Assessment of autonomic function in the late term fetus: The effects of sex and state

Zavala, Julia H.; Ecklund‐Flores, Lisa; Myers, Michael; Fifer, William P.

doi:10.1002/dev.21865

Cited by 10 publications

(8 citation statements)

References 36 publications

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“…But these differences were not reflected in the respective latency values. While there have been recent reports (DiPietro & Voegtline, 2017;Wheelock et al, 2019;Zavala, Ecklund-Flores, Myers, & Fifer, 2019) showing differences in fetal heart rate variability and functional connectivity in the brain between male and female fetuses, our results of the effect of GA period, fetal sex, and their interaction-based testing of first-peak latencies for AER and VER for fetal-sex differences were not significant. Again this needs to be examined further, and as mentioned above, since latency trajectory may be different for each of the high-risk conditions, by combining them in one group we may have obliterated the potential effects of GA and sex.…”

Section: Discussioncontrasting

confidence: 99%

Tracking evoked responses to auditory and visual stimuli in fetuses exposed to maternal high‐risk conditions

Eswaran

Lau

Murphy

et al. 2020

Developmental Psychobiology

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The study of the fetal brain poses a number of unique challenges that have historically been restricted to postnatal investigation and extrapolation. During fetal life, disturbance of the fetal environment can potentially produce lifelong effects (Gluckman, Hanson, Cooper, & Thornburg, 2008). Thus, use of technology that is safe and, ideally, non-invasive is essential. While electroencephalography (EEG) and magnetoencephalography (MEG) recordings (Baillet, 2017; Cohen, 1972) have demonstrated their efficacy and safety in adults and even newborns (Chen et al., 2019; Dereymaeker et al., 2017) the maternal abdomen remains a formidable obstacle to assess fetal brain signals. Fetal EEG, in principle, is feasible from the surface of the maternal abdomen, but several factors including high impedance of the maternal skin weaken the tiny signals produced by fetal brain activity, making detection highly unreliable. Fetal MEG (fMEG), on the other hand, measures magnetic fields rather than electrocortical potentials.

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Section: Discussioncontrasting

confidence: 99%

Tracking evoked responses to auditory and visual stimuli in fetuses exposed to maternal high‐risk conditions

Eswaran

Lau

Murphy

et al. 2020

Developmental Psychobiology

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“…An increase in RMSSD was also found. Nevertheless, proportionally SDNN increased more than RMSSD during fetal activity (Brändle et al, 2015 ; Stone et al, 2017 ; Zavala et al, 2019 ).…”

Section: Resultsmentioning

confidence: 99%

“…Wheeler et al showed a significant association between active fetuses and SDNN with a higher SDNN in active fetuses compared to resting fetuses in term pregnancies (Wheeler et al, 1980). This was confirmed by Frank et al (2006), Brändle et al (2015) Stone et al (2017, and Zavala et al (2019). An increase in RMSSD was also found.…”

Section: Time Domain Parameters and Fetal Body Movementsmentioning

confidence: 89%

Fetal Heart Rate Variability Is Affected by Fetal Movements: A Systematic Review

et al. 2020

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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. Zizzo et al. Heart Rate Variability; Fetal Movements 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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“…Specifically, the post-dose decrease in STV was observed among SRI-Depressed group male fetuses, compared with the relative stability in STV between assessments in SRI-Depressed females. Indeed, sex difference in fetal HR variability have been reported in lowrisk singleton pregnancies (98,99), for example in a large CTG study, males had lower baseline HR but higher STV than females throughout gestation (78). Although basal HR and STV in males and females in the Control group did not differ significantly, SRI-Depressed males did have higher STV than SRI-Depressed females at the baseline/pre-dose assessment, pointing to a chronic/sustained SRI-related sex difference that is evident when maternal depressive symptoms persist.…”

Section: Acute Sri Effects On Fetal Hr Variability Are Sex-specificmentioning

confidence: 99%

Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation

et al. 2021

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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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Assessment of autonomic function in the late term fetus: The effects of sex and state

Cited by 10 publications

References 36 publications

Tracking evoked responses to auditory and visual stimuli in fetuses exposed to maternal high‐risk conditions

Tracking evoked responses to auditory and visual stimuli in fetuses exposed to maternal high‐risk conditions

Fetal Heart Rate Variability Is Affected by Fetal Movements: A Systematic Review

Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation

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