Changes in Maternal Heart Rate Variability in Response to the Administration of Routine Obstetric Medication in Hospitalized Patients: Study Protocol for a Cohort Study (MAMA-Heart Study)

Abstract

Pregnancy is a period of continuous change in the maternal cardiovascular system, partly mediated by the autonomic nervous system. Insufficient autonomic adaptation to increasing gestation is associated with pregnancy complications, such as hypertensive disorders of pregnancy and preterm birth (both major causes of perinatal morbidity and mortality). Consequently, maternal heart rate variability (mHRV), which is a proxy measure for autonomic activity, is increasingly assessed in these cohorts to investigate the pathophysiology of their complications. A better pathophysiological understanding could facilitate the early detection of these complications, which remains challenging. However, such studies (typically performed in pregnancies leading to hospitalization) have generated conflicting findings. A probable reason for these conflicting findings is that these study cohorts were likely administered routine obstetric medications during the study period of which the effects on mHRV are largely unknown. Subsequently, we design a longitudinal, observational study to quantifying the effect of these medications—particularly corticosteroids, which are known to affect fetal HRV—on mHRV to improve the interpretation of past and future studies. We will enroll 61 women admitted to a tertiary obstetric unit with an indication to receive corticosteroids antenatally. Participants’ mHRV will be continuously acquired throughout their hospitalization with wrist-worn photoplethysmography to facilitate a within-patient comparison of the effect of corticosteroids on mHRV.

Changes in Maternal Heart Rate and Autonomic Regulation following the Antenatal Administration of Corticosteroids: A Secondary Analysis

“…However, regardless of the physiological mechanisms at play, we find that betamethasone influences autonomic activity in women with pregnancy complications. The next step would be to confirm these findings with a paired analysis from a prospective study dedicated to investigating the effect of betamethasone on maternal physiology [ 18 ]. Future studies should investigate the potential impact of betamethasone on additional markers of maternal health, for example, BP.…”

“…Owing to the association between maternal autonomic dysfunction and pregnancy complications [ 10 , 13 ], there is increasing interest in using maternal heart rate variability (HRV)—a proxy measure for the ANS [ 14 ]—as an obstetric screening tool [ 15 , 16 , 17 ]. However, using HRV to track maternal health, as well as appropriately interpreting HRV in women who’ve received corticosteroids, requires quantifying the potential effect of this routinely administered medication on maternal HRV [ 11 , 18 ].…”

Re: Effects of antenatal corticosteroids on maternal cardiovascular system, an underestimated notion in pregnant women

“…And there was no study elaborated maternal cardiovascular effect after ACSs use during late preterm period. 4 As Professor Hantoushzadeh stated, it is important to know the side effects of ACSs on the cardiovascular system. 5 In the era of personalized medicine, there is both significant scope and imperative need for further research-informed refinement to the use of ACSs.…”

Re: Effects of antenatal corticosteroids on maternal cardiovascular system, an underestimated notion in pregnant women

“…And no study has focused on maternal cardiovascular effects after ACSs use during the late preterm period. 4 As Prof. Hantoushzadeh stated, it is important to know the side effects of ACSs on the cardiovascular system. 5 In the era of personalised medicine, there is both significant scope and an imperative need for further researchinformed refinement of the use of ACSs.…”