Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG.

Lobmaier, Silvia M; Müller, A; Zelgert, C; Shen, C; Su, P C; Schmidt, G; Haller, B; Berg, G; Fabre, B; Weyrich, J; Wu, H T; Frasch, M G; Antonelli, M C

doi:10.1007/s00404-019-05390-8

2020

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Document type:: Article; Early Access; Journal Article
Author(s):: Lobmaier, Silvia M; Müller, A; Zelgert, C; Shen, C; Su, P C; Schmidt, G; Haller, B; Berg, G; Fabre, B; Weyrich, J; Wu, H T; Frasch, M G; Antonelli, M C
Title:: Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG.
Abstract:: PURPOSE: Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR. METHODS: Prospective case-control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2-3 months, was measured at birth. RESULTS: 538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother-child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (- 0.49-0.18), p < 0.001]. CONCLUSION: Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied. TRIAL REGISTRATION: Clinical trial registration: NCT03389178.
Journal title abbreviation:: Arch Gynecol Obstet
Year:: 2020
Journal volume:: 301
Journal issue:: 2
Pages contribution:: 405-414
Fulltext / DOI:: doi:10.1007/s00404-019-05390-8
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31781889
Print-ISSN:: 0932-0067
TUM Institution:: Frauenklinik und Poliklinik; I. Medizinische Klinik und Poliklinik (Kardiologie); Institut für Medizinische Statistik und Epidemiologie
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