Longitudinally Tracking Maternal Autonomic Modulation During Normal Pregnancy With Comprehensive Heart Rate Variability Analyses

Bester, Maretha; Joshi, Rohan; Mischi, Massimo; Laar, Judith O E H van; Vullings, Rik

doi:10.3389/fphys.2022.874684

Cited by 8 publications

(3 citation statements)

References 67 publications

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“…However, the opposite is observed; MFCC F→M decreases with progressing pregnancy. This decrease is likely due to the maternal ANS becoming increasingly hypo-responsive to external stimuli, such as fetal movements, during healthily progressing pregnancy [ 41 , 48 , 49 ]. Small-scale studies using mice models also support the hypothesis of the ANS playing a central role in MFCC as indices of MFCC in pregnant mice reveal an antagonistic response to maternal sympathetic or para-sympathetic blockade [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Evidence and clinical relevance of maternal-fetal cardiac coupling: A scoping review

et al. 2023

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Background Researchers have long suspected a mutual interaction between maternal and fetal heart rhythms, referred to as maternal-fetal cardiac coupling (MFCC). While several studies have been published on this phenomenon, they vary in terms of methodologies, populations assessed, and definitions of coupling. Moreover, a clear discussion of the potential clinical implications is often lacking. Subsequently, we perform a scoping review to map the current state of the research in this field and, by doing so, form a foundation for future clinically oriented research on this topic. Methods A literature search was performed in PubMed, Embase, and Cochrane. Filters were only set for language (English, Dutch, and German literature were included) and not for year of publication. After screening for the title and the abstract, a full-text evaluation of eligibility followed. All studies on MFCC were included which described coupling between heart rate measurements in both the mother and fetus, regardless of the coupling method used, gestational age, or the maternal or fetal health condition. Results 23 studies remained after a systematic evaluation of 6,672 studies. Of these, 21 studies found at least occasional instances of MFCC. Methods used to capture MFCC are synchrograms and corresponding phase coherence indices, cross-correlation, joint symbolic dynamics, transfer entropy, bivariate phase rectified signal averaging, and deep coherence. Physiological pathways regulating MFCC are suggested to exist either via the autonomic nervous system or due to the vibroacoustic effect, though neither of these suggested pathways has been verified. The strength and direction of MFCC are found to change with gestational age and with the rate of maternal breathing, while also being further altered in fetuses with cardiac abnormalities and during labor. Conclusion From the synthesis of the available literature on MFCC presented in this scoping review, it seems evident that MFCC does indeed exist and may have clinical relevance in tracking fetal well-being and development during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Evidence and clinical relevance of maternal-fetal cardiac coupling: A scoping review

et al. 2023

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“…A 4th-order Butterworth bandpass filter of 1 to 70 Hz was applied to the recordings to suppress artifacts and out-of-band noise, followed by a notch filter at 50 Hz, which suppressed powerline interference. Next, a fixed linear combination of the various abdominal channels was applied to enhance maternal QRS peaks [ 22 ], and hereafter a previously detailed peak detector was used to detect the maternal R-peaks [ 23 , 24 ]. Once these peaks were detected, signals representing the RR-intervals could be generated.…”

Section: Methodsmentioning

confidence: 99%

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

Bester

Joshi

Dooren

et al. 2023

JCM

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While the effect of antenatally administered corticosteroids on fetal heart rate (HR) and heart rate variability (HRV) is well established, little information is available on how these drugs affect maternal physiology. In this secondary analysis of a prospective, observational cohort study, we quantify how corticosteroids affect maternal HR and HRV, which serve as a proxy measure for autonomic regulation. Abdominal ECG measurements were recorded before and in the five days following the administration of betamethasone—a corticosteroid commonly used for fetal maturation—in 46 women with singleton pregnancies. Maternal HR and HRV were determined from these recordings and compared between these days. HRV was assessed with time- and frequency-domain features, as well as non-linear and complexity features. In the 24 h after betamethasone administration, maternal HR was significantly increased (p < 0.01) by approximately 10 beats per minute, while HRV features linked to parasympathetic activity and HR complexity were significantly decreased (p < 0.01 and p < 0.001, respectively). Within four days after the initial administration of betamethasone, HR decreases and HRV features increase again, indicating a diminishing effect of betamethasone a few days after administration. We conclude that betamethasone administration results in changes in maternal HR and HRV, despite the heterogeneity of the studied population. Therefore, its recent administration should be considered when evaluating these cardiovascular metrics.

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“…The smart wearable devices, capable of capturing pertinent biomarkers continuously, address barriers to disease identification and treatment while facilitating disease prediction by providing continuous data. For instance, heart rate variability (HRV) has been suggested as a biomarker for hypertensive disorders in pregnancy [ 8 – 9 ] When assessed continuously, HRV shows promise in the early identification of hypertensive disorders as an important leading cause of maternal mortality [ 10 ]. By enabling monitoring of lifestyle factors such as activity and nutrition, smart wearables also hold potential for improving pregnancy outcomes [ 11 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of continuous smart health monitoring in pregnant population: A mixed-method approach

Sharifi-Heris,

Fortier,

Rahmani

et al. 2024

PLOS Digit Health

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The utilization of smart monitoring technology offers potential for enhancing health outcomes, yet its feasibility and acceptance among Hispanic pregnant individuals remain uncertain. This is particularly crucial to investigate within the context of apparently healthy individuals identified as low risk, who still face a 10% likelihood of complications. Given their frequent underrepresentation in healthcare services and relative lack of attention, improving the feasibility of remote monitoring in this population could yield significant benefits. To address this gap, our study aimed to adapt and evaluate the practicality of a smart monitoring platform among healthy Hispanic pregnant women during the second and third trimesters of pregnancy, as well as one week following childbirth, a period when complications often arise. This longitudinal study followed n = 16 participants for an average of 17 weeks. Participants were instructed to wear the Oura ring for objective data collection, including activity, sleep, and heart rate, and to complete survey questions through REDcap to assess mental health and lifestyle factors. The study framework utilized the RE-AIM approach, with acceptability and adherence as key components of the feasibility evaluation. Our findings revealed that completion rates for biweekly and monthly surveys remained consistently high until after childbirth (approximately 80%), while daily question completion remained above 80% until 38th week of gestation, declining thereafter. The wearing rate of the Oura ring remained consistently above 80% until the 35th gestational week, decreasing to around 31% postpartum. Participants cited barriers to wearing the ring during the postpartum period, including difficulties managing the newborn, forgetfulness, and concerns about scratching the baby’s skin. The enrollment rate was 71.42%, with an attrition rate of 6.25%. Thematic analysis of one-on-one interviews identified three main themes: personal desire for health improvement, social acceptability and support, and conditions influencing device/platform efficiency. In conclusion, while adherence varied based on gestational week and survey frequency, the study demonstrated strong acceptability of the smart monitoring platform among the study population, indicated by the high enrollment rate. Qualitative insights underscored the significance of personal motivation, social support, and device/platform efficiency in enhancing patient engagement with digital health monitoring during pregnancy, offering valuable considerations for future healthcare interventions in this domain.

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Longitudinally Tracking Maternal Autonomic Modulation During Normal Pregnancy With Comprehensive Heart Rate Variability Analyses

Cited by 8 publications

References 67 publications

Evidence and clinical relevance of maternal-fetal cardiac coupling: A scoping review

Evidence and clinical relevance of maternal-fetal cardiac coupling: A scoping review

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

Feasibility of continuous smart health monitoring in pregnant population: A mixed-method approach

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