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Howland MA, Sandman CA, Davis EP, Glynn LM. Prenatal maternal psychological distress and fetal developmental trajectories: associations with infant temperament. Dev Psychopathol 2020; 32:1685-1695. [PMID: 33427168 PMCID: PMC8643070 DOI: 10.1017/s095457942000142x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Associations between prenatal maternal psychological distress and offspring developmental outcomes are well documented, yet relatively little research has examined links between maternal distress and development in utero, prior to postpartum influences. Fetal heart rate (FHR) parameters are established indices of central and autonomic nervous system maturation and function which demonstrate continuity with postnatal outcomes. This prospective, longitudinal study of 149 maternal-fetal pairs evaluated associations between prenatal maternal distress, FHR parameters, and dimensions of infant temperament. Women reported their symptoms of psychological distress at five prenatal visits, and FHR monitoring was conducted at the last three visits. Maternal report of infant temperament was collected at 3 and 6 months of age. Exposure to elevated prenatal maternal psychological distress was associated with higher late-gestation resting mean FHR (FHRM) among female but not male fetuses. Higher late-gestation FHRM was associated with lower infant orienting/regulation and with higher infant negative affectivity, and these associations did not differ by infant sex. A path analysis identified higher FHRM as one pathway by which elevated prenatal maternal distress was associated with lower orienting/regulation among female infants. Findings suggest that, for females, elevated maternal distress alters fetal development, with implications for postnatal function. Results also support the notion that, for both sexes, individual differences in regulation emerge prenatally and are maintained into infancy. Collectively, these findings underscore the utility of direct assessment of development in utero when examining if prenatal experiences are carried forward into postnatal life.
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Affiliation(s)
- Mariann A Howland
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Curt A Sandman
- Department of Psychiatry & Human Behavior, University of California, Irvine, CA, USA
| | - Elysia Poggi Davis
- Department of Psychiatry & Human Behavior, University of California, Irvine, CA, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
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Abstract
OBJECTIVES To characterize state regulation and behavior of preterm infants after discharge from the neonatal intensive care unit (NICU). METHODS We recruited singleton infants born at ≤35 weeks of gestational age (GA) before NICU discharge. Parents completed surveys at discharge and 1, 3, and 6 months after discharge. Infant medical history was gleaned from the medical record. Surveys captured sociodemographic information and measures of infant state regulation (Baby Pediatric Symptom Checklist [BPSC]) and feeding behaviors. We calculated the median BPSC subscale scores at each time point and the proportion of infants with scores in the problem range (≥3/5). We explored longitudinal and cross-sectional correlates of BPSC scores. RESULTS Fifty families completed the discharge questionnaire, and 42 (84%) completed the 6-month questionnaire. The median GA at birth was 34 weeks (IQR 30.1, 34.4 weeks); the median birth weight was 1930 g (IQR 1460, 2255 g). The median scores were above population norms for irritability and difficulty with routines. Twenty-one infants (40%) had irritability subscale scores in the problem range at 1 month, and 20 (38%) had problem scores on difficulties with routines. Only 9 infants (17%) had problem scores on the inflexibility subscale. Scores in all 3 domains showed different patterns from population norms from 1 to 6 months. BPSC scores were correlated with infant feeding behaviors at 1, 3, and 6 months. CONCLUSION Scores for irritability and difficulty with routines among preterm infants were high compared with population norms and differed from normative values through 6 months after discharge. Preterm infants demonstrate problems with state regulation after NICU discharge that may require directed intervention.
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Abstract
There remains little debate that the period before birth sets the stage for subsequent development, yet scant evidence exists showing continuity from characteristics of the individual fetus to characteristics of the child. This report examines, in two studies, whether baseline and evoked fetal neurobehavioral functioning are predictive of features of child temperament and behavior as reported by mothers when offspring were between 7 and 14 years old (M = 10.1 years). Study 1 utilizes data generated from 333 maternal-fetal pairs collected during an undisturbed condition during the second half of gestation in relation to the child temperament dimensions of behavioral inhibition and exuberance. Associations at 32 weeks gestation were detected between all features of fetal neurobehavior and behavioral inhibition. In adjusted models, slower fetal heart rate and less fetal movement were associated with significant unique variance in predicting higher levels of childhood behavioral inhibition. No associations were detected for exuberance. Study 2 focuses on the association of evoked fetal reactivity and recovery to induced maternal arousal with subsequent child behavioral difficulties in a subset of the full sample (n = 130). Greater recovery in fetal heart rate following maternal stimulation was predictive of fewer behavioral difficulties and more prosocial behavior in childhood. Results from both studies provide support for gestational origins of core individual differences that portend childhood outcomes with foundational reactivity and regulatory components.
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Stroud LR, McCallum M, Salisbury AL. Impact of maternal prenatal smoking on fetal to infant neurobehavioral development. Dev Psychopathol 2018; 30:1087-1105. [PMID: 30068428 PMCID: PMC6541397 DOI: 10.1017/s0954579418000676] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite recent emphasis on the profound importance of the fetal environment in "programming" postnatal development, measurement of offspring development typically begins after birth. Using a novel coding strategy combining direct fetal observation via ultrasound and actocardiography, we investigated the impact of maternal smoking during pregnancy (MSDP) on fetal neurobehavior; we also investigated links between fetal and infant neurobehavior. Participants were 90 pregnant mothers and their infants (52 MSDP-exposed; 51% minorities; ages 18-40). Fetal neurobehavior at baseline and in response to vibro-acoustic stimulus was assessed via ultrasound and actocardiography at M = 35 weeks gestation and coded via the Fetal Neurobehavioral Assessment System (FENS). After delivery, the NICU Network Neurobehavioral Scale was administered up to seven times over the first postnatal month. MSDP was associated with increased fetal activity and fetal limb movements. Fetal activity, complex body movements, and cardiac-somatic coupling were associated with infants' ability to attend to stimuli and to self-regulate over the first postnatal month. Furthermore, differential associations emerged by MSDP group between fetal activity, complex body movements, quality of movement, and coupling, and infant attention and self-regulation. The present study adds to a growing literature establishing the validity of fetal neurobehavioral measures in elucidating fetal programming pathways.
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Avitan T, Sanders A, Brain U, Rurak D, Oberlander TF, Lim K. Variations from morning to afternoon of middle cerebral and umbilical artery blood flow, and fetal heart rate variability, and fetal characteristics in the normally developing fetus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:235-240. [PMID: 29235099 DOI: 10.1002/jcu.22569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/08/2017] [Accepted: 11/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine if there are changes in maternal uterine blood flow, fetal brain blood flow, fetal heart rate variability, and umbilical blood flow between morning (AM) and afternoon (PM) in healthy, uncomplicated pregnancies. STUDY DESIGN In this prospective study, 68 uncomplicated singleton pregnancies (mean 35 + 0.7 weeks gestation) underwent a standard observational protocol at both 08:00 (AM) and 13:30 (PM) of the same day. This protocol included Doppler measurements of uterine, umbilical, and fetal middle cerebral artery (MCA) volume flow parameters (flow, HR, peak systolic velocity [PSV], PI, and RI) followed by computerized cardiotocography. Standard descriptive statistics, χ2 and t tests were used where appropriate. P < .05 was considered significant. RESULTS A significant increase in MCA flow and MCA PSV was observed in the PM compared to the AM. This was accompanied by a fall in MCA resistance. Higher umbilical artery resistance indices were also observed in the PM compared to AM. In contrast, fetal heart rate characteristics, maternal uterine artery Doppler flow and resistance indices did not vary significantly between the AM and PM. CONCLUSION In normal pregnancies, variations in fetal cerebral and umbilical blood flow parameters were observed between AM and PM independent of other fetal movements or baseline fetal heart rate. In contrast, uterine flow parameters remained stable across the day. These findings may have implications for the use of serial Doppler parameters used to guide clinical management in high-risk pregnancies.
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Affiliation(s)
- Tehila Avitan
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
| | - Ari Sanders
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
| | - Ursula Brain
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Dan Rurak
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Tim F Oberlander
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Ken Lim
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
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Voegtline KM, Costigan KA, DiPietro JA. Maternal salivary testosterone in pregnancy and fetal neuromaturation. Dev Psychobiol 2017; 59:822-831. [PMID: 28888054 DOI: 10.1002/dev.21550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/28/2017] [Indexed: 11/07/2022]
Abstract
Testosterone exposure during pregnancy has been hypothesized as a mechanism for sex differences in brain and behavioral development observed in the postnatal period. The current study documents the natural history of maternal salivary testosterone from 18 weeks gestation of pregnancy to 6 months postpartum, and investigates associations with fetal heart rate, motor activity, and their integration. Findings indicate maternal salivary testosterone increases with advancing gestation though no differences by fetal sex were detected. High intra-individual stability in prenatal testosterone levels extend into the postnatal period, particularly for pregnancies with male fetuses. With respect to fetal development, by 36 weeks gestation higher maternal prenatal salivary testosterone was significantly associated with faster fetal heart rate and less optimal somatic-cardiac integration. Measurement of testosterone in saliva is a useful tool for repeated-measures studies of hormonal concomitants of pregnancy. Moreover, higher maternal testosterone levels are associated with modest interference to fetal neurobehavioral development.
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Affiliation(s)
- Kristin M Voegtline
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kathleen A Costigan
- Maternal-Fetal Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Janet A DiPietro
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Infant EEG and temperament negative affectivity: Coherence of vulnerabilities to mothers' perinatal depression. Dev Psychopathol 2016; 28:895-911. [DOI: 10.1017/s0954579416000614] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractAssociations between infants' frontal EEG asymmetry and temperamental negative affectivity (NA) across infants' first year of life and the potential moderating role of maternal prenatal depressive symptoms were examined prospectively in infants (n = 242) of mothers at elevated risk for perinatal depression. In predicting EEG, in the context of high prenatal depressive symptoms, infant NA and frontal EEG asymmetry were negatively associated at 3 months of age and positively associated by 12 months of age. By contrast, for low depression mothers, infant NA and EEG were not significantly associated at any age. Postnatal depressive symptoms did not add significantly to the models. Dose of infants' exposure to maternal depression mattered: infants exposed either pre- or postnatally shifted from a positive association at 3 months to a negative association at 12 months; those exposed both pre- and postnatally shifted from a negative association at 3 months to a positive association at 12 months. Prenatal relative to postnatal exposure did not matter for patterns of association between NA and EEG. The findings highlight the importance of exploring how vulnerabilities at two levels of analysis, behavioral and psychophysiological, co-occur over the course of infancy and in the context of mothers' depressive symptomatology.
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Abstract
OBJECTIVE Children with sleep disorders tend to experience attention problems, yet little is known about the relationship between sleep and attention in early development. This prospective follow-up study investigated the longitudinal relationships between neonatal sleep, attention, and distraction in infants born preterm. METHOD We used actigraphy and sleep-wake diaries in the neonatal intensive care unit (NICU, N = 65), attention orienting in a visual-recognition-memory task (VRM) at age 4 months, and structured observation of attention and distractibility at age 18 months. RESULTS Infants with poorer neonatal sleep (n = 31) exhibited longer first gaze durations in the VRM at 4 months and longer distraction episodes at 18 months relative to neonatal controls who slept well (p < .01). Hierarchical regression models support relations between neonatal sleep and gaze behavior at 4 months and distractibility at 18 months; moreover, alterations in orienting attention at 4 months predicted the likelihood of being distracted during the second year of life. CONCLUSION Findings underscore the importance of early sleep-wake and attention regulation in the development of distraction in infants born preterm.
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Affiliation(s)
- Ronny Geva
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Hagit Yaron
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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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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Aldrete-Cortez V, Schnaas L, Poblano A, Carrillo-Mora P, Olivas-Peña E, Bello-Muñoz JC, Guzmán-Huerta M, Mansilla-Olivares A. Effect of late-onset fetal growth restriction on organization of behavioral state in infants. Pediatr Int 2015; 57:902-8. [PMID: 25807994 DOI: 10.1111/ped.12628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/03/2015] [Accepted: 03/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to analyze whether late-onset fetal growth restriction (FGR) alters regulatory capability in infants, and whether this can be detected using both the neonatal behavior assessment scale (NBAS) and brainstem auditory-evoked potentials (BAEP). METHODS The diagnosis of FGR was made on Doppler examination in the third trimester of pregnancy. NBAS and BAEP measurement were performed at 1 month of corrected postnatal age. RESULTS The group with late-onset FGR was integrated with 17 infants and the control group consisted of 14 subjects. The NBAS range of state score, which reflects organization of behavioral state, was low in infants with late-onset FGR. No differences were found in BAEP between groups. No association between NBAS and BAEP was detected. CONCLUSION Late-onset FGR has a deleterious effect on NBAS range of state, but possibly does not alter BAEP response. It is proposed that regulatory capabilities in the neonatal period play a primary role in subtle cognitive difficulties in infants with late-onset FGR in the long term.
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Affiliation(s)
- Vania Aldrete-Cortez
- Faculty of Psychology, National Autonomous University of Mexico (UNAM).,Department of Developmental Neurobiology, National Institute of Perinatology (INper).,School of Psychology of Panamericana University (UP), Mexico City, Mexico
| | - Lourdes Schnaas
- Department of Developmental Neurobiology, National Institute of Perinatology (INper)
| | - Adrián Poblano
- Clinic of Sleep Disorders, National Autonomous University of Mexico (UNAM).,Department of Neurological Rehabilitation, Subdivision of Neurobiology, National Institute of Rehabilitation
| | - Paul Carrillo-Mora
- Department of Neuroscience, Subdivision of Neurobiology, National Institute of Rehabilitation
| | - Efraín Olivas-Peña
- Department of Perinatal Neurology, National Institute of Perinatology (INper)
| | | | - Mario Guzmán-Huerta
- Department of Maternal-Fetal Medicine, National Institute of Perinatology (INper)
| | - Armando Mansilla-Olivares
- Ministry of Health (SSA), Coordination of National Institutes of Health and High-Specialization Hospitals, Mexico
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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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Abstract
ABSTRACT
Neurological failure is the most apprehension complication of pregnancy, labor and the neonatal period. The origin and outcome correlation is frequently doubtful. The arrival of four-dimensional ultrasonography (4D US) and its function to study fetal behavior patterns have initiated to offer insight into the structural and functional fetal brain development. Although many fetal behavioral studies have been conducted, it is still questionable whether the assessment of continuity from fetal to neonatal behavior could improve our ability of early detection of brain pathology. Neurological assessment of fetus in utero is extremely difficult even having such sophisticated equipment like 4D ultrasound. As it is well known that quantity of GMs is not so informative and predictive for neurological impairment, their quality should be assessed. Gestalt perception of premature GMs we are dealing with in utero and several weeks postnatally are not as predictive for the detection of neurologically abnormal fetuses or newborns as fidgety GMs. Therefore, some additional parameters should be added to the prenatal neurological examination in order to improve our ability to make the distinction between normal and abnormal fetuses.
How to cite this article
Kurjak A, Antsaklis P, Stanojevic M. Fetal Neurology: Past, Present and Future. Donald School J Ultrasound Obstet Gynecol 2015;9(1):6-29.
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Weikum WM, Oberlander TF, Hensch TK, Werker JF. Prenatal exposure to antidepressants and depressed maternal mood alter trajectory of infant speech perception. Proc Natl Acad Sci U S A 2012; 109 Suppl 2:17221-7. [PMID: 23045665 PMCID: PMC3477387 DOI: 10.1073/pnas.1121263109] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Language acquisition reflects a complex interplay between biology and early experience. Psychotropic medication exposure has been shown to alter neural plasticity and shift sensitive periods in perceptual development. Notably, serotonin reuptake inhibitors (SRIs) are antidepressant agents increasingly prescribed to manage antenatal mood disorders, and depressed maternal mood per se during pregnancy impacts infant behavior, also raising concerns about long-term consequences following such developmental exposure. We studied whether infants' language development is altered by prenatal exposure to SRIs and whether such effects differ from exposure to maternal mood disturbances. Infants from non-SRI-treated mothers with little or no depression (control), depressed but non-SRI-treated (depressed-only), and depressed and treated with an SRI (SRI-exposed) were studied at 36 wk gestation (while still in utero) on a consonant and vowel discrimination task and at 6 and 10 mo of age on a nonnative speech and visual language discrimination task. Whereas the control infants responded as expected (success at 6 mo and failure at 10 mo) the SRI-exposed infants failed to discriminate the language differences at either age and the depressed-only infants succeeded at 10 mo instead of 6 mo. Fetuses at 36 wk gestation in the control condition performed as expected, with a response on vowel but not consonant discrimination, whereas the SRI-exposed fetuses showed accelerated perceptual development by discriminating both vowels and consonants. Thus, prenatal depressed maternal mood and SRI exposure were found to shift developmental milestones bidirectionally on infant speech perception tasks.
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Affiliation(s)
- Whitney M. Weikum
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V6H 3V4
| | - Tim F. Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V6H 3V4
| | - Takao K. Hensch
- Center for Brain Science, Harvard University, Cambridge, MA 02138; and
| | - Janet F. Werker
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
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Kurjak A, Predojevic M, Stanojevic M, Kadic AS, Miskovic B, Badreldeen A, Talic A, Zaputovic S, Honemeyer U. Intrauterine growth restriction and cerebral palsy. Acta Inform Med 2012; 18:64-82. [PMID: 25473145 PMCID: PMC4232345 DOI: 10.5455/aim.2010.18.64-82] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 04/30/2010] [Indexed: 11/26/2022] Open
Abstract
Intrauterine growth restriction (IUGR) can be described as condition in which fetus fails to reach his potential growth. It is common diagnosis in obstetrics, and carries an increased risk of perinatal mortality and morbidity. Moreover, IUGR has lifelong implications on health, especially on neurological outcome. There is a need for additional neurological assessment during monitoring of fetal well-being, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Studies have revealed that the behavior of the fetus reflects the maturational processes of the central nervous system (CNS). Hence, ultrasound investigation of the fetal behavior can give us insight into the integrity and functioning of the fetal CNS. Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS. Based on previous observations and several years of investigation, our reaserch group has proposed a new scoring system for the assessment of fetal neurological status by 4D sonography named Kurjak antenatal neurodevelopmental test (KANET). The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies. However, preliminary results are very encouraging.
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Affiliation(s)
- Asim Kurjak
- Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia ; Feto Maternal Medicine Unit, Women'S Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maja Predojevic
- Department Of Physiology, Medical School, University Of Zagreb, Zagreb, Croatia
| | - Milan Stanojevic
- Division Of Neonatology, Department Of Obstetrics And Gynecology, Clinical Hospital "Sv. Duh", Zagreb, Croatia
| | - Aida Salihagic- Kadic
- Department Of Physiology, Medical School, University Of Zagreb, Zagreb, Croatia ; Croatian Institute For Brain Research, Medical School, University Of Zagreb, Zagreb, Croatia
| | - Berivoj Miskovic
- Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia
| | - Ahmed Badreldeen
- Feto Maternal Medicine Unit, Women'S Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amira Talic
- University Of Medical Sciences And Technology, Khartoum, Sudan
| | - Sanja Zaputovic
- Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia
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Kurjak A, Carrera JM, Stanojevic M, Andonotopo W, Azumendi G, Scazzocchio E, Medic M, Salihagic-Kadic A. The role of 4D sonography in the neurological assessment of early human development. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/14722240400017075] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Andonotopo W, Stanojevic M, Kurjak A, Azumendi G, Carrera JM. Assessment of fetal behavior and general movements by four-dimensional sonography. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/14722240400016895] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Talic A, Kurjak A, Stanojevic M, Honemeyer U, Badreldeen A, DiRenzo GC. The assessment of fetal brain function in fetuses with ventrikulomegaly: the role of the KANET test. J Matern Fetal Neonatal Med 2011; 25:1267-72. [DOI: 10.3109/14767058.2011.634463] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sandman CA, Cordova CJ, Davis EP, Glynn LM, Buss C. Patterns of fetal heart rate response at ∼30 weeks gestation predict size at birth. J Dev Orig Health Dis 2011; 2:212-7. [PMID: 25141165 PMCID: PMC10486311 DOI: 10.1017/s2040174411000250] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is evidence that fetal exposure to maternal stress is associated with adverse birth outcomes. Less is known about the association between fetal responses to a stressor and indicators of fetal maturity and developmental outcomes. The purpose of the present study was to determine whether fetal heart rate (FHR) patterns in response to a startling stimulus at ∼30 weeks of gestation were associated with gestational age at birth and birth weight. FHR was measured in 156 maternal-fetal dyads following a vibroacoustic stimulus. All pregnancies were singleton intrauterine pregnancies in English-speaking women who were primarily married, middle class, White and at least 18 years of age. Group-based trajectory modeling identified five groups of fetuses displaying distinctive longitudinal trajectories of FHR response to the startling stimulus. The FHR group trajectories were significantly associated with birth weight percentile (P < 0.01) even after controlling for estimated fetal weight at the time of assessment and parity, which are the known factors influencing birth weight (P < 0.01). Post hoc analyses indicated that two groups accounted for the association between FHR patterns and birth weight. The group (n = 23) with the lowest birth weight exhibited an immediate FHR deceleration followed by an immediate acceleration that does not recover. An FHR pattern characterized by immediate and fast acceleration to the peak and a slow discovery to baseline was associated with the highest birth weight. This is the first direct evidence showing that low birth weight and the resulting neurological consequences may have their origins in early fetal development.
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Affiliation(s)
- C. A. Sandman
- Women and Children’s Health and Well-Being Project, Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA
| | - C. J. Cordova
- Women and Children’s Health and Well-Being Project, Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA
| | - E. P. Davis
- Women and Children’s Health and Well-Being Project, Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - L. M. Glynn
- Women and Children’s Health and Well-Being Project, Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA
- Crean School of Health and Life Sciences, Chapman University, Orange, CA, USA
| | - C. Buss
- Women and Children’s Health and Well-Being Project, Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
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Goodman SH, Rouse MH, Long Q, Ji S, Brand SR. Deconstructing antenatal depression: What is it that matters for neonatal behavioral functioning? Infant Ment Health J 2011; 32:339-361. [DOI: 10.1002/imhj.20300] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Predojevic M, Miskovic B, Ahmed B, Vladareanu R, Kadic AS, Shaddad AN, Al-Noobi M, Talic A, Stanojevic M, Lebit D, Abu-Yaqoub S. An Attempt to Standardize Kurjak's Antenatal Neurodevelopmental Test: Osaka Consensus Statement. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10009-1209] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Analysis of the dynamics of fetal behavior in comparison with morphological studies has led to the conclusion that fetal behavioral patterns are directly reflecting developmental and maturational processes of fetal central nervous system (CNS). Four-dimensional ultrasound (4D US) offers a practical means for assessment of both the brain function and structure. The visualization of fetal activity in utero by 4D US could allow distinction between normal and abnormal behavioral patterns which might make possible the early recognition of fetal brain impairment. That new technology enabled introduction of Kurjak's antenatal neurodevelopmental test (KANET) in low- and high-risk pregnancies. In order to make the test reproducible, the standardization of the test was proposed in Osaka, Japan, during the International Symposium on Fetal Neurology of International Academy of Perinatal Medicine.
The KANET should be performed in the 3rd trimester from 28th to 38th week of gestation. The assessment should last from 15 to 20 minutes, and the fetuses should be examined when awake. If the fetus is sleeping, the assessment should be postponed for 30 minutes or for the next day between 14 and 16 hours. In cases of definitely abnormal or borderline score, the test should be repeated every two weeks till delivery. New modified KANET test should be used with eight instead of 10 parameters: Facial and mouth movements are combined in one category, isolated hand movements and hand to face movements are combined in one category. The score should be the same for abnormal fetuses 0 to 5, borderline score is from 6 to 13 and normal score is 14 or above.
After 4D US assessment of behavioral patterns in the fetuses from high-risk pregnancies, it is very important to continue with follow-up after delivery in infants who were borderline or abnormal as fetuses. Postnatal assessment of neonates includes initial neurological assessment according to Amiel-Tison's methodology (Amiel-Tison Neurological Assessment at Term, ATNAT) in the early neonatal period and every two weeks in preterm infants till discharge and at the postmenstrual age (PMA) between 37 and 40 weeks. If ATNAT is borderline or abnormal, initial assessment of general movements at the age of 36 to 38 weeks of PMA should be performed, than at writhing age (between 46 and 52 weeks), and at the fidgety age after 54 weeks of PMA. If the finding of fidgety movements is mildly abnormal or definitely abnormal, then one more assessment should be done in 2 to 4 weeks till PMA of 58 weeks. Brain ultrasonography should be performed in the first week of life and every 2 weeks afterward till discharge. In severely affected infants with grade 3 and above intraventricular hemorrhage, and those highly suspicious of hypoxic ischemic brain damage, magnetic resonance (MR) should be done if available. Infants should be followed until the age of at least 24 months when diagnosis of disabling or nondisabling cerebral palsy can be ultimately made. Infants with CP should be reassessed at the age of 6 years.
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Zalud I, Perva S, Honemeyer U, Al-Noobi M, Luetic AT, Talic A, Tomasovic S, Zaputovic S. Further Experience in the Clinical Assessment of Fetal Neurobehavior. ACTA ACUST UNITED AC 2010. [DOI: 10.5005/jp-journals-10009-1130] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract
Recent development of three-dimensional (3D) and four-dimensional ultrasound (4D) provided us with new possibilities to study fetal movements and behavior. Many studies have been conducted in order to provide information on specific movement pattern appearance in normal and high-risk fetus. This was the base for multicenter study on use of new scoring system for fetal neurobehavior which purpose is to recognize fetuses with increased risk for poor neurological outcome. The purpose of this paper is to give brief review on the use of 3D and 4D ultrasound in the assessment of fetal behavior.
Objectives
Define possibilities to study fetal movements and behavior by 3D and 4D ultrasound
Decribe new scoring system for neurobehavior in fetuses with increased risk for poor neurological outcome
Summarize behavioral perinatology research and potential clinical applications
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Buss C, Davis EP, Class QA, Gierczak M, Pattillo C, Glynn LM, Sandman CA. Maturation of the human fetal startle response: evidence for sex-specific maturation of the human fetus. Early Hum Dev 2009; 85:633-8. [PMID: 19726143 PMCID: PMC2767415 DOI: 10.1016/j.earlhumdev.2009.08.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 07/21/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Abstract
Despite the evidence for early fetal experience exerting programming influences on later neurological development and health risk, very few prospective studies of human fetal behavior have been reported. In a prospective longitudinal study, fetal nervous system maturation was serially assessed by monitoring fetal heart rate (FHR) responses to vibroacoustic stimulation (VAS) in 191 maternal/fetal dyads. Responses were not detected at 26 weeks gestational age (GA). Sex-specific, age-characteristic changes in the FHR response to VAS were observed by 31 weeks' GA. Males showed larger responses and continued to exhibit maturational changes until 37 weeks' GA, females however, presented with a mature FHR startle response by 31 weeks' GA. The results indicate that there are different rates of maturation in the male and female fetuses that may have implications for sex-specific programming influences.
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Affiliation(s)
- Claudia Buss
- Department of Psychiatry and Human Behavior, University of California, Irvine, 333 The City Blvd. W, Suite 1200, Orange, CA 92868
| | - Elysia Poggi Davis
- Department of Psychiatry and Human Behavior, University of California, Irvine, 333 The City Blvd. W, Suite 1200, Orange, CA 92868,Department of Pediatrics, University of California, Irvine, Irvine, CA 92697-5020
| | - Quetzal A. Class
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Matt Gierczak
- Department of Psychiatry and Human Behavior, University of California, Irvine, 333 The City Blvd. W, Suite 1200, Orange, CA 92868
| | - Carol Pattillo
- Department of Psychiatry and Human Behavior, University of California, Irvine, 333 The City Blvd. W, Suite 1200, Orange, CA 92868
| | - Laura M. Glynn
- Department of Psychiatry and Human Behavior, University of California, Irvine, 333 The City Blvd. W, Suite 1200, Orange, CA 92868,Department of Psychology, Chapman University, Orange, CA 92866
| | - Curt A. Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, 333 The City Blvd. W, Suite 1200, Orange, CA 92868
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Schneider U, Schleussner E, Fiedler A, Jaekel S, Liehr M, Haueisen J, Hoyer D. Fetal heart rate variability reveals differential dynamics in the intrauterine development of the sympathetic and parasympathetic branches of the autonomic nervous system. Physiol Meas 2009; 30:215-26. [PMID: 19179746 DOI: 10.1088/0967-3334/30/2/008] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to investigate the hypothesis that fetal beat-to-beat heart rate variability (fHRV) displays the different time scales of sympatho-vagal development prior to and after 32 weeks of gestation (wks GA). Ninety-two magnetocardiograms of singletons with normal courses of pregnancy between 24 + 1 and 41 + 6 wks GA were studied. Heart rate patterns were either quiet/non-accelerative (fHRP I) or active/accelerative (fHRP II) and recording quality sufficient for fHRV. The sample was divided into the GA groups <32 wks GA/>32 wks GA. Linear parameters of fHRV were calculated: mean heart rate (mHR), SDNN and RMSSD of normal-to-normal interbeat intervals, power in the low (0.04-0.15 Hz) and high frequency range (0.15-0.4 Hz) and the ratios SDNN/RMSSD and LF/HF as markers for sympatho-vagal balance. fHRP I is characterized by decreasing SDNN/RMSSD, LF/HF and mHR. The decrease is more pronounced <32 wks GA. Beyond that GA SDNN/RMSSD is predominantly determined by RMSSD during fHRP I and by SDNN during fHRP II. In contrast to fHRP I, during fHRP II, mHR is positively correlated to SDNN/RMSSD instead of SDNN >32 wks GA. LF/HF increases in fHRP II during the first half of the third trimester. Non-accelerative fHRP are indicative of parasympathetic dominance >32 wks GA. In contrast, the sympathetic accentuation during accelerative fHRP is displayed in the interrelations between mHR, SDNN and SDNN/RMSSD. Prior to 32 wks GA, fHRV reveals the increasing activity of the respective branches of the autonomic nervous system differentiating the types of fHRP.
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Affiliation(s)
- U Schneider
- Department of Obstetrics, University Hospital, Friedrich Schiller University of Jena, Jena, Germany.
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Schneider U, Frank B, Fiedler A, Kaehler C, Hoyer D, Liehr M, Haueisen J, Schleussner E. Human fetal heart rate variability-characteristics of autonomic regulation in the third trimester of gestation. J Perinat Med 2009; 36:433-41. [PMID: 18605969 DOI: 10.1515/jpm.2008.059] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To describe developmental aspects of the sympatho-vagal heart rate regulation in the human fetus by applying numerics to visual descriptions of fetal heart rate patterns throughout the third trimester of pregnancy. The focus is to determine potential benefits of this alternative means of assessing the maturation of the fetal autonomic nervous system by analysis of fetal heart rate variability (fHRV). SUBJECTS AND METHODS The magnetocardiograms of 103 normal fetuses between 24+1 and 41+6 weeks of gestation were studied. Fetal heart beat intervals were determined with a temporal precision of 1 ms. The levels of fetal activity were estimated according to characteristic heart rate patterns (I-III) prior to 32, between 32-35 and beyond 35 (groups 1-3) completed weeks. Mean heart rate (mHR), standard deviation of normal-to-normal beat intervals (SDNN) and root mean square of successive differences of normal beats (RMSSD) served as fHRV indices, mean permutation entropy (PE_Mean) as complexity measure. SDNN/RMSSD was introduced as a potential marker for sympatho-vagal balance. RESULTS Low activity fHRP (I) were characterized by significantly lower level fHRV indices and higher PE_Mean when compared to fHRP II. We found that SDNN/RMSSD decreases with gestation in fHRP I, which suggests increasing vagal influence. In fHRP III (assigned to active awake fetuses only after 32 weeks), highest level SDNN and mHR are associated with a dramatically reduced complexity. fHRV indices cluster characteristically with the activity levels. CONCLUSIONS We conclude that a combined analysis of fHRV, based on SDNN/RMSSD and PE_Mean, and fHRP is advantageous in the assessment of maturation of the fetal autonomic nervous system.
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Affiliation(s)
- Uwe Schneider
- University Hospital, Department of Obstetrics, Friedrich Schiller University of Jena, Germany.
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Prenatal origins of temperamental reactivity in early infancy. Early Hum Dev 2008; 84:569-75. [PMID: 18289801 PMCID: PMC2572989 DOI: 10.1016/j.earlhumdev.2008.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 12/03/2007] [Accepted: 01/14/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Temperament theory has long considered individual differences in reactivity and regulation to be present at birth. Recent evidence suggests that such differences may be present prenatally and moderated by maternal emotionality. AIMS To determine whether induced maternal emotional activation generates a fetal response and whether observed fetal responsivity is associated with early infant temperament. STUDY DESIGN Women viewed an emotionally evocative labor and delivery documentary at 32 weeks gestation while physiological indices were evaluated and their infant's temperament was assessed at 6 weeks postnatal age. SUBJECTS Participants were 137 pregnant women and their infants. OUTCOME MEASURES Maternal physiological (heart rate and skin conductance) and fetal neurobehavioral (heart rate and motor activity) data were collected during gestation in response to the stimulus. Infant temperament (irritability and consolability) data were based on observational methods after birth. RESULTS Fetuses reacted to maternal viewing of the video with decreased heart rate variability, fewer motor bouts, and decreased motor activity. There was correspondence between the nature of individual maternal physiological responses to the full video, as well as phasic responses to a graphic birth scene, and fetal responsivity. Fetuses that reacted more intensively to maternal stimulation were significantly more likely to become infants that demonstrated greater irritability during a developmental examination at 6 weeks of age. DISCUSSION These results support the presumption that early postnatal temperamental characteristics emerge during the prenatal period.
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Miskovic B, Ahmed B, Younis M, Abo-Yaquab S, Saleh H, Shaddad AN, Bahar AJA, Khenyab N. An Attempt to Introduce Neurological Test for Fetus Based on 3D and 4D Sonography. ACTA ACUST UNITED AC 2008. [DOI: 10.5005/jp-journals-10009-1076] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract
Fetal neurology is a new challenging field. Brain damage often originates in fetal life. Early identification of this damage has implications for perinatal management; moreover documentation of such lesions is essential in case of litigation. In the last two decades, fetal imaging with 2-dimensional ultrasounds and conventional magnetic resonance imaging have made a major contribution in the identification of classic brain lesions and malformations. However, it is only recently with diffusion weight imaging that the whole spectrum of perinatal white matter injuries has been described in the neonate. The recent advances of 3DUS and 4DUS in exploring fetal motor behavior should support a better clinical description of the full spectrum of fetal damage. New neurological test (KANET) of the fetus recently suggested by us (Kurjak et al 2008) might be helpful in the assessment of fetal neurobehavior.
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Bergner S, Monk C, Werner EA. Dyadic Intervention during Pregnancy? Treating Pregnant Women and Possibly Reaching the Future Baby. Infant Ment Health J 2008; 29:399-419. [PMID: 23885132 PMCID: PMC3718067 DOI: 10.1002/imhj.20190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIt is well established that postnatally, maternal psychopathology greatly increases a child's risk for emotional disorders. This article addresses the formative phase that precedes the mother–infant mutually regulating dyad. Biopsychological data presented here suggest that women's affective states during pregnancy—specifically depression, anxiety, and elevated life‐stress—are associated with subtle alterations in the neurobiological substrate of the fetus' emerging affect regulation system. The article moves to a general discussion of the emotional experience of pregnancy, and to the use of psychodynamic psychotherapy when problematic aspects of women's representational world lead to negative or dysregulated affect. Two case vignettes are presented: one described in brief and the other in greater detail. This kind of therapeutic intervention aims to achieve mood improvement, address women's emerging relationship with her baby, and potentially, influence the course of fetal development. Winnicott (1960) said there is no such thing as a baby alone; all the more so during pregnancy.
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Poblano A, Haro R, Arteaga C. Neurophysiologic measurement of continuity in the sleep of fetuses during the last week of pregnancy and in newborns. Int J Biol Sci 2007; 4:23-8. [PMID: 18167533 PMCID: PMC2140151 DOI: 10.7150/ijbs.4.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 12/12/2007] [Indexed: 11/22/2022] Open
Abstract
Our aim was to measure the correlation between fetal electrocardiographic (FECG) recordings of low-risk pregnancies and polysomnographic (PSG) study parameters in low-risk infants born at term as a measurement of perinatal sleep-development continuity. We designed a short, prospective, observational follow-up of physiologic parameters between fetuses and newborns. We studied 10 fetuses from low-risk pregnant female out-patients and the same subjects as low-risk newborns delivered at term. Fetal state (FS) was defined in FECG recordings reassembling the following: fetal state I (quiet sleep or QS); fetal state II (active sleep or AS); fetal state III (quiet waking), and fetal state IV (active waking). Percentages of AS, QS, and wakefulness in PSG studies of newborns were also determined. Comparisons of FS I with QS showed a significant reduction in QS, while comparison of FS II with AS showed significant reduction in AS. Negative correlations were found between FS I with QS, and FS II with AS. Number of cycles in FECG recordings and PSG sleep cycles also demonstrated significant correlation. In conclusion our data showed partial but significant sleep function continuity from fetal to neonatal period.
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Affiliation(s)
- Adrián Poblano
- Clinic of Sleep Disorders, School of Medicine, National University of Mexico, Mexico City, Mexico.
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29
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Werner EA, Myers MM, Fifer WP, Cheng B, Fang Y, Allen R, Monk C. Prenatal predictors of infant temperament. Dev Psychobiol 2007; 49:474-84. [PMID: 17577231 DOI: 10.1002/dev.20232] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Emerging data suggest that prenatal factors influence children's temperament. In 50 dyads, we examined fetal heart rate (FHR) activity and women's antenatal psychiatric illness as predictors of infant temperament at 4 months (response to novelty and the Infant Behavior Checklist). FHR change during maternal challenge was positively associated with observed infant motor reactivity to novelty (p = .02). The odds of being classified as high versus low motor among fetuses who had an increase in FHR during maternal stress was 11 times those who had a decrease in FHR (p = .0006). Antenatal psychiatric diagnosis was associated with an almost fourfold greater odds of having a high cry reactivity classification (p = .03). There also were modest associations between baseline FHR and maternal reports of infant temperament and between observed temperament and that based on mothers' reports. All of the infant results were found independent of the influence of women's postnatal anxiety. These data indicate that physiological markers of individual differences in infant temperament are identifiable in the fetal period, and possibly shaped by the prenatal environment.
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Affiliation(s)
- Elizabeth A Werner
- Department of Psychiatry Behavioral Medicine Program Columbia University Medical Center 1150 St Nicholas Avenue Suite 1-121, New York, NY 10032, USA
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Abstract
The complexities of neurobehavioral assessment of the fetus, which can be neither directly viewed nor manipulated, cannot be understated. Impetus to develop methods for measuring fetal neurobehavioral development has been provided by the recognition that individual differences in neurobehavioral functioning do not originate with birth and acceptance of the key contribution of the antenatal period to postnatal life. Research has centered around four aspects of fetal functioning: heart rate, motor activity, behavioral state, and responsivity to stimulation. Longitudinal studies have revealed that the developmental trajectories of these characteristics parallel the developing nervous system, detected a transitional period between 28 and 32 weeks gestation, and established within-fetal stability during the second half of gestation. Despite the promise of fetal stimulation and habituation paradigms as measures of neural functioning, significant safety and ethical concerns exist. Construction of a unified fetal neurobehavioral scale is premature until a sufficient degree of normative data is available and the predictive validity of specific aspects of fetal neurobehavior to child developmental outcomes is better established.
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Affiliation(s)
- Janet A DiPietro
- Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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31
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Morrison JL, Riggs KW, Rurak DW. Fluoxetine during pregnancy: impact on fetal development. Reprod Fertil Dev 2005; 17:641-50. [PMID: 16263070 DOI: 10.1071/rd05030] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 06/12/2005] [Indexed: 11/23/2022] Open
Abstract
Women are at greatest risk of suffering from depression during the childbearing years and thus may either become pregnant while taking an antidepressant or may require a prescription for one during pregnancy. The antidepressant fluoxetine (FX) is a selective serotonin reuptake inhibitor (SSRI), which increases serotonin neurotransmission. Serotonin is involved in the regulation of a variety of physiological systems, including the sleep–wake cycle, circadian rhythms and the hypothalamic–pituitary–adrenal axis. Each of these systems also plays an important role in fetal development. Compared with other antidepressant drugs, the SSRIs, such as FX, have fewer side effects. Because of this, they are now frequently prescribed, especially during pregnancy. Clinical studies suggest poor neonatal outcome after exposure to FX in utero. Recent studies in the sheep fetus describe the physiological effects of in utero exposure to FX with an 8 day infusion during late gestation in the sheep. This is a useful model for determining the effects of FX on fetal physiology. The fetus can be studied for weeks in its normal intrauterine environment with serial sampling of blood, thus permitting detailed studies of drug disposition in both mother and fetus combined with monitoring of fetal behavioural state and cardiovascular function. Fluoxetine causes an acute increase in plasma serotonin levels, leading to a transient reduction in uterine blood flow. This, in turn, reduces the delivery of oxygen and nutrients to the fetus, thereby presenting a mechanism for reducing growth and/or eliciting preterm delivery. Moreover, because FX crosses the placenta, the fetus is exposed directly to FX, as well as to the effects of the drug on the mother. Fluoxetine increases high-voltage/non-rapid eye movement behavioural state in the fetus after both acute and chronic exposure and, thus, may interfere with normal fetal neurodevelopment. Fluoxetine also alters hypothalamic function in the adult and increases the magnitude of the prepartum rise in fetal cortisol concentrations in sheep. Fetal FX exposure does not alter fetal circadian rhythms in melatonin or prolactin. Studies of the effects of FX exposure on fetal development in the sheep are important in defining possible physiological mechanisms that explain human clinical studies of birth outcomes after FX exposure. To date, there have been insufficient longer-term follow-up studies in any precocial species of offspring exposed to SSRIs in utero. Thus, further investigation of the long-term consequences of in utero exposure to FX and other SSRIs, as well as the mechanisms involved, are required for a complete understanding of the impact of these agents on development. This should involve studies in both humans and appropriate animal models.
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Affiliation(s)
- Janna L Morrison
- Discipline of Physiology, School of Molecular and Biomedical Science, Centre for the Early Origins of Adult Disease, University of Adelaide, Australia.
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Huizink AC, Mulder EJH, Buitelaar JK. Prenatal stress and risk for psychopathology: specific effects or induction of general susceptibility? Psychol Bull 2004; 130:115-42. [PMID: 14717652 DOI: 10.1037/0033-2909.130.1.115] [Citation(s) in RCA: 324] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review focuses on prenatal stress as a risk factor for psychopathology. Evidence from animal studies is summarized, and the relevance of prenatal stress models in animals for human studies is discussed. In the offspring of prenatally stressed animals, overactivity and impaired negative feedback regulation of the hypothalamic-pituitary-adrenal axis are consistent findings and may reflect a pathophysiological mechanism involved in the development of psychopathology. Reduced activity of the opioid GABA/benzodiazepine, serotonin, and dopamine systems and increased activity of the sympathico-adrenal system have been found as well. These alterations have been linked to a diverse spectrum of psychopathology. Therefore, the evidence supports the view that exposure to prenatal stress may result in a general susceptibility to psychopathology, rather than exerting a direct effect on a specific form of psychopathology.
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Affiliation(s)
- Anja C Huizink
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute for Neurosciences, University Medical Center Utrecht, Utrecht, Netherlands.
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DiPietro JA, Hilton SC, Hawkins M, Costigan KA, Pressman EK. Maternal stress and affect influence fetal neurobehavioral development. Dev Psychol 2002. [DOI: 10.1037/0012-1649.38.5.659] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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