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Jansson LM, McConnell K, Velez ML, Spencer N, Milio L, Leoutsakos J, DiPietro JA. Gestational buprenorphine-naloxone exposure and fetal neurobehavior. Neurotoxicol Teratol 2024; 104:107368. [PMID: 38906389 PMCID: PMC11300143 DOI: 10.1016/j.ntt.2024.107368] [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: 01/17/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Buprenorphine-naloxone treatment may confer substantial benefits for the treatment of opioid use disorder (OUD) during pregnancy including lower risk for overdose/death, less diversion potential and reduced use of other substances. Treatment may also result in less severe Neonatal Abstinence Syndrome (NAS), but little is known about the effects of this medication on fetal neurodevelopment. METHODS The purpose of the current study is to evaluate neurobehaviors among fetuses exposed to buprenorphine-naloxone at four time points over the second and third trimesters of gestation in pregnant women with OUD on buprenorphine-naloxone therapy. Sixty minutes of continuous fetal monitoring via fetal actocardiograph with a single wide array abdominal transducer took place at times of peak and trough buprenorphine-naloxone levels in 24 pregnant women. Data collection, which included measures of fetal heart rate and motor activity, was conducted between 24 and 36 weeks gestation, with the majority (84.6%) monitored at two or more gestational ages. Medication dose and other substance use was monitored throughout the study and infant NAS severity was assessed. RESULTS Fetal heart rate (FHR), FHR variability, accelerations in FHR, and motor activity were suppressed when buprenorphine-naloxone levels were at pharmacologic peak as compared to trough concentrations at 36 weeks, but not earlier in gestation. Maternal medication dose was unrelated to infant NAS severity. CONCLUSIONS Conclusions: There were evident subclinical fetal neurophysiological responses at times of peak maternal buprenorphine/naloxone levels in later gestation, similar to those previously described for buprenorphine only. Further studies evaluating the effects of these changes in fetal neurobehaviors on the longer-term infant development are needed.
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Affiliation(s)
- Lauren M Jansson
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21224, USA.
| | - Krystle McConnell
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21224, USA
| | - Martha L Velez
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21224, USA
| | - Nancy Spencer
- Johns Hopkins Bayview Medical Center, Department of Nursing, Baltimore, MD 21224, USA
| | - Lorraine Milio
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD 21224, USA
| | - Jeannie Leoutsakos
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA
| | - Janet A DiPietro
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, MD 21224, USA
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2
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Ayala K, Huynh C, Voegtline K, Rutherford HJ. Made to move: A review of measurement strategies to characterize heterogeneity in normal fetal movement. Infant Behav Dev 2024; 75:101949. [PMID: 38663329 DOI: 10.1016/j.infbeh.2024.101949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/29/2024] [Accepted: 03/31/2024] [Indexed: 06/11/2024]
Abstract
Fetal movement is a crucial indicator of fetal well-being. Characteristics of fetal movement vary across gestation, posing challenges for researchers to determine the most suitable assessment of fetal movement for their study. We summarize the current measurement strategies used to assess fetal movement and conduct a comprehensive review of studies utilizing these methods. We critically evaluate various measurement approaches including subjective maternal perception, ultrasound, Doppler ultrasound, wearable technology, magnetocardiograms, and magnetic resonance imaging, highlighting their strengths and weaknesses. We discuss the challenges of accurately capturing fetal movement, which is influenced by factors such as differences in recording times, gestational ages, sample sizes, environmental conditions, subjective perceptions, and characterization across studies. We also highlight the clinical implications of heterogeneity in fetal movement assessment for monitoring fetal behavior, predicting adverse outcomes, and improving maternal attachment to the fetus. Lastly, we propose potential areas of future research to overcome the current gaps and challenges in measuring and characterizing abnormal fetal movement. Our review contributes to the growing body of literature on fetal movement assessment and provides insights into the methodological considerations and potential applications for research.
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Affiliation(s)
- Kathy Ayala
- Yale University, Yale University School of Medicine, Yale Child Study Center, USA.
| | - Christina Huynh
- Johns Hopkins School of Medicine, Department of Pediatrics, USA.
| | - Kristin Voegtline
- Johns Hopkins School of Medicine, Department of Pediatrics, USA; Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, USA.
| | - Helena Jv Rutherford
- Yale University, Yale University School of Medicine, Yale Child Study Center, USA.
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3
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Samir H, Swelum AA, Farag A, El-Sherbiny HR. Emotional temperaments in advanced pregnant goats and its relationship with the feto-maternal blood flow and placentome echotexture. Vet Res Commun 2024; 48:1545-1561. [PMID: 38379058 PMCID: PMC11147941 DOI: 10.1007/s11259-024-10330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024]
Abstract
The current study aimed to investigate the effect of xylazine sedation (non-sedated versus sedated conditions) and animal temperament on the fetal and maternal hemodynamics during the late stage of gestation in goats. In addition, it aimed to study the concentrations of cortisol and the echotexture of the placentome. Fourteen goats were assigned into two equal groups (n = 7, each) based on the animal's emotional temperament (calm versus nervous groups). All goats were examined for assessment of the blood flow within the fetal aorta (FA), umbilical artery (UMA), and middle uterine artery (MUA) using color-pulsed Doppler ultrasonography. Goats were exposed to light sedation using the recommended dose of xylazine (0.05 mg/Kg Bw) intramuscularly. Goats in each group were reassessed for the studied parameters after sedation. Blood samples were drawn to determine the concentrations of cortisol. Placentome echotexture pixel intensity (PXI) was evaluated using computer image analysis software. Results revealed the significant impact of the xylazine sedation on the Doppler indices of the blood flow within the measured arteries (FA, UMA, and MUA), the PXI of placentome echotexture, and cortisol concentrations. The emotional temperament of goats had significant effects on the blood flow parameters of the MUA and UMA, concentrations of cortisol, and the PXI of the placentome. The interaction effect (sedation x temperament) was noticed in the measured parameters of the UMA blood flow, fetal heart rate, and cortisol concentrations. In conclusion, xylazine sedation and emotional temperaments induced alterations in the echotexture of the placentomes as well as the hemodynamic parameters of late-stage pregnant goats without affecting the pregnancy outcomes.
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Affiliation(s)
- Haney Samir
- Department of Theriogenology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt.
| | - Ayman A Swelum
- Department of Theriogenology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Farag
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Hossam R El-Sherbiny
- Department of Theriogenology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
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Pollatou A, Holland CM, Stockton TJ, Peterson BS, Scheinost D, Monk C, Spann MN. Mapping Early Brain-Body Interactions: Associations of Fetal Heart Rate Variation with Newborn Brainstem, Hypothalamic, and Dorsal Anterior Cingulate Cortex Functional Connectivity. J Neurosci 2024; 44:e2363232024. [PMID: 38604780 PMCID: PMC11140686 DOI: 10.1523/jneurosci.2363-23.2024] [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: 12/15/2023] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
The autonomic nervous system (ANS) regulates the body's physiology, including cardiovascular function. As the ANS develops during the second to third trimester, fetal heart rate variability (HRV) increases while fetal heart rate (HR) decreases. In this way, fetal HR and HRV provide an index of fetal ANS development and future neurobehavioral regulation. Fetal HR and HRV have been associated with child language ability and psychomotor development behavior in toddlerhood. However, their associations with postbirth autonomic brain systems, such as the brainstem, hypothalamus, and dorsal anterior cingulate cortex (dACC), have yet to be investigated even though brain pathways involved in autonomic regulation are well established in older individuals. We assessed whether fetal HR and HRV were associated with the brainstem, hypothalamic, and dACC functional connectivity in newborns. Data were obtained from 60 pregnant individuals (ages 14-42) at 24-27 and 34-37 weeks of gestation using a fetal actocardiograph to generate fetal HR and HRV. During natural sleep, their infants (38 males and 22 females) underwent a fMRI scan between 40 and 46 weeks of postmenstrual age. Our findings relate fetal heart indices to brainstem, hypothalamic, and dACC connectivity and reveal connections with widespread brain regions that may support behavioral and emotional regulation. We demonstrated the basic physiologic association between fetal HR indices and lower- and higher-order brain regions involved in regulatory processes. This work provides the foundation for future behavioral or physiological regulation research in fetuses and infants.
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Affiliation(s)
- Angeliki Pollatou
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032
| | - Cristin M Holland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032
| | - Thirsten J Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032
| | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, California 90027
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Dustin Scheinost
- Departments of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut 06520
- Child Study Center, Yale School of Medicine, New Haven, Connecticut 06520
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, Connecticut 06520
- Department of Statistics and Data Science, Yale University, New Haven, Connecticut 06511
- Wu Tsai Institute, Yale University, New Haven, Connecticut 06506
| | - Catherine Monk
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York 10032
| | - Marisa N Spann
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York 10032
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5
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Parisi F, Høifødt RS, Bohne A, Wang CEA, Pfuhl G. Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study. Behav Sci (Basel) 2024; 14:117. [PMID: 38392470 PMCID: PMC10886085 DOI: 10.3390/bs14020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parent-infant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety Questionnaire-Revised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (τ = -0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period.
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Affiliation(s)
- Francesca Parisi
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | | | - Agnes Bohne
- Department of Psychology, UiT the Arctic University of Norway, 9019 Tromsø, Norway
- Division of Child and Adolescent Health, University Hospital of Northern Norway, 9019 Tromsø, Norway
| | | | - Gerit Pfuhl
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Psychology, UiT the Arctic University of Norway, 9019 Tromsø, Norway
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6
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Dantas FMNA, Magalhães PAF, Hora ECN, Andrade LB, Sarinho ESC. Heart rate variability in school-age children born moderate-to-late preterm. Early Hum Dev 2024; 189:105922. [PMID: 38163385 DOI: 10.1016/j.earlhumdev.2023.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Prematurity is associated with reduced cardiac autonomic function. This study aimed to investigate the heart rate variability (HRV) in school-age children born moderately to late preterm (MLPT). METHODS This cross-sectional study investigated school-age children, aged 5 to 10 years, born moderate-to-late preterm. Electrocardiograms recordings were performed during fifteen-minutes. Time and frequency domain parameters were calculated, corrected for heart rate and compared between the groups. RESULTS A total of 123 children were evaluated and 119 were included in this study. HRV measures, studied in the time and frequency domains, were similar in both groups. Corrected values of root mean square of successive differences between normal cycles (RMSSD), percentage of successive cycles with a duration difference >50 ms (pNN50%), and high frequency (HF), indices that predominantly represent the parasympathetic activity of the autonomic nervous system, were 1.6E-7 and 1.8E-7 (p=0.226); 1.6E-13 and 1.6E-13 (p=0.506); 6.9E-12 and 7.4E-12 (p=0.968) in the preterm and control groups, respectively. CONCLUSION This study did not find differences in heart rate variability between school-age children born MLPT and those born at term, suggesting that plasticity of cardiac autonomic modulation continues to occur in children up to school age or there is less impairment of the autonomic system in MLPT.
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Affiliation(s)
- Fabianne M N A Dantas
- Research Group of Neonatal and Pediatric Physical Therapy, Baby GrUPE, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil; Department of Physical Therapy, Universidade de Pernambuco, Pernambuco, Brazil.
| | - Paulo A F Magalhães
- Research Group of Neonatal and Pediatric Physical Therapy, Baby GrUPE, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil; Department of Physical Therapy, Universidade de Pernambuco, Pernambuco, Brazil; Graduate Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil
| | - Emilly C N Hora
- Universidade Federal de Sergipe, Aracaju, Pernambuco, Brazil
| | - Lívia B Andrade
- Professor Fernando Figueira Integral Medicine Institute, Recife, Pernambuco, Brazil
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7
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Jones-Mason K, Coccia M, Alkon A, Melanie Thomas KCP, Laraia B, Adler N, Epel ES, Bush NR. Parental sensitivity modifies the associations between maternal prenatal stress exposure, autonomic nervous system functioning and infant temperament in a diverse, low-income sample. Attach Hum Dev 2023; 25:487-523. [PMID: 37749913 DOI: 10.1080/14616734.2023.2257669] [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: 08/02/2022] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
Evidence suggests that adversity experienced during fetal development may shape infant physiologic functioning and temperament. Parental sensitivity is associated with child stress regulation and may act as a buffer against risk for intergenerational health effects of pre- or postnatal adversity. Building upon prior evidence in a racially and ethnically diverse sample of infants (M infant age = 6.5 months) and women of low socioeconomic status, this study examined whether coded parenting sensitivity moderated the association between an objective measure of prenatal stress exposures (Stressful Life Events (SLE)) and infant parasympathetic (respiratory sinus arrhythmia; RSA) or sympathetic (pre-ejection period; PEP) nervous system functioning assessed during administration of the Still-Face-Paradigm (SFP) (n = 66), as well as maternal report of temperament (n = 154). Results showed that parental sensitivity moderated the associations between prenatal stress exposures and infant RSA reactivity, RSA recovery, PEP recovery, and temperamental negativity. Findings indicate that greater parental sensitivity is associated with lower infant autonomic nervous system reactivity and greater recovery from challenge. Results support the hypothesis that parental sensitivity buffers infants from the risk of prenatal stress exposure associations with offspring cross-system physiologic reactivity and regulation, potentially shaping trajectories of health and development and promoting resilience.
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Affiliation(s)
- Karen Jones-Mason
- Department of Psychiatry, University of California, San Francisco, USA
| | - Michael Coccia
- Department of Psychiatry, University of California, San Francisco, USA
| | - Abbey Alkon
- School of Nursing, University of California, San Francisco, USA
| | | | - Barbara Laraia
- School of Public Health, University of California, Berkeley, USA
| | - Nancy Adler
- Department of Psychiatry, University of California, San Francisco, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California, San Francisco, USA
| | - Nicole R Bush
- Department of Psychiatry, University of California, San Francisco, USA
- Department of Pediatrics, University of California, San Francisco, USA
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8
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Gao MM, Saenz C, Neff D, Santana ML, Amici J, Butner J, Raby KL, Crowell SE, Conradt E. Bringing the laboratory into the home: A protocol for remote biobehavioral data collection in pregnant women with emotion dysregulation and their infants. J Health Psychol 2022; 27:2644-2667. [PMID: 34875931 PMCID: PMC10066794 DOI: 10.1177/13591053211064984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnant women struggling with emotion dysregulation may be more likely to engage in a wide range of health risk behaviors. This protocol describes a study on intergenerational transmission of emotion dysregulation from the third trimester of pregnancy to 18 months postpartum. Biobehavioral markers of emotion dysregulation are typically measured in laboratory settings which was prohibited by many universities during the COVID-19 pandemic. We describe how markers of emotion dysregulation (e.g. maternal, fetal, and infant heart rate variability) are collected remotely. We detail how data collection can be augmented to reach diverse populations who may not otherwise participate in laboratory-based research.
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9
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Ogenyi P, Chiegwu HU, England A, Akanegbu UE, Ogbonna OS, Abubakar A, Luntsi G, Zira DJ, Dauda M. Appraisal of trimester-specific fetal heart rate and its role in gestational age prediction. Radiography (Lond) 2022; 28:926-932. [PMID: 35820355 DOI: 10.1016/j.radi.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate and report normal sonographic FHR values among low-risk singleton women across the three trimesters of pregnancy and determine FHR role in gestational age prediction. METHOD A prospective cross-sectional study of 2727 low-risk singleton pregnant women was undertaken. FHR measurements were obtained by a consultant radiologist and three experienced sonographers using transabdominal approach from January 2019 to December 2020. Two FHR measurements were taken for each participant. The fetal lie and presentation were also documented in the first trimester. Data were analysed using SPSS version 24 (IBM, Armonk, NY, USA). RESULT The maternal mean ± SD age was 25.8 ± 6.5 years and mean FHR for first, second and third trimesters were 151 ± 16, 145 ± 6 and 125±6 bpm respectively. The mean ± SD gestational age were 10 ± 2, 19 ± 3 and 34 ± 2 weeks for the first, second and third trimester respectively. Using ANOVA, there were statistically significant differences in FHR across the three trimesters (p ≤ 0.05). A positive correlation existed between maternal age and FHR (r = 0.57, p ≤ 0.05). CONCLUSION This study has established normal values for FHR in first, second and third trimester respectively. Referring physicians, radiologists, sonographers, obstetricians and gynaecologists may consider FHR of (135-167) bpm (139-151) bpm and (119-131) bpm as normal FHR ranges for the first, second and third trimester respectively. This study has also revealed the possibility of gestational age prediction using FHR with the equation [Gestational Age = 87.8 - (0.47) FHR]. IMPLICATIONS FOR PRACTICE This paper provides the most up-to-date sonographic FHR recommendations for fetal management. More importantly, findings from this study also suggests that ultrasound practitioners can use FHR measurements as a reliable alternative for fetal dating.
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Affiliation(s)
- P Ogenyi
- Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - H U Chiegwu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A England
- School of Medicine, University College Cork, Ireland
| | - U E Akanegbu
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - O S Ogbonna
- Department of Radiography, Nnamdi Azikiwe University, Awka
| | - A Abubakar
- Department of Radiography, University of Maiduguri, Nigeria
| | - G Luntsi
- Department of Radiography, University of Maiduguri, Nigeria
| | - D J Zira
- Department of Radiography, Federal University Lafia, Nigeria
| | - M Dauda
- Department of Medical Physics, Nasarawa State University, Keffi, Nigeria
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10
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Schwartz N, Mhajna M, Moody HL, Zahar Y, Shkolnik K, Reches A, Lowery CL. Novel uterine contraction monitoring to enable remote, self-administered nonstress testing. Am J Obstet Gynecol 2022; 226:554.e1-554.e12. [PMID: 34762863 DOI: 10.1016/j.ajog.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The serial fetal monitoring recommended for women with high-risk pregnancies places a substantial burden on the patient, often disproportionately affecting underprivileged and rural populations. A telehealth solution that can empower pregnant women to obtain recommended fetal surveillance from the comfort of their own home has the potential to promote health equity and improve outcomes. We have previously validated a novel, wireless pregnancy monitor that can remotely capture fetal and maternal heart rates. However, such a device must also detect uterine contractions if it is to be used to robustly conduct remote nonstress tests. OBJECTIVE This study aimed to describe and validate a novel algorithm that uses biopotential and acoustic signals to noninvasively detect uterine contractions via a wireless pregnancy monitor. STUDY DESIGN A prospective, open-label, 2-center study evaluated simultaneous detection of uterine contractions by the wireless pregnancy monitor and an intrauterine pressure catheter in women carrying singleton pregnancies at ≥32 0/7 weeks' gestation who were in the first stage of labor (ClinicalTrials.gov Identifier: NCT03889405). The study consisted of a training phase and a validation phase. Simultaneous recordings from each device were passively acquired for 30 to 60 minutes. In a subset of the monitoring sessions in the validation phase, tocodynamometry was also deployed. Three maternal-fetal medicine specialists, blinded to the data source, identified and marked contractions in all modalities. The positive agreement and false-positive rates of both the wireless monitor and tocodynamometry were calculated and compared with that of the intrauterine pressure catheter. RESULTS A total of 118 participants were included, 40 in the training phase and 78 in the validation phase (of which 39 of 78 participants were monitored simultaneously by all 3 devices) at a mean gestational age of 38.6 weeks. In the training phase, the positive agreement for the wireless monitor was 88.4% (1440 of 1692 contractions), with a false-positive rate of 15.3% (260/1700). In the validation phase, using the refined and finalized algorithm, the positive agreement for the wireless pregnancy monitor was 84.8% (2722/3210), with a false-positive rate of 24.8% (897/3619). For the subgroup who were monitored only with the wireless monitor and intrauterine pressure catheter, the positive agreement was 89.0% (1191/1338), with a similar false-positive rate of 25.4% (406/1597). For the subgroup monitored by all 3 devices, the positive agreement for the wireless monitor was significantly better than for tocodynamometry (P<.0001), whereas the false-positive rate was significantly higher (P<.0001). Unlike tocodynamometry, whose positive agreement was significantly reduced in the group with obesity compared with the group with normal weight (P=.024), the positive agreement of the wireless monitor did not vary across the body mass index groups. CONCLUSION This novel method to noninvasively monitor uterine activity, via a wireless pregnancy monitoring device designed for self-administration at home, was more accurate than the commonly used tocodynamometry and unaffected by body mass index. Together with the previously reported remote fetal heart rate monitoring capabilities, this added ability to detect uterine contractions has created a complete telehealth solution for remote administration of nonstress tests.
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11
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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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12
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Hunter SK, Freedman R, Law AJ, Christians U, Holzman JB, Johnson Z, Hoffman MC. Maternal corticosteroids and depression during gestation and decreased fetal heart rate variability. Neuroreport 2021; 32:1170-1174. [PMID: 34284445 PMCID: PMC9762166 DOI: 10.1097/wnr.0000000000001711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Maternal depression during gestation is an adverse factor in fetal brain development that manifests in later childhood behavioral problems. Fetal heart rate variability (FHRV) mediated by parasympathetic input is a marker of gestational nervous system development. Biological mediators of adverse effects of maternal depression may involve the mother's corticosteroids; however, links between depression, corticosteroids, and early nervous system development remain inconclusive. METHODS Heart rate was recorded in 23 fetuses by transabdominal Doppler at 28-33 weeks gestation. The SD of interbeat intervals over 20 min assessed FHRV. Maternal depression ratings and hair concentrations of cortisol and cortisone were assayed. An auditory sensory gating paradigm assessed newborn development of cerebral inhibition. Parents rated their infant's temperament characteristics on the Infant Behavior Questionnaire-Revised Short Form (IBQ-R). RESULTS Maternal depression was associated with lower FHRV, especially for male fetuses, β = -0.633, P = 0.045. Maternal depression was associated with lower cortisol to total corticosteroids ratios, β = -0.519, P = 0.033. Lower cortisol ratios were associated with decreased FHRV, β = 0.485, P = 0.019. Decreased FHRV was associated with increased newborn sensory gating deficits, β = -0.992, P = 0.035, indicating poorer development of cerebral inhibition. Higher FHRV was related to increased infant IBQ-R self-regulatory behaviors, r = 0.454, P = 0.029. CONCLUSION Maternal depression is associated via corticosteroids with decreased development of nervous system control of fetal heart rate. Decreased FHRV indicates developmental alterations in gestation that correlate with altered brain function and subsequent regulatory challenges in early infancy.
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Affiliation(s)
- Sharon K. Hunter
- Department of Psychiatry, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Robert Freedman
- Department of Psychiatry, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Amanda J. Law
- Department of Psychiatry, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Cell and Developmental Biology, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Medicine, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Uwe Christians
- Department of Anesthesiology, iC42 Clinical Research and Development, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Jacob B.W. Holzman
- Department of Psychiatry, Children’s Hospital Colorado, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Zachary Johnson
- Department of Psychiatry, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - M. Camille Hoffman
- Department of Psychiatry, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Colorado Denver School of Medicine Children’s Hospital Colorado, Aurora, Colorado, USA
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13
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Hadas IM, Joseph M, Luba Z, Michal KL. Assessing parasympathetic measures of heart rate variability shortly after birth to predict motor repertoire at four months in low risk preterm infants born between 28 and 32 weeks of gestation. Early Hum Dev 2021; 161:105438. [PMID: 34392066 DOI: 10.1016/j.earlhumdev.2021.105438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
In low risk preterm infants, the risk for mild to moderate neuro-motor impairment is extremely high. Additionally, the autonomic nervous system (ANS) function was also found to be impaired. ANS activity may predict neuro-motor development at four months corrected age. This study examines the predictive value of the ANS function in detecting neuro-motor impairments during the first 4 months of life among low risk preterm infants born between 28 and 32 weeks of gestation. 46 infants were recruited. For each infant, heart rate variability (HRV) measures were obtained at week born, 32- and 35-weeks postmenstrual age (PMA). The General Movement Assessment (GMA) and the Motor Optimality Score for 3- to 5- Month- Old Infants (MOS) were performed at 35 weeks PMA and at 4 months corrected age respectively. A significant correlation was found between the parasympathetic nervous system (PSNS) components of HRV and the MOS evaluation. Preterm infants with suboptimal MOS scores showed significantly lower HRV values in the components of the PSNS (0.01 < p-value <0.04). A weak correlation was found between the HRV and the GMA. A Receiver Operating Characteristic was designed and revealed the predictive validity of the PSNS in preterm infants with a suboptimal MOS score. The current study shows that among very preterm infants with no additional risk factors, the PSNS component of HRV can predict neuro-motor outcome at 4 months corrected age and may be used as an early sign for mild neuro-motor impairments in order to initiate an early intervention program.
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Affiliation(s)
- Israeli-Mendlovic Hadas
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mendlovic Joseph
- Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
| | - Zuk Luba
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Katz-Leurer Michal
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
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14
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Cerritelli F, Frasch MG, Antonelli MC, Viglione C, Vecchi S, Chiera M, Manzotti A. A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows. Front Neurosci 2021; 15:721605. [PMID: 34616274 PMCID: PMC8488382 DOI: 10.3389/fnins.2021.721605] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors-i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure-may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.
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Affiliation(s)
- Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Martin G. Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability, University of Washington, Seattle, WA, United States
| | - Marta C. Antonelli
- Facultad de Medicina, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis”, Universidad de Buenos Aires, Buenos Aires, Argentina
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chiara Viglione
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Stefano Vecchi
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
- Department of Pediatrics, Division of Neonatology, “V. Buzzi” Children's Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
- Research Department, Istituto Osteopatia Milano, Milan, Italy
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15
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Pingeton BC, Goodman SH, Monk C. Prenatal origins of temperament: Fetal cardiac development & infant surgency, negative affectivity, and regulation/orienting. Infant Behav Dev 2021; 65:101643. [PMID: 34479091 DOI: 10.1016/j.infbeh.2021.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Temperament, i.e. individual differences in reactivity and self-regulation, emerges early in infancy; might temperament originate during fetal development? Mixed findings and methodological issues in the literature examining this consideration limit our understanding of the continuity between these fetal indices and infant temperament. The primary aims of the current study were to improve on published studies by (a) using standardized and well-accepted fetal cardiac (actocardiograph) and infant temperament measures (the Infant Behavior Questionnaire-Revised; IBQ-R) (b) expanding fetal assessments to include coupling (the cross correlation of heart rate with movement), and (c) examining a diverse sample to determine if findings of associations between fetal neurobehavior and infant temperament generalize beyond cohorts that are demographically well-resourced and predominantly white. Building on theory and empirical findings, we hypothesized that (1) FHR would be positively associated with Surgency and Negative Affectivity, (2) FHRV would be positively associated with Surgency, and Regulation/Orienting and inversely associated with Negative Affectivity, and (3) fetal coupling would be positively associated with Regulation/Orienting and Surgency and inversely associated with Negative Affectivity. We collected 20 min of fetal data (m gestational age = 34.42 weeks) and mothers completed the IBQ-R (n = 90 women; 60 % non-Caucasian race; 63 % Latina ethnicity). We found that FHR was positively associated with Negative Affectivity but not associated with Surgency (or Regulation/Orienting). FHRV was inversely associated with Surgency but not associated with Negative Affectivity or Regulation/Orienting. Coupling was positively associated with Regulation/Orienting and Surgency but not associated with Negative Affectivity. Our findings, from a more diverse sample and with established measures, provide further evidence that individual differences in reactivity and regulation can be identified in the in-utero period and show theory-based continuity to specific infant temperament constructs.
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Affiliation(s)
- B C Pingeton
- Department of Psychology, Emory University, United States.
| | - S H Goodman
- Department of Psychology, Emory University, United States
| | - C Monk
- Department of Obstetrics and Gynecology and Psychiatry, Columbia University Irving Medical Center, United States; New York State Psychiatric Institute, United States
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16
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Lucchini M, Shuffrey LC, Nugent JD, Pini N, Sania A, Shair M, Brink L, du Plessis C, Odendaal HJ, Nelson ME, Friedrich C, Angal J, Elliott AJ, Groenewald CA, Burd LT, Myers MM, Fifer WP. Effects of Prenatal Exposure to Alcohol and Smoking on Fetal Heart Rate and Movement Regulation. Front Physiol 2021; 12:594605. [PMID: 34400909 PMCID: PMC8363599 DOI: 10.3389/fphys.2021.594605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Negative associations of prenatal tobacco and alcohol exposure (PTE and PAE) on birth outcomes and childhood development have been well documented, but less is known about underlying mechanisms. A possible pathway for the adverse fetal outcomes associated with PTE and PAE is the alteration of fetal autonomic nervous system development. This study assessed PTE and PAE effects on measures of fetal autonomic regulation, as quantified by heart rate (HR), heart rate variability (SD-HR), movement, and HR-movement coupling in a population of fetuses at ≥ 34 weeks gestational age. Participants are a subset of the Safe Passage Study, a prospective cohort study that enrolled pregnant women from clinical sites in Cape Town, South Africa, and the Northern Plains region, United States. PAE was defined by six levels: no alcohol, low quit early, high quit early, low continuous, moderate continuous, and high continuous; while PTE by 4 levels: no smoking, quit early, low continuous, and moderate/high continuous. Linear regression analyses of autonomic measures were employed controlling for fetal sex, gestational age at assessment, site, maternal education, household crowding, and depression. Analyses were also stratified by sleep state (1F and 2F) and site (South Africa, N = 4025, Northern Plains, N = 2466). The final sample included 6491 maternal-fetal-dyad assessed in the third trimester [35.21 ± 1.26 (mean ± SD) weeks gestation]. PTE was associated with a decrease in mean HR in state 2F, in a dose dependent fashion, only for fetuses of mothers who continued smoking after the first trimester. In state 1F, there was a significant increase in mean HR in fetuses whose mother quit during the first trimester. This effect was driven by the Norther Plains cohort. PTE was also associated with a significant reduction in fetal movement in the most highly exposed group. In South Africa a significant increase in mean HR both for the high quit early and the high continuous group was observed. In conclusion, this investigation addresses a critical knowledge gap regarding the relationship between PTE and PAE and fetal autonomic regulation. We believe these results can contribute to elucidating mechanisms underlying risk for adverse outcomes.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - J. David Nugent
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Nicoló Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Margaret Shair
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Lucy Brink
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Carlie du Plessis
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Hein J. Odendaal
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Morgan E. Nelson
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Christa Friedrich
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Jyoti Angal
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Amy J. Elliott
- Center for Pediatric and Community Research, Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Coen A. Groenewald
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Larry T. Burd
- Department of Pediatrics, University of North Dakota Medical School, Grand Forks, ND, United States
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
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17
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Elmetwally MA, Samy A, Eldesouky A, Lenis YY, Eldomany W. Uterine blood flow, fetal heart rate, gestational length, and fetal birth weight variability in response to maternal temperament in the goat. Anim Sci J 2021; 92:e13563. [PMID: 34013649 DOI: 10.1111/asj.13563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
This prospective study was designed to investigate the effects of maternal temperament on uterine blood flow, fetal heart rate, gestational length, and fetal birth weight in a goat experimental model. Based on the arena test, behavioral testing related to fear-eliciting stimulus, goats were divided into nervous (n = 13) and calm (n = 11) groups. After mating, the perfusion of maternal uterine arteries (UTAs) and its related Doppler parameters, blood flow volume (BFV), time-averaged mean velocity (TAMEANV), acceleration (Acce), and resistance impedance (S/D), were evaluated biweekly from week two until the end of pregnancy. Fetal heart rate (FHR) was investigated during the pregnancy in addition to the gestation length (GL) and fetal birth weight (FBW). The UTA-BFV and TAMEANV, as well as Acce and S/D, were influenced by maternal temperament (p < .05). The FHR showed no significant changes between experimental animals of different temperaments (p = .81). Both GL and FBW were increased in calm rather than nervous goats (p < .05). These results indicated that the maternal nervous (temperament) have negative impacts on uterine artery Doppler indices, fetal growth, and gestational length in a goat experimental model.
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Affiliation(s)
- Mohammed A Elmetwally
- Department of Theriogenology, Mansoura University, Mansoura, Egypt.,Institute of Reproductive Biology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Alaa Samy
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf Eldesouky
- Department of Theriogenology, Mansoura University, Mansoura, Egypt
| | - Yasser Y Lenis
- Division of Animal Science, University of Missouri, Columbia, Missouri, USA.,OHVRI, Health and Veterinary Innovative Research and Development, School of Veterinary Medicine, Faculty of Agrarian Science, Antioquia University, Medellín, Colombia.,Departamento de Ciencia Animal, Facultad de Ciencias Agropecuarias, Universidad Nacional de Colombia, Palmira, Colombia
| | - Wael Eldomany
- Department of Theriogenology, Mansoura University, Mansoura, Egypt
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18
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Koumarela C, Kokkinaki T, Giannakakis G, Koutra K, Hatzidaki E. Autonomic Nervous System Maturation and Emotional Coordination in Interactions of Preterm and Full-Term Infants With Their Parents: Protocol for a Multimethod Study. JMIR Res Protoc 2021; 10:e28089. [PMID: 33843606 PMCID: PMC8076991 DOI: 10.2196/28089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is limited knowledge on the physiological and behavioral pathways that may affect the developmental outcomes of preterm infants and particularly on the link between autonomic nervous system maturation and early social human behavior. Thus, this study attempts to investigate the way heart rate variability (HRV) parameters are related to emotional coordination in interactions of preterm and full-term infants with their parents in the first year of life and the possible correlation with the developmental outcomes of infants at 18 months. Objective The first objective is to investigate the relationship between emotional coordination and HRV in dyadic full-term infant–parent (group 1) and preterm infant–parent (group 2) interactions during the first postpartum year. The second objective is to examine the relationship of emotional coordination and HRV in groups 1 and 2 in the first postpartum year with the developmental outcomes of infants at 18 months. The third objective is to investigate the effect of maternal and paternal postnatal depression on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. The fourth objective is to examine the effect of family cohesion and coping on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. Methods This is an observational, naturalistic, and longitudinal study applying a mixed method design that includes the following: (1) video recordings of mother-infant and father-infant interactions at the hospital, in the neonatal period, and at home at 2, 4, 6, 9, and 12 months of the infants’ life; (2) self-report questionnaires of parents on depressive symptoms, family cohesion, and dyadic coping of stress; (3) infants’ HRV parameters in the neonatal period and at each of the above age points during and after infant-parent video recordings; and (4) assessment of toddlers’ social and cognitive development at 18 months through an observational instrument. Results The study protocol has been approved by the Research Ethics Committee of the University of Crete (number/date: 170/September 18, 2020). This work is supported by the Special Account for Research Funds of the University of Crete (grant number: 10792-668/08.02.2021). All mothers (with their partners) of full-term and preterm infants who give birth between March 2021 and January 2022 at the General University Hospital of Crete (northern Crete, Greece) will be invited to participate. The researcher will invite the parents of infants to participate in the study 1 to 2 days after birth. Data collection is expected to be completed by March 2023, and the first results will be published by the end of 2023. Conclusions Investigating the regulatory role of HRV and social reciprocity in preterm infants may have implications for both medicine and psychology. International Registered Report Identifier (IRRID) PRR1-10.2196/28089
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Affiliation(s)
- Christina Koumarela
- Laboratory of Applied Psychology, Department of Psychology, University of Crete, Rethymnon, Greece
| | - Theano Kokkinaki
- Laboratory of Applied Psychology, Department of Psychology, University of Crete, Rethymnon, Greece
| | - Giorgos Giannakakis
- Institute of Computer Science, Foundation of Research and Technology, Heraklion, Greece
| | - Katerina Koutra
- Department of Psychology, University of Crete, Rethymnon, Greece
| | - Eleftheria Hatzidaki
- Department of Neonatology, Neonatal Intensive Care Unit, School of Medicine, University of Crete, Heraklion, Greece
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19
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Howland MA, Sandman CA, Davis EP, Stern HS, Phelan M, Baram TZ, Glynn LM. Prenatal maternal mood entropy is associated with child neurodevelopment. Emotion 2021; 21:489-498. [PMID: 32202848 PMCID: PMC10491461 DOI: 10.1037/emo0000726] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emerging evidence indicates that the predictability of signals early in life may influence the developing brain. This study examines links between a novel indicator of maternal mood dysregulation, mood entropy, and child neurodevelopmental outcomes. Associations between prenatal maternal mood entropy and child neurodevelopment were assessed in 2 longitudinal cohorts. Maternal mood was measured several times over pregnancy beginning as early as 15 weeks' gestation. Shannon's mood entropy was applied to distributions of mothers' responses on mood questionnaires. Child cognitive and language development were evaluated at 2 and 6-9 years of age. Higher prenatal maternal mood entropy was associated with lower cognitive development scores at 2 years of age and lower expressive language scores at 6-9 years of age. These associations persisted after adjusting for maternal pre and postnatal mood levels and for other relevant sociodemographic factors. Our findings identify maternal mood entropy as a novel predictor of child neurodevelopment. Characterizing components of maternal mood in addition to level of severity or valence may further our understanding of specific processes by which maternal mood shapes child development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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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
| | - Hal S. Stern
- Department of Statistics, University of California, Irvine, CA, USA
| | - Michael Phelan
- Department of Statistics, University of California, Irvine, CA, USA
| | - Tallie Z. Baram
- Department of Anatomy/Neurobiology, University of California, Irvine, CA USA
- Department of Pediatrics, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
| | - Laura M. Glynn
- Department of Psychiatry & Human Behavior, University of California, Irvine, CA, USA
- Department of Psychology, Chapman University, Orange, CA, USA
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20
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Campbell KSJ, Collier AC, Irvine MA, Brain U, Rurak DW, Oberlander TF, Lim KI. Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation. Front Psychiatry 2021; 12:680177. [PMID: 34483982 PMCID: PMC8415315 DOI: 10.3389/fpsyt.2021.680177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants increases risk for adverse neurodevelopmental outcomes, yet little is known about whether effects are present before birth. In relation to maternal SRI pharmacokinetics, this study investigated chronic and acute effects of prenatal SRI exposure on third-trimester fetal heart rate variability (HRV), while evaluating confounding effects of maternal depressed mood. Methods: At 36-weeks' gestation, cardiotocograph measures of fetal HR and HRV were obtained from 148 pregnant women [four groups: SRI-Depressed (n = 31), SRI-Non-Depressed (n = 18), Depressed (unmedicated; n = 42), and Control (n = 57)] before, and ~5-h after, typical SRI dose. Maternal plasma drug concentrations were quantified at baseline (pre-dose) and four time-points post-dose. Mixed effects modeling investigated group differences between baseline/pre-dose and post-dose fetal HR outcomes. Post hoc analyses investigated sex differences and dose-dependent SRI effects. Results: Maternal SRI plasma concentrations were lowest during the baseline/pre-dose fetal assessment (trough) and increased to a peak at the post-dose assessment; concentration-time curves varied widely between individuals. No group differences in fetal HR or HRV were observed at baseline/pre-dose; however, following maternal SRI dose, short-term HRV decreased in both SRI-exposed fetal groups. In the SRI-Depressed group, these post-dose decreases were displayed by male fetuses, but not females. Further, episodes of high HRV decreased post-dose relative to baseline, but only among SRI-Non-Depressed group fetuses. Higher maternal SRI doses also predicted a greater number of fetal HR decelerations. Fetuses exposed to unmedicated maternal depressed mood did not differ from Controls. Conclusions: Prenatal SRI exposure had acute post-dose effects on fetal HRV in late gestation, which differed depending on maternal mood response to SRI pharmacotherapy. Importantly, fetal SRI effects were sex-specific among mothers with persistent depressive symptoms, as only male fetuses displayed acute HRV decreases. At trough (pre-dose), chronic fetal SRI effects were not identified; however, concurrent changes in maternal SRI plasma levels suggest that fetal drug exposure is inconsistent. Acute SRI-related changes in fetal HRV may reflect a pharmacologic mechanism, a transient impairment in autonomic functioning, or an early adaption to altered serotonergic signaling, which may differ between males and females. Replication is needed to determine significance with postnatal development.
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Affiliation(s)
- Kayleigh S J Campbell
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Abby C Collier
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ursula Brain
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Dan W Rurak
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth I Lim
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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21
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Schlatterer SD, du Plessis AJ. Exposures influencing the developing central autonomic nervous system. Birth Defects Res 2020; 113:845-863. [PMID: 33270364 DOI: 10.1002/bdr2.1847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022]
Abstract
Autonomic nervous system function is critical for transition from in-utero to ex-utero life and is associated with neurodevelopmental and neuropsychiatric outcomes later in life. Adverse prenatal and neonatal conditions and exposures can impair or alter ANS development and, as a result, may also impact long-term neurodevelopmental outcomes. The objective of this article is to provide a broad overview of the impact of factors that are known to influence autonomic development during the fetal and early neonatal period, including maternal mood and stress during and after pregnancy, fetal growth restriction, congenital heart disease, toxic exposures, and preterm birth. We touch briefly on the typical development of the ANS, then delve into both in-utero and ex-utero maternal and fetal factors that may impact developmental trajectory of the ANS and, thus, have implications in transition and in long-term developmental outcomes. While many types of exposures and conditions have been shown to impact development of the autonomic nervous system, there is still much to be learned about the mechanisms underlying these influences. In the future, more advanced neuromonitoring tools will be required to better understand autonomic development and its influence on long-term neurodevelopmental and neuropsychological function, especially during the fetal period.
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Affiliation(s)
- Sarah D Schlatterer
- Children's National Hospital, Prenatal Pediatrics Institute, Washington, District of Columbia, USA.,George Washington University School of Health Sciences, Departments of Neurology and Pediatrics, Washington, District of Columbia, USA
| | - Adre J du Plessis
- Children's National Hospital, Prenatal Pediatrics Institute, Washington, District of Columbia, USA.,George Washington University School of Health Sciences, Departments of Neurology and Pediatrics, Washington, District of Columbia, USA
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22
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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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23
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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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24
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Israeli-Mendlovic H, Mendlovic J, Zuk L, Katz-Leurer M. Reproducibility of 24-h heart rate variability measures in preterm infants born at 28-32 weeks of gestation. Early Hum Dev 2020; 148:105117. [PMID: 32604010 DOI: 10.1016/j.earlhumdev.2020.105117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023]
Abstract
AIMS To determine the reproducibility and minimum detectable change (MDC) of heart rate variability (HRV) measures during two sequential 24-h periods, at week 32 of gestation, in preterm infants born between 28 and 32 weeks, hospitalized in the neonatal intensive care unit (NICU). The second aim is to assess postnatal changes in HRV measures between 32 and 35 weeks. STUDY DESIGN 32 preterm infants born between 28 and 32 weeks of gestation were recruited. For each infant 48 h of recordings of RR interval were performed at week 32 and week 35. HRV parameters included time and frequency parameters. RESULTS At week 32, the intra-class correlation coefficient (ICC) of all HRV values was statistically significant with high correlation coefficients (ICC = 0.83-0.97). At week 35, a significant increase was noted in the HRV parameters, characterize mainly the sympathetic tone, with over half the infants showing an increase greater than the MDC for these parameters. CONCLUSIONS Using 24-h recording at week 32 of gestation during NICU routine is reliable, feasible, not costly and may have important implications for an early identification of premature in a state of stress such as sepsis, or as a follow-up measure.
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Affiliation(s)
- H Israeli-Mendlovic
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - J Mendlovic
- Shaare-Zedek Medical Center, Jerusalem, Israel
| | - L Zuk
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - M Katz-Leurer
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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25
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Cardiac interaction between mother and infant: enhancement of heart rate variability. Sci Rep 2019; 9:20019. [PMID: 31882635 PMCID: PMC6934483 DOI: 10.1038/s41598-019-56204-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/09/2019] [Indexed: 02/05/2023] Open
Abstract
The vagal activity of infants is represented by heart rate variability (HRV) and associated with both growth and socioemotional development. The enhancement of an infant's vagal tone activity might be beneficial for development. This study explored whether HRV in infants aged 3-8 months can be enhanced by influencing HRV in mothers (40 dyads). The power of the low frequency (LF) component of maternal HRV was facilitated using slow-paced breathing. We investigated whether the change in maternal HRV affected the LF component in infants held by their mothers. In older infants (N = 14, 6-8 months) the LF power showed an increase during maternal paced breathing, whereas a delayed increase occurred after termination of maternal paced breathing in younger infants (N = 16, 3-5 months). These results show that the effects of maternal cardiac activity on the infant's HRV are age-dependent. This age-dependent reactivity of the infant's HRV could be due to the development of the inner model in infants which regulates physiological functions, including cardiac activity. This finding might help develop efficient methods for enhancing vagal nerve activity in infants.
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26
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Autonomic signatures of late preterm, early term, and full term neonates during early postnatal life. Early Hum Dev 2019; 137:104817. [PMID: 31352221 DOI: 10.1016/j.earlhumdev.2019.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Late preterm and early term births account for ~25% of live births. Infants born prior to term are at significantly higher risk for subsequent morbidity and mortality. AIMS Determine autonomic regulation differences in infants (35-40 weeks gestation) during sleep at birth and one-month after delivery. STUDY DESIGN Consecutive enrollment until at least 20 infants per group: 75 late preterm (35-36 weeks gestation), 110 early term (37-38 weeks), and 130 full term (39-40 weeks). Assess autonomic parameters 12-84 h after delivery and again at one month of life. SUBJECTS 329 newborns met inclusion criteria. EXCLUSIONS maternal age < 18 years, major maternal medical problems, psychiatric medications, drug use, Apgar <8 at 5 min, medical complications requiring other than standard care, non-English or non-Spanish speaking. OUTCOME MEASURES Heart rate and two measures of heart rate variability in active and quiet sleep at birth and at one month of life. RESULTS Late preterm and early term newborns demonstrate immature patterns of autonomic regulation at birth. Heart rate decreased with gestational age in both sleep states whereas the standard deviation of R-R intervals and beat-to-beat variability in heart rate both increased with gestational age in both sleep states. One month after delivery, i.e. at term-equivalent age, late preterm infants continued to have higher heart rates than infants born full term; and their heart rate was also significantly higher when compared to that of full term newborns at birth, i.e. their autonomic signature did not "normalize" over the first four weeks of life. Early term infants, however, did not differ from full term infants when they reached a postmenstrual age of 44 weeks. CONCLUSION The specific patterns of immature autonomic regulation in late preterm and early term infants during early postnatal life may underlie their increased morbidity and mortality in infancy and later in development. Future studies should address how early autonomic measures might relate to adverse outcomes. Results suggest the need for autonomic nomograms at birth and at one month after delivery that are stratified by both gestational week and sleep state.
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27
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Saboory E, Mohammadi S, Dindarian S, Mohammadi H. Prenatal stress and elevated seizure susceptibility: Molecular inheritable changes. Epilepsy Behav 2019; 96:122-131. [PMID: 31132613 DOI: 10.1016/j.yebeh.2019.04.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 01/08/2023]
Abstract
Stressful episodes are common during early-life and may have a wide range of negative effects on both physical and mental status of the offspring. In addition to various neurobehavioral complications induced by prenatal stress (PS), seizure is a common complication with no fully explained cause. In this study, the association between PS and seizure susceptibility was reviewed focusing on sex differences and various underlying mechanisms. The role of drugs in the initiation of seizure and the effects of PS on the nervous system that prone the brain for seizure, especially the hypothalamic-pituitary-adrenal (HPA) axis, are also discussed in detail by reviewing the papers studying the effect of PS on glutamatergic, gamma-aminobutyric acid (GABA)ergic, and adrenergic systems in the context of seizure and epilepsy. Finally, epigenetic changes in epilepsy are described, and the underlying mechanisms of this change are expanded. As the effects of PS may be life-lasting, it is possible to prevent future psychiatric and behavioral disorders including epilepsy by preventing avoidable PS risk factors.
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Affiliation(s)
- Ehsan Saboory
- Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Sedra Mohammadi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.
| | - Sina Dindarian
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hozan Mohammadi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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28
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Harrison TM. Improving neurodevelopment in infants with complex congenital heart disease. Birth Defects Res 2019; 111:1128-1140. [PMID: 31099484 DOI: 10.1002/bdr2.1517] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
Worldwide, more than 400,000 infants are born each year with complex congenital heart disease (CCHD) requiring surgical intervention within the first months of life. Although improvements in perioperative care have resulted in increased rates of survival, more than half of infants with CCHD have neurodevelopmental impairments affecting subsequent educational achievements, job opportunities, and mental health. Brain maturity and impaired outcomes in infants with CCHD are similar to those of prematurely born infants. Developmentally supportive care, including foundational application of kangaroo care (KC), improves neurodevelopment in premature infants. Provision of developmentally supportive care with KC during the early hospitalization of infants with CCHD has the potential to similarly improve neurodevelopment. The purposes of the article are to describe common congenital heart defects, describe developmentally supportive care with an emphasis on KC, and to offer specific recommendations for KC and research in infants with CCHD.
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29
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Ask TF, Ranjitkar S, Ulak M, Chandyo RK, Hysing M, Strand TA, Kvestad I, Shrestha L, Andreassen M, Lugo RG, Shilpakar JS, Shrestha M, Sütterlin S. The Association Between Heart Rate Variability and Neurocognitive and Socio-Emotional Development in Nepalese Infants. Front Neurosci 2019; 13:411. [PMID: 31105521 PMCID: PMC6499022 DOI: 10.3389/fnins.2019.00411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many young children in developing countries do not reach their developmental potential. Traditional methods for assessing developmental outcome are time consuming, thus, physiological measures that can contribute to the prediction of developmental outcomes in high risk groups have been suggested. Vagally mediated heart rate variability (vmHRV) is considered a neurophysiological or peripheral proxy for prefrontal and executive functioning and might serve as a supplement for traditional measurements of developmental status and as a potential useful risk indicator. AIM In the present study, we wanted to describe the vmHRV in Nepalese infants and relate it to the Bayley Scales of infant and toddler development, 3. edition (Bayley-III) subscales. METHODS 600 Nepalese infants were included in the study. At 6-11 and 17-24 months, we measured neurodevelopmental and socio-emotional outcomes by the Bayley-III. Inter-beat intervals were recorded at two measurement points when the children were 17-24 months. RESULTS There was a high intraclass correlation between HRV indices generated from the two measurement points. No significant associations between vmHRV and Bayley-III sub scales were found at any time. CONCLUSION This study is the first to describe vmHRV in healthy infants and the relationship between Bayley-III scores. Our results suggest that vmHRV is not associated with measures of general development in infancy.
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Affiliation(s)
- Torvald F. Ask
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Suman Ranjitkar
- Child Health Research Project, Department of Pediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Manjeswori Ulak
- Child Health Research Project, Department of Pediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Ram K. Chandyo
- Child Health Research Project, Department of Pediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tor A. Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Ingrid Kvestad
- Regional Center for Child and Youth Mental Health, NORCE Norwegian Research Center, Bergen, Norway
| | - Laxman Shrestha
- Child Health Research Project, Department of Pediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Marita Andreassen
- RG-CHaP, Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Ricardo G. Lugo
- RG-CHaP, Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Jaya S. Shilpakar
- Child Health Research Project, Department of Pediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Merina Shrestha
- Child Health Research Project, Department of Pediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Stefan Sütterlin
- Faculty of Health and Welfare Sciences, Østfold University College, Halden, Norway
- Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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30
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Zeegers MA, de Vente W, Nikolić M, Majdandžić M, Bögels SM, Colonnesi C. Mothers' and fathers' mind-mindedness influences physiological emotion regulation of infants across the first year of life. Dev Sci 2018; 21:e12689. [PMID: 29920863 PMCID: PMC6220880 DOI: 10.1111/desc.12689] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 04/20/2018] [Indexed: 11/28/2022]
Abstract
The main aim of this study was to test whether mothers' (n = 116) and fathers' (n = 116) mind-mindedness predicts infants' physiological emotion regulation (heart rate variability; HRV) across the first year of life. Three hypotheses were examined: (a) parents' mind-mindedness at 4 and 12 months predicts infants' HRV at 12 months over and above infants' initial HRV levels at 4 months, (b) mothers' and fathers' mind-mindedness independently predict infant HRV, and (c) the effects of mind-mindedness on infant HRV (partially) operate via parenting behaviour. Infants' HRV was assessed during rest and a stranger approach. Mind-mindedness was assessed by calculating the proportions of appropriate and non-attuned mind-related comments during free-play interactions, and parenting quality was observed at 4 and 12 months in the same interactions. Path analyses showed that mothers' appropriate mind-related comments at 4 and 12 months predicted higher baseline HRV at 12 months, whereas mothers' non-attuned comments predicted lower baseline HRV at 12 months. Similar, but concurrent, relations were found for fathers' appropriate and non-attuned mind-related comments and infant baseline HRV at 12 months. In addition, fathers' appropriate mind-related comments showed an indirect association with infant baseline HRV at 12 months via fathers' parenting quality. With regard to infant HRV reactivity during the stranger approach, mothers' appropriate mind-related comments at 4 months and fathers' non-attuned mind-related comments at 12 months predicted a larger HRV decline during the stranger approach at 12 months. Infants' HRV at 4 months did not predict parents' later mind-mindedness. The results indicate that mothers' and fathers' appropriate and non-attuned mind-related speech uniquely impacts the development of infants' physiological emotion regulation.
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Affiliation(s)
- Moniek A.J. Zeegers
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wieke de Vente
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Milica Nikolić
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjana Majdandžić
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Cristina Colonnesi
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
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31
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Major depressive disorder during pregnancy: Psychiatric medications have minimal effects on the fetus and infant yet development is compromised. Dev Psychopathol 2018; 30:773-785. [PMID: 30068426 DOI: 10.1017/s0954579418000639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psychotropic medication use and psychiatric symptoms during pregnancy each are associated with adverse neurodevelopmental outcomes in offspring. Commonly, studies considering medication effects do not adequately assess symptoms, nor evaluate children when the effects are believed to occur, the fetal period. This study examined maternal serotonin reuptake inhibitor and polypharmacy use in relation to serial assessments of five indices of fetal neurobehavior and Bayley Scales of Infant Development at 12 months in N = 161 socioeconomically advantaged, non-Hispanic White women with a shared risk phenotype, diagnosed major depressive disorder. On average fetuses showed the expected development over gestation. In contrast, infant average Bayley psychomotor and mental development scores were low (M = 84.10 and M = 89.92, range of normal limits 85-114) with rates of delay more than 2-3 times what would be expected based on this measure's normative data. Controlling for prenatal and postnatal depressive symptoms, prenatal medication effects on neurobehavioral development were largely undetected in the fetus and infant. Mental health care directed primarily at symptoms may not address the additional psychosocial needs of women parenting infants. Speculatively, prenatal serotonin reuptake inhibitor exposure may act as a plasticity rather than risk factor, potentially enhancing receptivity to a nonoptimal postnatal environment in some mother-infant dyads.
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32
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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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Bazelmans T, Jones EJH, Ghods S, Corrigan S, Toth K, Charman T, Webb SJ. Heart rate mean and variability as a biomarker for phenotypic variation in preschoolers with autism spectrum disorder. Autism Res 2018; 12:39-52. [PMID: 30114343 DOI: 10.1002/aur.1982] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/06/2018] [Accepted: 06/10/2018] [Indexed: 02/03/2023]
Abstract
Interest in autonomic arousal in autism spectrum disorder (ASD) is increasing; however, reliability of these measures in ASD is unknown, and previously reported associations with social and cognitive abilities are inconsistent. This study assesses heart rate (HR) and HR variability (HRV) in preschoolers with ASD or typical development (TD) while they passively watched naturalistic videos. Measurement reliability, group differences, and the relationship with social and cognitive abilities were evaluated. Seventy one ASD and 66 TD children (2-4 years) provided cardiac data from two sessions. Test-retest intraclass correlations of HR and HRV over a 3-week period were moderate to good in both groups. Groups did not differ in mean level of HR or HRV. Intra-individual variability of HR between video segments within a session was higher in the ASD group, but intraclass correlations of this metric were low. Higher HR related to better language skills in TD children, but not after accounting for age and nonverbal ability. Higher HRV related to better expressive and receptive language in ASD children after controlling for age and nonverbal ability. HR/HRV were not related to social or executive functioning skills and did not explain any additional variance in abilities at a 12-month follow-up visit. In summary, variation in language abilities is associated with HR in the TD group and HRV in the ASD group. While preliminary, these results are promising for consideration of autonomic control as a biomarker for individual differences in ASD and may help us understand the mechanisms that contribute to communication skills. Autism Research 2019, 12: 39-52. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Cardiac activity, such as heart rate and heart rate variability, is linked to a wide range of psychological functions. This study shows that there is an association between heart rate and heart rate variability and language skills in young children with autism spectrum disorder (ASD). These results may help us understand what underlies individual differences in developmental abilities in young children with ASD.
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Affiliation(s)
- Tessel Bazelmans
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Sheila Ghods
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Sarah Corrigan
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Karen Toth
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Tony Charman
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sara J Webb
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington
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Hayat TTA, Rutherford MA. Neuroimaging perspectives on fetal motor behavior. Neurosci Biobehav Rev 2018; 92:390-401. [PMID: 29886176 DOI: 10.1016/j.neubiorev.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
We are entering a new era of understanding human development with the ability to perform studies at the earliest time points possible. There is a substantial body of evidence to support the concept that early motor behaviour originates from supraspinal motor centres, reflects neurological integrity, and that altered patterns of behaviour precede clinical manifestation of disease. Cine Magnetic Resonance Imaging (cineMRI) has established its value as a novel method to visualise motor behaviour in the human fetus, building on the wealth of knowledge gleaned from ultrasound based studies. This paper presents a state of the art review incorporating findings from human and preclinical models, the insights from which, we propose, can proceed a reconceptualisation of fetal motor behaviour using advanced imaging techniques. Foremost is the need to better understand the role of the intrauterine environment, and its inherent unique set of stimuli that activate sensorimotor pathways and shape early brain development. Finally, an improved model of early motor development, combined with multimodal imaging, will provide a novel source of in utero biomarkers predictive of neurodevelopmental disorders.
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Affiliation(s)
- Tayyib T A Hayat
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Mary A Rutherford
- Centre for the Developing Brain, Perinatal Imaging & Health, Imaging Sciences & Biomedical Engineering Division, King's College London, London, United Kingdom
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Maternal Immune Activation During the Third Trimester Is Associated with Neonatal Functional Connectivity of the Salience Network and Fetal to Toddler Behavior. J Neurosci 2018; 38:2877-2886. [PMID: 29487127 DOI: 10.1523/jneurosci.2272-17.2018] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/06/2018] [Accepted: 01/22/2018] [Indexed: 12/14/2022] Open
Abstract
Prenatal maternal immune activation (MIA) is associated with altered brain development and risk of psychiatric disorders in offspring. Translational human studies of MIA are few in number. Alterations of the salience network have been implicated in the pathogenesis of the same psychiatric disorders associated with MIA. If MIA is pathogenic, then associated abnormalities in the salience network should be detectable in neonates immediately after birth. We tested the hypothesis that third trimester MIA of adolescent women who are at risk for high stress and inflammation is associated with the strength of functional connectivity in the salience network of their neonate. Thirty-six women underwent blood draws to measure interleukin-6 (IL-6) and C-reactive protein (CRP) and electrocardiograms to measure fetal heart rate variability (FHRV) at 34-37 weeks gestation. Resting-state imaging data were acquired in the infants at 40-44 weeks postmenstrual age (PMA). Functional connectivity was measured from seeds placed in the anterior cingulate cortex and insula. Measures of cognitive development were obtained at 14 months PMA using the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). Both sexes were studied. Regions in which the strength of the salience network correlated with maternal IL-6 or CRP levels included the medial prefrontal cortex, temporoparietal junction, and basal ganglia. Maternal CRP level correlated inversely with FHRV acquired at the same gestational age. Maternal CRP and IL-6 levels correlated positively with measures of cognitive development on the BSID-III. These results suggest that MIA is associated with short- and long-term influences on offspring brain and behavior.SIGNIFICANCE STATEMENT Preclinical studies in rodents and nonhuman primates and epidemiological studies in humans suggest that maternal immune activation (MIA) alters the development of brain circuitry and associated behaviors, placing offspring at risk for psychiatric illness. Consistent with preclinical findings, we show that maternal third trimester interleukin-6 and C-reactive protein levels are associated with neonatal functional connectivity and with both fetal and toddler behavior. MIA-related functional connectivity was localized to the salience, default mode, and frontoparietal networks, which have been implicated in the pathogenesis of psychiatric disorders. Our results suggest that MIA alters functional connectivity in the neonatal brain, that those alterations have consequences for cognition, and that these findings may provide pathogenetic links between preclinical and epidemiological studies associating MIA with psychiatric risk in offspring.
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Bush NR, Jones-Mason K, Coccia M, Caron Z, Alkon A, Thomas M, Coleman-Phox K, Wadhwa PD, Laraia BA, Adler NE, Epel ES. Effects of pre- and postnatal maternal stress on infant temperament and autonomic nervous system reactivity and regulation in a diverse, low-income population. Dev Psychopathol 2017; 29:1553-1571. [PMID: 29162167 PMCID: PMC5726291 DOI: 10.1017/s0954579417001237] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We examined the prospective associations of objective and subjective measures of stress during pregnancy with infant stress reactivity and regulation, an early-life predictor of psychopathology. In a racially and ethnically diverse low-income sample of 151 mother-infant dyads, maternal reports of stressful life events (SLE) and perceived stress (PS) were collected serially over gestation and the early postpartum period. Infant reactivity and regulation at 6 months of age was assessed via maternal report of temperament (negativity, surgency, and regulation) and infant parasympathetic nervous system physiology (respiratory sinus arrhythmia [RSA]) during the Still Face Paradigm. Regression models predicting infant temperament showed higher maternal prenatal PS predicted lower surgency and self-regulation but not negativity. Regression models predicting infant physiology showed higher numbers of SLE during gestation predicted greater RSA reactivity and weaker recovery. Tests of interactions revealed SLE predicted RSA reactivity only at moderate to high levels of PS. Thus, findings suggest objective and subjective measures of maternal prenatal stress uniquely predict infant behavior and physiology, adjusting for key pre- and postnatal covariates, and advance the limited evidence for such prenatal programming within high-risk populations. Assessing multiple levels of maternal stress and offspring stress reactivity and regulation provides a richer picture of intergenerational transmission of adversity.
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Affiliation(s)
- Nicole R. Bush
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
- Department of Pediatrics, University of California, San Francisco
| | - Karen Jones-Mason
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
| | - Michael Coccia
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
| | - Zoe Caron
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
| | - Abbey Alkon
- Department of Nursing, University of California, San Francisco
| | - Melanie Thomas
- Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Kim Coleman-Phox
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
| | - Pathik D. Wadhwa
- School of Medicine, Development, Health and Disease Research Program, University of California, Irvine
| | | | - Nancy E. Adler
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
| | - Elissa S. Epel
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
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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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38
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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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39
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Dewi M, Carlson SE, Gustafson KM, Sullivan DK, Wick JA, Hull HR. Programming of infant neurodevelopment by maternal obesity: potential role of maternal inflammation and insulin resistance. Asia Pac J Clin Nutr 2017. [PMID: 28625035 DOI: 10.6133/apjcn.062017.s11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent studies show that maternal obesity is associated with impaired offspring neurodevelopmental outcomes. The mechanism underlying the association is unclear. However, there is evidence to suggest a role for intra-uterine exposure to inflammation and insulin resistance (IR). We aimed to determine if maternal IR and inflammation were associated to fetal neurodevelopment as indicated by fetal heart rate variability (HRV), an index of fetal cardiac autonomic nervous system development. METHODS AND STUDY DESIGN A total of 44 healthy maternal-fetal pairs (maternal pre-pregnancy BMI distribution: n=20 normal weight, 8 overweight, 16 obese) were analyzed. We assessed maternal inflammation (plasma IL-6 and TNF-α) and IR (HOMA index). Fetal HRV, a proxy for fetal neurodevelopment, was assessed using fetal magnetocardiogram at the 36th week of pregnancy. The relationships between maternal inflammation and IR with fetal HRV (SD1 and SD2) were estimated individually by Pearson bivariate correlations. RESULTS No correlations were observed between the fetal HRV components with maternal HOMA-IR and maternal plasma levels of IL-6 and TNF-α (all p<0.05). However, the negative association between maternal TNF-α level and fetal SD2 approached significance (correlation coefficient=-0.29, 95% confidence interval=-0.62,-0.03, p=0.07). CONCLUSION Maternal IR and inflammation during pregnancy were not associated with fetal cardiac autonomic nervous system development. Further studies with a larger sample size and more maternal inflammatory indicators are needed to explore these relationships.
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Affiliation(s)
- Mira Dewi
- Department of Dietetics and Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Community Nutrition, Faculty of Human Ecology, Bogor Agricultural University, Bogor, Indonesia
| | - Susan E Carlson
- Department of Community Nutrition, Faculty of Human Ecology, Bogor Agricultural University, Bogor, Indonesia
| | - Kathleen M Gustafson
- Department of Neurology, School of Medicine, Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, USAa
| | - Debra K Sullivan
- Department of Community Nutrition, Faculty of Human Ecology, Bogor Agricultural University, Bogor, Indonesia
| | - Jo A Wick
- Department of Biostatistics, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Holly R Hull
- Department of Dietetics and Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
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40
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JAVORKA K, LEHOTSKA Z, KOZAR M, UHRIKOVA Z, KOLAROVSZKI B, JAVORKA M, ZIBOLEN M. Heart Rate Variability in Newborns. Physiol Res 2017; 66:S203-S214. [DOI: 10.33549/physiolres.933676] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Heart rate (HR) and heart rate variability (HRV) in newborns is influenced by genetic determinants, gestational and postnatal age, and other variables. Premature infants have a reduced HRV. In neonatal HRV evaluated by spectral analysis, a dominant activity can be found in low frequency (LF) band (combined parasympathetic and sympathetic component). During the first postnatal days the activity in the high frequency (HF) band (parasympathetic component) rises, together with an increase in LF band and total HRV. Hypotrophy in newborn can cause less mature autonomic cardiac control with a higher contribution of sympathetic activity to HRV as demonstrated by sequence plot analysis. During quiet sleep (QS) in newborns HF oscillations increase – a phenomenon less expressed or missing in premature infants. In active sleep (AS), HRV is enhanced in contrast to reduced activity in HF band due to the rise of spectral activity in LF band. Comparison of the HR and HRV in newborns born by physiological vaginal delivery, without (VD) and with epidural anesthesia (EDA) and via sectio cesarea (SC) showed no significant differences in HR and in HRV time domain parameters. Analysis in the frequency domain revealed, that the lowest sympathetic activity in chronotropic cardiac chronotropic regulation is in the VD group. Different neonatal pathological states can be associated with a reduction of HRV and an improvement in the health conditions is followed by changes in HRV what can be use as a possible prognostic marker. Examination of heart rate variability in neonatology can provide information on the maturity of the cardiac chronotropic regulation in early postnatal life, on postnatal adaptation and in pathological conditions about the potential dysregulation of cardiac function in newborns, especially in preterm infants.
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Affiliation(s)
- K. JAVORKA
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Commenius University in Bratislava, Martin, Slovakia
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Siddiqui S, Fifer WP, Ordonez-Retamar M, Nugent JD, Williams IA. An antenatal marker of neurodevelopmental outcomes in infants with congenital heart disease. J Perinatol 2017; 37:953-957. [PMID: 28471442 PMCID: PMC5578909 DOI: 10.1038/jp.2017.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Prenatal exposures are known to alter fetal neurodevelopment and autonomic control. We aimed to explore the correlation between fetal autonomic activity, measured by fetal heart rate variability, and 18-month developmental outcome in subjects with congenital heart disease. STUDY DESIGN From 2010 to 2013, 5 fetuses with hypoplastic left heart syndrome, 9 with transposition of the great arteries and 9 with tetralogy of Fallot were included in this prospective cohort study. A maternal abdominal fetal electrocardiogram monitor recorded fetal heart rate at 34 to 38 weeks gestational age. We assessed associations between fetal heart rate parameters including interquartile range and s.d. of the fetal RR intervals and 18-month Bayley Scales of Infant Development-III scores using Pearson's correlation coefficient. Multivariable regression modeling identified predictors of neurodevelopmental scores. RESULTS Fetal heart rate variability parameters at 34 to 38 weeks gestational age correlated with 18-month Cognition (r=0.47, P=0.03) and Motor scores (r=0.66, P=0.001). The interquartile range of the fetal RR intervals predicted Cognition (β=0.462, P=0.028, R2=0.282) and Motor (β=0.637, P<0.001, R2=0.542) scores. CONCLUSIONS In fetuses with congenital heart disease, low heart rate variability at 34 to 38 weeks gestational age predicts diminished 18-month Cognitive and Motor performance. Prenatal autonomic activity may serve as a marker of early childhood development in these high-risk patients.
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Affiliation(s)
- Saira Siddiqui
- Department of Pediatrics, Columbia University Medical Center, New
York, NY
| | - William P. Fifer
- Department of Psychiatry, Columbia University Medical Center, New
York, NY
- Department of Pediatrics, Columbia University Medical Center, New
York, NY
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
| | - Maria Ordonez-Retamar
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
| | - J. David Nugent
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
| | - Ismée A. Williams
- Department of Pediatrics, Columbia University Medical Center, New
York, NY
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
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Özdemir R, Olukman Ö, Karadeniz C, Çelik K, Katipoğlu N, Muhtar Yılmazer M, Çalkavur Ş, Meşe T, Arslanoğlu S. Effect of unconjugated hyperbilirubinemia on neonatal autonomic functions: evaluation by heart rate variability. J Matern Fetal Neonatal Med 2017; 31:2763-2769. [PMID: 28707558 DOI: 10.1080/14767058.2017.1355901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Serum bilirubin levels beyond the physiological limits, may lead to alterations in autonomic regulation in a newborn infant. Heart rate variability (HRV), is a noninvasive and quantitative marker of the activity of the autonomic nervous system (ANS). To date, few studies have demonstrated the undesirable effects of severe unconjugated hyperbilirubinemia (UHB) on autonomic functions, and only one study has used HRV as a marker of the autonomic activity. However, the relationship between altered cardiac autonomic functions and UHB by using the HRV derived from 24-hour Holter electrocardiography (ECG) recording has not been investigated previously. OBJECTIVE We aimed to assess whether a relationship exists between severe UHB and cardiac autonomic dysfunction by evaluating HRV via 24-hour Holter ECG recording. METHODS This single-center, prospective, case-control study was conducted on 50 full-term newborn infants with severe UHB requiring phototherapy and 50 healthy infants as controls. HRV assessment was performed by using 24-hour Holter ECG recording. RESULTS There was no significant difference in terms of mean average heart rate, mean maximum heart rate and mean RR duration between the groups. However, mean minimum heart rate was significantly lower in the study group. When 24-hour time and frequency domain parameters were compared, time and frequency domain parameters rMSDD as well as high frequency (HF), which represent parasymphathetic activity, were significantly higher in the study group. Furthermore, low frequency to high frequency (LF/HF) ratio, that serves as an indicator of sympathovagal balance, was significantly lower in the study group. CONCLUSION Severe UHB may cause cardiac autonomic dysfunction in favor of parasympathetic predominance in jaundiced neonates.
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Affiliation(s)
- Rahmi Özdemir
- a Division of Pediatric Cardiology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Özgür Olukman
- b Division of Neonatology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Cem Karadeniz
- a Division of Pediatric Cardiology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Kıymet Çelik
- b Division of Neonatology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Nagehan Katipoğlu
- c Department of Pediatrics , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Murat Muhtar Yılmazer
- a Division of Pediatric Cardiology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Şebnem Çalkavur
- b Division of Neonatology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Timur Meşe
- a Division of Pediatric Cardiology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Sertaç Arslanoğlu
- b Division of Neonatology , Izmir Dr. Behcet Uz Children's Hospital , Izmir , Turkey
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Inui T, Kumagaya S, Myowa-Yamakoshi M. Neurodevelopmental Hypothesis about the Etiology of Autism Spectrum Disorders. Front Hum Neurosci 2017; 11:354. [PMID: 28744208 PMCID: PMC5504094 DOI: 10.3389/fnhum.2017.00354] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/20/2017] [Indexed: 11/13/2022] Open
Abstract
Previous models or hypotheses of autism spectral disorder (ASD) failed to take into full consideration the chronological and causal developmental trajectory, leading to the emergence of diverse phenotypes through a complex interaction between individual etiologies and environmental factors. Those phenotypes include persistent deficits in social communication and social interaction (criteria A in DSM-5), and restricted, repetitive patterns of behavior, interests, or activities (criteria B in DSM-5). In this article, we proposed a domain-general model that can explain criteria in DSM-5 based on the assumption that the same etiological mechanism would trigger the various phenotypes observed in different individuals with ASD. In the model, we assumed the following joint causes as the etiology of autism: (1) Hypoplasia of the pons in the brainstem, occurring immediately following neural tube closure; and (2) Deficiency in the GABA (γ-aminobutyric acid) developmental switch during the perinatal period. Microstructural abnormalities of the pons directly affect both the structural and functional development of the brain areas strongly connected to it, especially amygdala. The impairment of GABA switch could not only lead to the deterioration of inhibitory processing in the neural network, but could also cause abnormal cytoarchitecture. We introduced a perspective that atypical development in both brain structure and function can give full explanation of diverse phenotypes and pathogenetic mechanism of ASD. Finally, we discussed about neural mechanisms underlying the phenotypic characteristics of ASD that are not described in DSM-5 but should be considered as important foundation: sleep, global precedence, categorical perception, intelligence, interoception and motor control.
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Affiliation(s)
- Toshio Inui
- Department of Psychology, Otemon Gakuin UniversityOsaka, Japan
| | - Shinichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of TokyoTokyo, Japan
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Schneebaum Sender N, Govindan RB, Whitehead MT, Massaro AN, Metzler M, Wang J, Cheng YI, du Plessis AJ. Cerebral modulation of the autonomic nervous system in term infants. J Perinatol 2017; 37:558-562. [PMID: 28079874 DOI: 10.1038/jp.2016.248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/02/2016] [Accepted: 11/22/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Central topography of autonomic nervous system (ANS) function has yet to be fully deciphered. In adults it has been shown to lateralize sympathetic and parasympathetic influence predominantly to the right and left cerebral hemispheres, respectively. We examined functional topography of central ANS in newborn subjects utilizing spectral analysis of heart rate variability (HRV), an established measure of ANS function. STUDY DESIGN We studied newborns with hypoxic-ischemic encephalopathy participating in a prospective study undergoing a therapeutic hypothermia protocol.We included subjects with continuous heart rate data over the first 3 h of normothermia (post rewarming) and brain magnetic resonance imaging, which was reviewed and scored according to a 4 region scheme. HRV was evaluated by spectral analysis in the low-frequency (0.05 to 0.25 Hz) and high-frequency (0.3 to 1 Hz) ranges. The relationship between injured brain regions and HRV was studied using multiple regressions. RESULTS Forty eight newborns were included. When examined in isolation, right hemisphere injury had a significant negative effect on HRV (-0.088; 95% CI: -0.225,-0.008). The combination of posterior fossa region injury with right hemispheric injury or left hemispheric injury demonstrated significant positive (0.299; 95% CI: 0.065, 0.518) and negative (-0.475; 95% CI: -0.852, -0.128) influences on HRV, respectively. The association between brain injury location and HRV in the high-frequency range did not reach significance. CONCLUSION Our data support the notion that lateralized cerebral modulation of the ANS, specifically of its sympathetic component, is present in the term newborn, and suggest complex modulation of these tracts by components of the posterior fossa.
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Affiliation(s)
- N Schneebaum Sender
- Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA
| | - R B Govindan
- Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA
| | - M T Whitehead
- Department of Radiology, Children's National Health System, Washington, DC, USA
| | - A N Massaro
- Division of Neonatology and Division of Fetal and Transitional Medicine, Children's National Health Systems Pediatrics, The George Washington University School of Medicine, Washington, DC, USA
| | - M Metzler
- Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA
| | - J Wang
- Division of Biostatistics and Study Methodology, Center for Translational Science, Children's Research Institute, Children's National Health System, Washington, DC, USA
| | - Y I Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Science, Children's Research Institute, Children's National Health System, Washington, DC, USA
| | - A J du Plessis
- Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA
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45
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Figueiredo B, Pinto TM, Pacheco A, Field T. Fetal heart rate variability mediates prenatal depression effects on neonatal neurobehavioral maturity. Biol Psychol 2017; 123:294-301. [DOI: 10.1016/j.biopsycho.2016.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/03/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022]
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46
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Souza LV, Oliveira V, De Meneck F, Grotti Clemente AP, Strufaldi MWL, Franco MDC. Birth Weight and Its Relationship with the Cardiac Autonomic Balance in Healthy Children. PLoS One 2017; 12:e0167328. [PMID: 28095501 PMCID: PMC5240907 DOI: 10.1371/journal.pone.0167328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/11/2016] [Indexed: 01/13/2023] Open
Abstract
Several studies indicate that the fetal environment plays a significant role in the development of cardiometabolic disease later in life. However, a few studies present conflicting data about the correlation between birth weight and the impairment of cardiac autonomic modulation. The purpose of the present study was to provide further knowledge to elucidate this contradictory relationship. One hundred children aged 5 and 14 years had anthropometric parameters, body composition and blood pressure levels determined. Heart rate variability (HRV) was evaluated by heart rate monitoring, including measurements of both the time and frequency domains. The results showed inverse correlation between the HRV parameters with BMI (RMSSD: P = 0.047; PNN50: P = 0.021; HF: P = 0.041), systolic (RMSSD: P = 0.023; PNN50: P = 0.032) and diastolic (PNN50: P = 0.030) blood pressure levels. On the other hand, there were consistent positive correlations between the HRV parameters and birth weight (RMSSD: P = 0.001; PNN50: P = 0.001; HF: P = 0.002). To determine the effect of birth weight on HRV parameters, we perform multivariate linear regression analysis adjusted for potentially confounding factors (prematurity, gender, age, BMI, physical activity index and SBP levels). These findings were preserved even after adjusting for these confounders. Our results suggested that impaired cardiac autonomic modulation characterized by a reduction in the parasympathetic activity occurs in children with low birth weight. One possible interpretation for these data is that a vagal withdrawal, rather than a sympathetic overactivity, could precede the development of hypertension and other cardiometabolic diseases in children with low birth weight. However, long-term studies should be performed to investigate this possibility.
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Affiliation(s)
| | - Vanessa Oliveira
- Nephrology Division, Federal University of São Paulo, São Paulo, Brazil
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47
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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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48
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Dietz P, Watson ED, Sattler MC, Ruf W, Titze S, van Poppel M. The influence of physical activity during pregnancy on maternal, fetal or infant heart rate variability: a systematic review. BMC Pregnancy Childbirth 2016; 16:326. [PMID: 27784276 PMCID: PMC5081933 DOI: 10.1186/s12884-016-1121-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background Physical activity (PA) during pregnancy has been shown to be associated with several positive effects for mother, fetus, and offspring. Heart rate variability (HRV) is a noninvasive and surrogate marker to determine fetal overall health and the development of fetal autonomic nervous system. In addition, it has been shown to be significantly influenced by maternal behavior. However, the influence of maternal PA on HRV has not yet been systematically reviewed. Therefore, the aim of this systematic review was to assess the influence of regular maternal PA on maternal, fetal or infant HRV. Methods A systematic literature search following a priori formulated criteria of studies that examined the influence of regular maternal PA (assessed for a minimum period of 6 weeks) on maternal, fetal or infant HRV was performed in the databases Pubmed and SPORTDiscus. Quality of each study was assessed using the standardized Quality Assessment Tool for Quantitative Studies (QATQS). Results Nine articles were included into the present systematic review: two intervention studies, one prospective longitudinal study, and six post-hoc analysis of subsets of the longitudinal study. Of these articles four referred to maternal HRV, five to fetal HRV, and one to infant HRV. The overall global rating for the standardized quality assessment of the articles was moderate to weak. The articles regarding the influence of maternal PA on maternal HRV indicated contrary results. Five of five articles regarding the influence of maternal PA on fetal HRV showed increases of fetal HRV on most parameters depending on maternal PA. The article referring to infant HRV (measured one month postnatal) showed an increased HRV. Conclusions Based on the current evidence available, our overall conclusion is that the hypothesis that maternal PA influences maternal HRV cannot be supported, but there is a trend that maternal PA might increase fetal and infant HRV (clinical conclusion). Therefore, we recommend that further, high quality studies addressing the influence of maternal PA on HRV should be performed (methodological conclusion).
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Affiliation(s)
- Pavel Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria.
| | - Estelle D Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Private Bag 3, Johannesburg, 2050, South Africa
| | - Matteo C Sattler
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria
| | - Wolfgang Ruf
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria
| | - Sylvia Titze
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria
| | - Mireille van Poppel
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
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49
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Maternal abuse history and reduced fetal heart rate variability: Abuse-related sleep disturbance is a mediator. Dev Psychopathol 2016; 29:1023-1034. [PMID: 27760572 DOI: 10.1017/s0954579416000997] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The consequences of childhood maltreatment are profound and long lasting. Not only does the victim of abuse suffer as a child, but there is mounting evidence that a history of maltreatment places the next generation at risk for significant psychopathology. Research identifies postnatal factors as affecting this intergenerational transmission of trauma. However, emerging evidence suggests that part of this risk may be transmitted before birth, passed on via abuse-related alterations in the in utero environment that are as yet largely unidentified. To date, no study has directly assessed the influence of pregnant women's abuse history on fetal neurobehavioral development, nor considered trauma-associated poor sleep quality as a mediator reflecting established physiological dysregulation. Using data from 262 pregnant adolescents (ages 14-19), a population at elevated risk for childhood maltreatment, the current study examined maternal emotional abuse history and sleep quality in relation to third-trimester fetal resting heart rate variability, an index of parasympathetic nervous system functioning. The results indicate that maternal emotional abuse history is indirectly associated with lower fetal heart rate variability via abuse-related sleep disturbances. These data demonstrate an association between maternal abuse histories and fetal development, showing that at least part of the intergenerational transmission of risk occurs during pregnancy.
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50
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Moyer C, Reoyo OR, May L. The Influence of Prenatal Exercise on Offspring Health: A Review. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:37-42. [PMID: 27777506 PMCID: PMC5075987 DOI: 10.4137/cmwh.s34670] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Abstract
Research has continued to demonstrate that exercise during pregnancy is safe. Growing evidence supports that exercise during pregnancy is beneficial for mother and fetus during gestation, with benefits persisting for the child into adulthood. Regardless of income or socioeconomic status, exercise during pregnancy is associated with increased incidence of full-term delivery. Additionally, normalization of birth measures, such as birth weight, occurs when women perform regular exercise throughout gestation. Measures of growth and development further indicate that exercise during pregnancy does not harm and may stimulate healthy growth throughout childhood. Measures of cognition and intelligence demonstrate that exercise during pregnancy causes no harm and may be beneficial. Overall, the benefits of exercise during pregnancy decrease the risk of chronic disease for both mother and child.
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Affiliation(s)
- Carmen Moyer
- Visiting Assistant Professor, Health and Human Sciences, Bridgewater College, Bridgewater, VA, USA
| | | | - Linda May
- Assistant Professor, Foundational Sciences and Research, East Carolina University, Greenville, NC, USA
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