Effect of tocolytic drugs on fetal heart rate variability: a systematic review

Verdurmen, Kmj Kim; Hulsenboom, Adj Alexandra; Laar, Joeh Judith van; Oei, S.G.

doi:10.1080/14767058.2016.1249844

Cited by 16 publications

(12 citation statements)

References 32 publications

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“…Since in daily clinical practice betamethasone, for threatened preterm delivery, is rarely administered without tocolytics, studying the effects of corticosteroids in patients without co-medication is not feasible. Verdurmen et al previously reviewed the literature concerning the effects of tocolytic drugs on HRV [42]. They found that nifedipine and atosiban had no significant effect on fHRV.…”

Section: Discussionmentioning

confidence: 99%

The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability

Noben

Verdurmen

Warmerdam

et al. 2019

Early Human Development

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Section: Discussionmentioning

confidence: 99%

The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability

Noben

Verdurmen

Warmerdam

et al. 2019

Early Human Development

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“…It could be speculated that-depending on the timing of delivery-prenatal corticosteroid administration may affect neonatal HRV. Maternal (perinatal) drug administration has also been shown to affect fetal HRV parameters (37). However, information on maternal (perinatal) drug administration was inconsistently recorded in our research database.…”

Section: Discussionmentioning

confidence: 92%

Fetal-growth-restricted preterm infants display compromised autonomic cardiovascular control on the first postnatal day but not during infancy

et al. 2017

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BackgroundFetal growth restriction (FGR) is associated with increased perinatal mortality and long-term cardiovascular and neurodevelopmental sequelae. We hypothesized that FGR impacts on the development of autonomic heart rate and blood pressure control, contributing to unfavorable short- and long-term outcomes following FGR.MethodsWe studied 25 preterm FGR and 22 preterm and 19 term appropriate for gestational age (AGA) infants. Preterm neonates were studied on postnatal day 1, and all infants were studied at 1 and 6 months post-term age. To investigate autonomic cardiovascular control, we examined heart rate variability (HRV) and baroreflex sensitivity using spectral power and transfer-function analyses.ResultsPreterm FGR neonates exhibited higher heart rates and reduced HRV compared with preterm AGA controls on postnatal day 1. No significant differences were found between the three groups at 1 or 6 months post-term age.ConclusionPreterm FGR neonates display compromised HRV on postnatal day 1, which may suggest increased vulnerability to circulatory instability. This may predispose these neonates to systemic and cerebral hypoperfusion and increase the risk of long-term neurodevelopmental sequelae. Differences were no longer found at 1 and 6 months post-term age, suggesting that the maturation of autonomic cardiovascular control may be preserved following FGR.

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“…MgSO4, which is often administered between 23 and 27 WGA or intrapartum for its tocolytic effect to delay labor onset in pregnancy at risk for preterm birth (Ramsey and Rouse, 2001 ; Ingemarsson and Lamont, 2003 ), does not seem to show a significant change in fHRV (Stallworth et al, 1981 ; Nensi et al, 2014 ). These results do not vary in co-administration with opioids (Cañez et al, 1987 ), whereas the association with sGC should deserve greater attention by the clinicians (Verdurmen et al, 2017 ). Moreover, the prolonged administration of MgSO4 seems to be associated with a change in fetal breathing movements (Peaceman et al, 1989 ) and to affect fHRV dose-dependently (Cardosi and Chez, 1998 ; Kamitomo et al, 2000 ).…”

Section: The Environmental Factors Affecting the Ans Developmentmentioning

confidence: 92%

A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows

Cerritelli¹,

Frasch²,

Antonelli³

et al. 2021

Front. Neurosci.

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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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Effect of tocolytic drugs on fetal heart rate variability: a systematic review

Abstract: In order to prevent iatrogenic preterm labor, the effects of tocolytic drugs on fetal HRV should be taken into account when monitoring these fetuses.

Cited by 16 publications

References 32 publications

The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability

The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability

Fetal-growth-restricted preterm infants display compromised autonomic cardiovascular control on the first postnatal day but not during infancy

A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows

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