Maternal cardiac deceleration capacity: a novel insight into maternal autonomic function in pregnancies complicated by hypertensive disorders and intrauterine growth restriction

Casati, D.; Stampalija, Tamara; Ferrazzi, E.; Alberti, Annalisa; Scebba, Ileana; Paganelli, Andrea; Martino, Daniela Di; Muggiasca, M.L.; Bauer, Axel

doi:10.1016/j.ejogrb.2016.08.007

Cited by 8 publications

(5 citation statements)

References 40 publications

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“…To this end, we hypothesize that the reduced autonomic responsiveness (which is reflected in our PRSA analyses as well as the known reduced neurocardiovascular transduction in pregnancy) is a mechanism by which the mother is protected against her autonomic state. This theory is further reflected in findings from Casati et al (2016), who observed increased autonomic responsiveness in women with pregnancy complications (such as hypertensive disorders of pregnancy) when compared to healthy pregnant controls. Subsequently, we believe PRSA analysis may be particularly useful in assessing maternal health via mHRV.…”

Section: Discussionmentioning

confidence: 92%

On the distinct differences in autonomic regulation between pregnant and non-pregnant women - a heart rate variability analysis

et al. 2023

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Objective Appropriate adaptation of the maternal autonomic nervous system to progressing gestation is essential to a healthy pregnancy. This is partly evidenced by the association between pregnancy complications and autonomic dysfunction. Therefore, assessing maternal heart rate variability (HRV) – a proxy measure for autonomic activity – may offer insights into maternal health, potentially enabling the early detection of complications. However, identifying abnormal maternal HRV requires a thorough understanding of normal maternal HRV. While HRV in women of childbearing age has been extensively investigated, less is known concerning HRV during pregnancy. Subsequently, we investigate the differences in HRV between healthy pregnant women and their non-pregnant counterparts. Approach We use a comprehensive suite of HRV features (assessing sympathetic and parasympathetic activity, heart rate (HR) complexity, HR fragmentation, and autonomic responsiveness) to quantify HRV in large groups of healthy pregnant (n=258) and non-pregnant women (n=252). We compare the statistical significance and effect size of the potential differences between the groups. Main results We find significantly increased sympathetic and decreased parasympathetic activity during healthy pregnancy, along with significantly attenuated autonomic responsiveness, which we hypothesize serves as a protective mechanism against sympathetic overactivity. HRV differences between these groups typically had a large effect size (Cohen’s d > 0.8), with the largest effect accompanying the significantly reduced HR complexity and altered sympathovagal balance observed in pregnancy (Cohen’s d > 1.2).Significance Healthy pregnant women are autonomically distinct from their non-pregnant counterparts. Subsequently, assumptions based on HRV research in non-pregnant women cannot be readily translated to pregnant women. 

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Section: Discussionmentioning

confidence: 92%

On the distinct differences in autonomic regulation between pregnant and non-pregnant women - a heart rate variability analysis

et al. 2023

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“…Therefore, acquiring measurements without the influence of such medications is not trivial. Some researchers avoid this by performing short measurements before corticosteroids are administered [9,40], while others mention these obstetric medications as potential confounders in their limitations [11,12]. Others still make no mention of corticosteroids, even though according to standard treatment protocols it is likely that their study groups would have been administered these medications [13,[41][42][43].…”

Section: Discussionmentioning

confidence: 99%

“…However, investigations into the mHRV of women with complicated pregnancies have been hindered by the routine administration of obstetric medications, such as tocolytics, beta-blockers, and corticosteroids, which are administered to women upon the diagnosis of complications. As the effect of these medications on mHRV is largely unknown, it is uncertain to which degree changes in HRV in this population reflect autonomic dysregulation associated with pregnancy complications, as opposed to merely reflecting the confounding effect of these medications [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study

Bester,

Nichting,

Joshi

et al. 2024

JCM

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Background: Owing to the association between dysfunctional maternal autonomic regulation and pregnancy complications, assessing non-invasive features reflecting autonomic activity—e.g., heart rate variability (HRV) and the morphology of the photoplethysmography (PPG) pulse wave—may aid in tracking maternal health. However, women with early pregnancy complications typically receive medication, such as corticosteroids, and the effect of corticosteroids on maternal HRV and PPG pulse wave morphology is not well-researched. Methods: We performed a prospective, observational study assessing the effect of betamethasone (a commonly used corticosteroid) on non-invasively assessed features of autonomic regulation. Sixty-one women with an indication for betamethasone were enrolled and wore a wrist-worn PPG device for at least four days, from which five-minute measurements were selected for analysis. A baseline measurement was selected either before betamethasone administration or sufficiently thereafter (i.e., three days after the last injection). Furthermore, measurements were selected 24, 48, and 72 h after betamethasone administration. HRV features in the time domain and frequency domain and describing heart rate (HR) complexity were calculated, along with PPG morphology features. These features were compared between the different days. Results: Maternal HR was significantly higher and HRV features linked to parasympathetic activity were significantly lower 24 h after betamethasone administration. Features linked to sympathetic activity remained stable. Furthermore, based on the PPG morphology features, betamethasone appears to have a vasoconstrictive effect. Conclusions: Our results suggest that administering betamethasone affects maternal autonomic regulation and cardiovasculature. Researchers assessing maternal HRV in complicated pregnancies should schedule measurements before or sufficiently after corticosteroid administration.

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“…However, the accompanying effect sizes are small and the dampening in HR responsiveness is not comparable to that seen in diseased states ( Bauer et al, 2006b ). Furthermore, the two other studies that have calculated PRSA to study maternal HRV found no significant correlations with GA ( Casati et al, 2016 ; Carpenter), although only DC was studied and assessing its correlation with GA was not the primary aim of these studies.…”

Section: Discussionmentioning

confidence: 99%

“…PRSA-based features not only independently predict mortality in cardiac disease ( Bauer et al, 2006b ; Eick et al, 2015 ) but are also sensitive to aging and fitness levels ( Campana et al, 2010 ). This method is increasingly being employed to assess fetal health ( Graatsma et al, 2012 ; Georgieva et al, 2014 ) but has rarely been used to assess maternal autonomic modulation ( Tejera et al, 2012 ; Casati et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Changes in the maternal autonomic nervous system are essential in facilitating the physiological changes that pregnancy necessitates. Insufficient autonomic adaptation is linked to complications such as hypertensive diseases of pregnancy. Consequently, tracking autonomic modulation during progressing pregnancy could allow for the early detection of emerging deteriorations in maternal health. Autonomic modulation can be longitudinally and unobtrusively monitored by assessing heart rate variability (HRV). Yet, changes in maternal HRV (mHRV) throughout pregnancy remain poorly understood. In previous studies, mHRV is typically assessed only once per trimester with standard HRV features. However, since gestational changes are complex and dynamic, assessing mHRV comprehensively and more frequently may better showcase the changing autonomic modulation over pregnancy. Subsequently, we longitudinally (median sessions = 8) assess mHRV in 29 healthy pregnancies with features that assess sympathetic and parasympathetic activity, as well as heart rate (HR) complexity, HR responsiveness and HR fragmentation. We find that vagal activity, HR complexity, HR responsiveness, and HR fragmentation significantly decrease. Their associated effect sizes are small, suggesting that the increasing demands of advancing gestation are well tolerated. Furthermore, we find a notable change in autonomic activity during the transition from the second to third trimester, highlighting the dynamic nature of changes in pregnancy. Lastly, while we saw the expected rise in mean HR with gestational age, we also observed increased autonomic deceleration activity, seemingly to counter this rising mean HR. These results are an important step towards gaining insights into gestational physiology as well as tracking maternal health via mHRV.

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Maternal cardiac deceleration capacity: a novel insight into maternal autonomic function in pregnancies complicated by hypertensive disorders and intrauterine growth restriction

Cited by 8 publications

References 40 publications

On the distinct differences in autonomic regulation between pregnant and non-pregnant women - a heart rate variability analysis

On the distinct differences in autonomic regulation between pregnant and non-pregnant women - a heart rate variability analysis

Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study

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

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