
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - F Schleger
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - M Weiss
- Department of Obstetrics and Gynaecology, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - I Kiefer-Schmidt
- Department of Obstetrics and Gynaecology, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - S Brucker
- Department of Obstetrics and Gynaecology, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - H-U Häring
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - H Preissl
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany.,Department of Pharmacy and Biochemistry, Institute of Pharmaceutical Sciences, Tübingen, Germany.,Interfaculty Centre for Pharmacogenomics and Pharma Research, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Institute for Diabetes and Obesity, Helmholtz Diabetes Centre, Helmholtz Zentrum München, German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
| | - A Fritsche
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
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Porta A, De Maria B, Bari V, Marchi A, Faes L. Are Nonlinear Model-Free Conditional Entropy Approaches for the Assessment of Cardiac Control Complexity Superior to the Linear Model-Based One? IEEE Trans Biomed Eng 2016; 64:1287-1296. [PMID: 27541327 DOI: 10.1109/tbme.2016.2600160] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We test the hypothesis that the linear model-based (MB) approach for the estimation of conditional entropy (CE) can be utilized to assess the complexity of the cardiac control in healthy individuals. METHODS An MB estimate of CE was tested in an experimental protocol (i.e., the graded head-up tilt) known to produce a gradual decrease of cardiac control complexity as a result of the progressive vagal withdrawal and concomitant sympathetic activation. The MB approach was compared with traditionally exploited nonlinear model-free (MF) techniques such as corrected approximate entropy, sample entropy, corrected CE, two k -nearest-neighbor CE procedures and permutation CE. Electrocardiogram was recorded in 17 healthy subjects at rest in supine position and during head-up tilt with table angles of 15°, 30°, 45°, 60°, and 75°. Heart period (HP) was derived as the temporal distance between two consecutive R-wave peaks and analysis was carried out over stationary sequences of 256 successive HPs. RESULTS The performance of the MB method in following the progressive decrease of HP complexity with tilt table angles was in line with those of MF approaches and the MB index was remarkably correlated with the MF ones. CONCLUSION The MB approach can be utilized to monitor the changes of the complexity of the cardiac control, thus speeding up dramatically the CE calculation. SIGNIFICANCE The remarkable performance of the MB approach challenges the notion, generally assumed in cardiac control complexity analysis based on CE, about the need of MF techniques and could allow real-time applications.
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Tetschke F, Schneider U, Schleussner E, Witte OW, Hoyer D. Assessment of fetal maturation age by heart rate variability measures using random forest methodology. Comput Biol Med 2016; 70:157-162. [PMID: 26848727 DOI: 10.1016/j.compbiomed.2016.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 11/17/2022]
Abstract
Fetal maturation age assessment based on heart rate variability (HRV) is a predestinated tool in prenatal diagnosis. To date, almost linear maturation characteristic curves are used in univariate and multivariate models. Models using complex multivariate maturation characteristic curves are pending. To address this problem, we use Random Forest (RF) to assess fetal maturation age and compare RF with linear, multivariate age regression. We include previously developed HRV indices such as traditional time and frequency domain indices and complexity indices of multiple scales. We found that fetal maturation was best assessed by complexity indices of short scales and skewness in state-dependent datasets (quiet sleep, active sleep) as well as in state-independent recordings. Additionally, increasing fluctuation amplitude contributed to the model in the active sleep state. None of the traditional linear HRV parameters contributed to the RF models. Compared to linear, multivariate regression, the mean prediction of gestational age (GA) is more accurate with RF than in linear, multivariate regression (quiet state: R(2)=0,617 vs. R(2)=0,461, active state: R(2)=0,521 vs. R(2)=0,436, state independent: R(2)=0,583 vs. R(2)=0,548). We conclude that classification and regression tree models such as RF methodology are appropriate for the evaluation of fetal maturation age. The decisive role of adjustments between different time scales of complexity may essentially extend previous analysis concepts mainly based on rhythms and univariate complexity indices. Those system characteristics may have implication for better understanding and accessibility of the maturating complex autonomic control and its disturbance.
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Affiliation(s)
- F Tetschke
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
| | - U Schneider
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - E Schleussner
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - O W Witte
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - D Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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DiPietro JA, Costigan KA, Voegtline KM. STUDIES IN FETAL BEHAVIOR: REVISITED, RENEWED, AND REIMAGINED. Monogr Soc Res Child Dev 2015; 80:vii;1-94. [PMID: 26303396 DOI: 10.1111/mono.v80.3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Among the earliest volumes of this monograph series was a report by Lester Sontag and colleagues, of the esteemed Fels Institute, on the heart rate of the human fetus as an expression of the developing nervous system. Here, some 75 years later, we commemorate this work and provide historical and contemporary context on knowledge regarding fetal development, as well as results from our own research. These are based on synchronized monitoring of maternal and fetal parameters assessed between 24 and 36 weeks gestation on 740 maternal-fetal pairs compiled from eight separate longitudinal studies, which commenced in the early 1990s. Data include maternal heart rate, respiratory sinus arrhythmia, and electrodrmal activity and fetal heartrate, motor activity, and their integration. Hierarchical linear modeling of developmental trajectories reveals that the fetus develops in predictable ways consistent with advancing parasympathetic regulation. Findings also include:within-fetus stability (i.e., preservation of rank ordering over time) for heart rate, motor, and coupling measures; a transitional period of decelerating development near 30 weeks gestation; sex differences in fetal heart rate measures but not in most fetal motor activity measures; modest correspondence in fetal neurodevelopment among siblings as compared to unrelated fetuses; and deviations from normative fetal development in fetuses affected by intrauterine growth restriction and other conditions. Maternal parameters also change during this period of gestation and there is evidence that fetal sex and individual variation in fetal neurobehavior influence maternal physio-logical processes and the local intrauterine context. Results are discussed within the framework of neuromaturation, the emergence of individual differences, and the bidirectional nature of the maternal-fetal relationship.We pose a number of open questions for future research. Although the human fetus remains just out of reach, new technologies portend an era of accelerated discovery of the earliest period of development
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30
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Hoyer D, Schneider U, Kowalski EM, Schmidt A, Witte OW, Schleußner E, Hatzmann W, Grönemeyer DH, van Leeuwen P. Validation of functional fetal autonomic brain age score fABAS in 5 min short recordings. Physiol Meas 2015; 36:2369-78. [PMID: 26489779 DOI: 10.1088/0967-3334/36/11/2369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With the objective of evaluating the functional maturation age and developmental disturbances we have previously introduced the fetal autonomic brain age score (fABAS) using 30 min fetal magnetocardiographic recordings (fMCG, Jena). The score is based on heart rate pattern indices that are related to universal principles of developmental biology. The present work aims at the validation of the fABAS methodology on 5 min recordings from an independent database (fMCG, Bochum).We found high agreement of fABAS obtained from Jena normal fetuses (5 min subsets, n = 364) and Bochum recordings (n = 322, normal fetuses). fABAS of 48 recordings from fetuses with intra-uterine growth restriction (IUGR, Bochum) was reduced in most of the cases, a result consistent with IUGR fetuses from Jena previously reported. fABAS calculated from 5 min snapshots only partly covers the accuracy when compared to fABAS from 30 min recordings. More precise diagnosis requires longer recordings.fABAS obtained from fMCG recordings is a strong candidate for standardized assessment of functional maturation age and developmental disturbances. Even 5 min recordings seem to be valuable for screening for maturation problems.
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Affiliation(s)
- Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, 07743, Germany
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31
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Vincze B, Gáspárdy A, Kulcsár M, Baska F, Bálint Á, Hegedűs GT, Szenci O. Equine alpha-fetoprotein levels in Lipizzaner mares with normal pregnancies and with pregnancy loss. Theriogenology 2015; 84:1581-6. [PMID: 26359849 DOI: 10.1016/j.theriogenology.2015.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
Alpha-fetoprotein has proved to be a good indicator of fetal well-being in human medicine for decades. Although this molecule is present in most of the mammalian species including horses, reference values in healthy and high-risk pregnant mares have not yet been published. The aim of the present study was to determine whether equine alpha-fetoprotein (eqAFP) is a good indicator of complicated pregnancies in Lipizzaner mares. A total of 111 serum samples from 30 mares have been analyzed for eqAFP levels throughout gestation (Days 60-325). After the pregnancy was confirmed, 23 mares had normal pregnancies with viable foals, six had late embryonic loss, and one of the mares aborted in the ninth gestational month. Equine alpha-fetoprotein concentrations significantly differed in the normal group (72.93 ± 49.25 pg/mL; mean ± standard deviation) and in the complicated pregnancy loss group (152 ± 36.48 pg/mL; mean ± standard deviation). The mares' age, gestational age, and the conception rate significantly affected the alpha-fetoprotein concentrations in the normal group. Furthermore, notable individual differences occurred in eqAFP concentrations between mares. Equine alpha-fetoprotein seems to be an important indicator of fetal well-being in horses, but there are still some unanswered questions (levels in foals of different age, ponies, and draft horses) regarding this serum protein. Large-scale studies are needed to assess the specificity, sensitivity, and reliability of this test as a possible future diagnostic tool for fetal well-being in horses.
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Affiliation(s)
- Boglárka Vincze
- Department and Clinic of Equine Medicine, Szent István University, Üllő, Hungary; MTA-SZIE Large Animal Clinical Research Group, Department and Clinic of Production Animal Medicine, Üllő, Hungary.
| | - András Gáspárdy
- Department of Animal Breeding and Genetics, Szent István University, Budapest, Hungary
| | - Margit Kulcsár
- Department and Clinic of Obstetrics and Reproduction, Szent István University, Budapest, Hungary
| | - Ferenc Baska
- Department of Pathology, Szent István University, Budapest, Hungary
| | - Ádám Bálint
- Veterinary Diagnostic Directorate, National Food Chain Safety Office, Budapest, Hungary
| | | | - Ottó Szenci
- MTA-SZIE Large Animal Clinical Research Group, Department and Clinic of Production Animal Medicine, Üllő, Hungary
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Karmakar C, Kimura Y, Palaniswami M, Khandoker A. Analysis of fetal heart rate asymmetry before and after 35 weeks of gestation. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2015.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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REFERENCES. Monogr Soc Res Child Dev 2015. [DOI: 10.1111/mono.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baska-Vincze B, Baska F, Szenci O. Fetal heart rate and fetal heart rate variability in Lipizzaner broodmares. Acta Vet Hung 2015; 63:89-99. [PMID: 25655416 DOI: 10.1556/avet.2015.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Monitoring fetal heart rate (FHR) and fetal heart rate variability (FHRV) helps to understand and evaluate normal and pathological conditions in the foal. The aim of this study was to establish normal heart rate reference values for the ongoing equine pregnancy and to perform a heart rate variability (HRV) time-domain analysis in Lipizzaner mares. Seventeen middle- and late-term (days 121-333) pregnant Lipizzaner mares were examined using fetomaternal electrocardiography (ECG). The mean FHR (P = 0.004) and the standard deviation of FHR (P = 0.012) significantly decreased during the pregnancy. FHR ± SD values decreased from 115 ± 35 to 79 ± 9 bpm between months 5 and 11. Our data showed that HRV in the foal decreased as the pregnancy progressed, which is in contrast with the findings of earlier equine studies. The standard deviation of normal-normal intervals (SDNN) was higher (70 ± 25 to 166 ± 108 msec) than described previously. The root mean square of successive differences (RMSSD) decreased from 105 ± 69 to 77 ± 37 msec between the 5th and 11th month of gestation. Using telemetric ECG equipment, we could detect equine fetal heartbeat on day 121 for the first time. In addition, the large differences observed in the HR values of four mare-fetus pairs in four consecutive months support the assumption that there might be 'high-HR' and 'low-HR' fetuses in horses. It can be concluded that the analysis of FHR and FHRV is a promising tool for the assessment of fetal well-being but the applicability of these parameters in the clinical setting and in studs requires further investigation.
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Affiliation(s)
| | - Ferenc Baska
- 2 Szent István University Department of Pathology Budapest Hungary
| | - Ottó Szenci
- 3 Hungarian Academy of Sciences - Large Animal Clinical Research Group Üllő Hungary
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Cysarz D, Edelhäuser F, Van Leeuwen P. Strategies of symbolization in cardiovascular time series to test individual gestational development in the fetus. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2015; 373:rsta.2014.0087. [PMID: 25548263 DOI: 10.1098/rsta.2014.0087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The analysis of symbolic dynamics applied to physiological time series retrieves dynamical properties of the underlying regulation which are robust against the symbolic transformation. In this study, three different transformations to produce a symbolic series were applied to fetal RR interval series to test whether they reflect individual changes of fetal heart rate variability in the course of pregnancy. Each transformation was applied to 215 heartbeat datasets obtained from 11 fetuses during the second and the third trimester of pregnancy (at least 10 datasets per fetus, median 17). In the symbolic series, the occurrence of symbolic sequences of length 3 was categorized according to the amount of variations in the sequence: no variation of the symbols, one variation, two variations. Linear regression with respect to gestational age showed that the individual course during pregnancy performed best using a binary transformation reflecting whether the RR interval differences are below or above a threshold. The median goodness of fit of the individual regression lines was 0.73 and also the variability among the individual slopes was low. Other transformations to symbolic dynamics performed worse but were still able to reflect the individual progress of fetal cardiovascular regulation.
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Affiliation(s)
- Dirk Cysarz
- Integrated Curriculum for Anthroposophic Medicine, University of Witten/Herdecke, Witten, Germany Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
| | - Friedrich Edelhäuser
- Integrated Curriculum for Anthroposophic Medicine, University of Witten/Herdecke, Witten, Germany Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
| | - Peter Van Leeuwen
- Department of Biomagnetism, Grönemeyer Institute for Microtherapy, University of Witten/Herdecke, Witten, Germany
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Karmakar C, Khandoker A, Kimura Y, Palaniswami M. Investigating foetal heart rate asymmetry. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:2261-4. [PMID: 25570438 DOI: 10.1109/embc.2014.6944070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we have investigated how the asymmetry of beat-to-beat foetal heart rate variability (fHRV) changes during development after 35 weeks and before 32 weeks of gestation. Noninvasive foetal electrocardiogram (fECG) signals from 78 pregnant women at the gestational age from 16 to 41 weeks with normal single pregnancies were analysed. Heart rate asymmetry (HRA) index that measures time asymmetry of RR interval time-series signal was used to understand the dynamics of fHRV. Results indicate that foetal HRA measured by Guzik's Index (GI) and Porta's Index (PI) changes after 35 weeks gestation compared to foetus before 32 weeks of gestation. It might be due to significant amount of maturation of the autonomic nervous system done after 35 and could potentially help identify the pathological autonomic nervous system development.
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Van Leeuwen P, Werner L, Hilal Z, Schiermeier S, Hatzmann W, Grönemeyer D. Fetal electrocardiographic measurements in the assessment of fetal heart rate variability in the antepartum period. Physiol Meas 2014; 35:441-54. [PMID: 24556971 DOI: 10.1088/0967-3334/35/3/441] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examines signal availability in fetal electrocardiogram (FECG) beat-to-beat acquisition and the accuracy of fetal heart rate variability (HRV) analysis in the clinical setting using a commercially available FECG monitor. Signal availability was examined in 130 FECG recordings of 0.3-17.5 h duration collected in 63 fetuses (25th-42nd week of gestation) under uncontrolled conditions. Identification of R-peaks demonstrated a signal loss of 30% ± 24% with 3.6 ± 1.7 signal gaps per minute. Median duration of the gaps within a recording was 1.8 ± 0.2 s. Per hour of recording, 1.8 ± 2.1 episodes of 5 min of uninterrupted data were found. Signal availability improved with gestational age and was poorer in women with high body-mass index. Fetal HRV between weeks 36-42 was examined on the basis of 5 min RR-interval episodes obtained under controlled quiet conditions in 55 FECG compared to 46 high quality fetal magnetocardiograms. There were no differences in RR-interval duration, its standard deviation and low frequency power. However, various measures of short-term HRV were significantly higher in the FECG data: root mean square of successive differences (10.0 ± 1.8 versus 6.6 ± 3.0 ms, p < 0.001, high frequency spectral power (24 ± 12 versus 13 ± 13 ms(2), p < 0.001) and approximate entropy (0.86 ± 0.16 versus 0.73 ± 0.24, p = 0.007). We conclude that, in spite of considerable signal loss, FECG recordings can accurately estimate heart rate and its overall variance. However, measures that quantify short-term beat-to-beat HRV will be compromised due to possible recurring inappropriate detection of single R-peaks.
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Affiliation(s)
- Peter Van Leeuwen
- Department of Biomagnetism, Grönemeyer Institute for Microtherapy, University of Witten/Herdecke, Universitätsstr. 142, D-44799 Bochum, Germany
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Porta A, Żebrowski J. Inferring cardiovascular control from spontaneous variability. Auton Neurosci 2013; 178:1-3. [PMID: 23746470 DOI: 10.1016/j.autneu.2013.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Indexed: 11/25/2022]
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Garzoni L, Faure C, Frasch M. Fetal cholinergic anti-inflammatory pathway and necrotizing enterocolitis: the brain-gut connection begins in utero. Front Integr Neurosci 2013; 7:57. [PMID: 23964209 PMCID: PMC3737662 DOI: 10.3389/fnint.2013.00057] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/18/2013] [Indexed: 12/25/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is an acute neonatal inflammatory disease that affects the intestine and may result in necrosis, systemic sepsis and multisystem organ failure. NEC affects 5-10% of all infants with birth weight ≤ 1500 g or gestational age less than 30 weeks. Chorioamnionitis (CA) is the main manifestation of pathological inflammation in the fetus and is strong associated with NEC. CA affects 20% of full-term pregnancies and upto 60% of preterm pregnancies and, notably, is often an occult finding. Intrauterine exposure to inflammatory stimuli may switch innate immunity cells such as macrophages to a reactive phenotype ("priming"). Confronted with renewed inflammatory stimuli during labour or postnatally, such sensitized cells can sustain a chronic or exaggerated production of proinflammatory cytokines associated with NEC (two-hit hypothesis). Via the cholinergic anti-inflammatory pathway, a neurally mediated innate anti-inflammatory mechanism, higher levels of vagal activity are associated with lower systemic levels of proinflammatory cytokines. This effect is mediated by the α7 subunit nicotinic acetylcholine receptor (α7nAChR) on macrophages. The gut is the most extensive organ innervated by the vagus nerve; it is also the primary site of innate immunity in the newborn. Here we review the mechanisms of possible neuroimmunological brain-gut interactions involved in the induction and control of antenatal intestinal inflammatory response and priming. We propose a neuroimmunological framework to (1) study the long-term effects of perinatal intestinal response to infection and (2) to uncover new targets for preventive and therapeutic intervention.
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Affiliation(s)
- L. Garzoni
- CHU Sainte Justine Research Center, MontrealQC, Canada
- Division of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, MontrealQC, Canada
| | - C. Faure
- CHU Sainte Justine Research Center, MontrealQC, Canada
- Division of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, MontrealQC, Canada
| | - M.G. Frasch
- CHU Sainte Justine Research Center, MontrealQC, Canada
- Department of Obstetrics and Gynaecology, University of MontrealMontreal, QC, Canada
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