Dev. Recently, placenta calcifications samples collected at delivery have been speculated to act as a memory of prenatal maternal stress and diseases exposure, hence highlighting the potential role of placenta in regulating the offspring's future cardiovascular and metabolic health, even through the in utero modulation of the developing ANS (Wallingford et al., 2018). Dev. doi: 10.1016/j.semnephrol.2010.10.007. Ther. J. Mol. Gynecol. Front. 27, 12451250. Med. A., Zimmerman, A., Hamadia, S., Ziv, O., Gurevich, V., Fichtman, B., et al. Commentary: Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Heart rate variability parameters and fetal movement complement fetal behavioral states detection via magnetography to monitor neurovegetative development. Moreover, considering the role of the vagus nerve in the CAP, which involves immune cells such as macrophages (Borovikova et al., 2000; Tracey, 2007; Fairchild et al., 2010; Frasch et al., 2016), and the sex-related neurodevelopment impact of microglial functions (Hanamsagar and Bilbo, 2016), the different characteristics of the developmental pattern of vagus nerve between male and female fetuses could predispose for sex-specific susceptibility and outcomes in many neurodevelopmental disorders (Berntson and Cacioppo, 2004). J. Physiol. It is interesting that fetal ANS impairment can also have consequences on infant temperament at both 3 and 6 months (Howland et al., 2020). J. Nurs. Eur. Stimulating the vagus nerve typically produces: a. We are also entering a new chapter in the story of fetal surveillance made possible by the coexistence of 4 factors: Given the complexity of the underlying physiology controlling heart rate, the many clinical conditions that can wax and wane to affect oxygen delivery to the fetus and natural variation in fetal reserves, a mathematical method capable of determining the most predictive fetal heart rate patterns in specific clinical circumstances is welcome. Am J Physiol Heart Circ Physiol. Drugs aside, the most relevant aspect to be evaluated during the 2nd stage of labor is certainly the mode of delivery. Sleep and prematurity: sleep outcomes in preterm children and influencing factors. Clinical significance of fetal heart rate patterns during labor. (2017). 46, 631639. Firstly, by directly affecting brain development, as the skull has a low bone density that fails in adequately protecting newborns' brain from EMF (Besset et al., 2020). Fetal programming of neuropsychiatric disorders. A Hierarchy of Cell Intrinsic and Target-Derived Homeostatic Signaling Alcohol easily crosses the placenta and can disrupt maternalfetal hormonal interactions, leading to long-term impairments on neuroendocrine and immune competence (Zhang et al., 2005). Acad. doi: 10.1212/wnl.56.10.1278, Kamendi, H., Stephens, C., Dergacheva, O., Wang, X., Huang, Z.-G., Bouairi, E., et al. Rev. Intrapartum management of category II fetal heart rate tracings: towards standardization of care. Physiol. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2015.06.020 doi: 10.1016/j.physio.2018.05.001, Cogan, R., and Spinnato, J. Category II Application The placental microbiome varies in association with low birth weight in full-term neonates. In this review, we highlighted the growing understanding of the vagus nerve's developmental physiology, the largest and perhaps most important homeostatic (or, better, homeokinetic) regulatory system in our body (Macklem and Seely, 2010; Herry et al., 2019). Neurotoxicol. Fetal heart rate, heart rate variability, and heart rate/movement coupling in the safe passage study. doi: 10.1053/j.nainr.2008.10.008, Gribble, M. O., Cheng, A., Berger, R. D., Rosman, L., and Guallar, E. (2015). BJOG. The human brain at stage 16, including the initial evagination of the neurohypophysis. (2020). Orthop. Volume and type of alcohol during early pregnancy and the risk of miscarriage. Similarly, clinical research doesnt support its efficacy in individuals with normal blood pressure. Biol. Porges, S. W. (2011). Heart rate variability. Bell R, Glinianaia SV, Rankin J, Wright C, Pearce MS, Parker L. Changing patterns of perinatal death, 1982-2000: a retrospective cohort study. 38, 2740. The vagus nerve and the inflammatory reflexlinking immunity and metabolism. Brain Mapp. Psychiatry 5:e545. Several animal studies in vertebrates and mammals show that vagal NC cells ablation heavily impairs the development and function of the aforementioned tissues. doi: 10.1523/JNEUROSCI.2534-15.2016, Gogou, M., Haidopoulou, K., and Pavlou, E. (2019). After 2 minutes of complete cord compression, the FHR in the deceleration began to recover despite continuing fall in cerebral oxygenation and rising hypertension. doi: 10.1016/0028-2243(80)90060-X, Venkata, C., and Venkateshiah, S. B. Use Misuse 49, 14371445. Fetal gut injury due to inflammation in a fetal sheep model of NEC etiology leaves a specific HRV signature and preterm neonates show abnormalities in HRV 13 days before clinical symptoms (Stone et al., 2013; Liu et al., 2016). 2: Maintaining homeostasis through feedback requires a stimulus, sensor, control center, and effector. a. Gynaecol. 181:108894. doi: 10.1016/j.envres.2019.108894, Bhide, A., and Acharya, G. (2018). J. Obstet. Glucocorticoid programming of the fetal male hippocampal epigenome. J. Obstet. Body temperature, heart rate, and short-term outcome of cooled infants. It is noteworthy that delayed umbilical cord clamping, that is, delaying the procedure by 60180 s seems to improve both peripheral and cerebral oxygenation, in addition to several hemodynamics parameters, which could reveal a positive effect on ANS function and development (Bruckner et al., 2021). 598, 249263. Trends Mol. 23, 117124. Furthermore, some studies have already shown the feasibility of correlating external factors related to maternal lifestyle or internal factors such as FM to fHRV changes as early as 2028 WGA (DiPietro et al., 2007; Hoyer et al., 2019; Shuffrey et al., 2019). These late decelerations were not associated with fetal acidosis. Validation of functional fetal autonomic brain age score fABAS in 5 min short recordings. doi: 10.1038/nri2566, Tribe, R. M., Taylor, P. D., Kelly, N. M., Rees, D., Sandall, J., and Kennedy, H. P. (2018). Electromagnetic field coming from the incubator power influences the ANS as revealed by HRV analysis as LF/HF increases, whereas HF decreases (Bellieni et al., 2008). doi: 10.1111/aji.12355, Simkin, J. E., Zhang, D., Stamp, L. A., and Newgreen, D. F. (2019). doi: 10.1088/1361-6579/aa5fca, Hutchins, E. J., Kunttas, E., Piacentino, M. L., Howard, A. G. A., Bronner, M. E., and Uribe, R. A. Heart rate variability in the perinatal period: a critical and conceptual review. Arch Dis Child Fetal Neonatal Ed. Everything You Need to Know, 2023 Flo Health Inc., Flo Health UK Limited, Maternal low blood pressure (or hypotension). Miljkovi, Z., Sabo, A., Stanulovi, M., Jakovljevi, V., and Gruji, I. 2016 Sep 1;594(17):4711-25. At about 1820 WGA, rapid eye movements (REM) can be detected (Borsani et al., 2019) as well as quiet and active sleeping states (Dereymaeker et al., 2017), although fetal behavioral states do not show particular coherence with ANS tone (Brndle et al., 2015). doi: 10.1038/s41372-020-00871-0, Tracey, K. J. 336, 287297. doi: 10.1159/000501906. doi: 10.1016/bs.ctdb.2014.11.007, Nguyen, T. A., Chow, T., Riggs, W., and Rurak, D. (2019). PLOS ONE 8:e74431. doi: 10.1038/jp.2017.15, Amarasekara, R., Jayasekara, R. W., Senanayake, H., and Dissanayake, V. H. W. (2015). Midwifery 56, 102111. Proc. Since this review focuses on the role of ANS in human fetuses and newborns, the discussed time spans regarding gestational age are related to human development. Gynecol. 1993 Feb;461:431-49. Clin. It is noteworthy that all the adaptations required to pass from intrauterine to extrauterine life seem to rely on cortisol, whose release is markedly reduced in case of preterm birth or lack of labor (Hillman et al., 2012; Morton and Brodsky, 2016). Maternal micronutrient deficiency, fetal development, and the risk of chronic disease. doi: 10.1159/000496471, Koolhaas, J. M., Bartolomucci, A., Buwalda, B., de Boer, S. F., Flgge, G., Korte, S. M., et al. 28, 2937. Exp. Meas. The pathologies that induce chronic hypoxemia in the mother, including SBD (Pien and Schwab, 2004) and anemia, may induce dysregulations in the vagal control systems. In this context, further research is needed to better clarify the relationship between maternal neuroendocrine dysregulation, due to chronobiological impairments, and the impact on fetal neurodevelopment, particularly on the CAP. doi: 10.3390/nu7032001, Stphan-Blanchard, E., Chardon, K., Lk, A., Delanaud, S., Bach, V., and Telliez, F. (2013). Figure 1. Eur. In short, there is no single fetal heart rate parameter that consistently identifies fetal compromise. 63, 281287. Philadelphia, PA: Elsevier. 68, 173186. J. Obstet. 108, 207223. Int. Nurs. Prenat. Fetal movements patterns could be limited as a consequence of an inappropriate ratio between fetal and uterine dimension (Shea et al., 2015; Verbruggen et al., 2018), as well as a consequence of an inadequate amount of amniotic fluid (Sival et al., 1990). Perinatol. Birth Defects Res. 54, 779782. doi: 10.1111/j.1471-0528.1981.tb01271.x, Karita, K., Iwata, T., Maeda, E., Sakamoto, M., and Murata, K. (2018). 25, 535537. In Figure 6, the decelerations from these two different mechanisms are superimposed demonstrating how size, shape and timing tend to converge in the presence of marked acidemia irrespective of the initial event precipitating the deceleration. Scand. Pain and discomfort thresholds in late pregnancy. doi: 10.1159/000264461, Murata, K., Sakamoto, M., Nakai, K., Dakeishi, M., Iwata, T., Liu, X.-J., et al. Indeed, fetuses with intrauterine growth restriction (IUGR) frequently present an oxygenation impairment, with a decrease of breathing movements and GMs, and an increasing number of HR decelerations (Bekedam et al., 1991). (2021). Pediatrics 139, S38S49. In order to prevent severe brain injury from a lack of oxygen, your doctor must revive the fetus and quickly address the source of late decels. NICE Clinical Guideline 55. Anesth. Saving the brain one heartbeat at a time: perspectives. Proc. (2016). New York, NY: W. W. Norton. 50, 652683. A. Baroreceptor B. Catecholamine C. Sympathetic correct answerA. Fetal growth and maternal exposure to particulate matter during pregnancy. 840, 4550. Figure 1: Schematic outline of heart rate control mechanisms. Taken together, non-invasive assessment of maternal and fetal health via HRV monitoring throughout the pregnancy, from its earliest stages, will enable an individualized risk profiling and outcome projection during the latter stages of gestation and during delivery, a true disruption of the status quo that will improve maternal and perinatal health outcomes. (2018). It is also in common use during the peripartum period to administer the mother antibiotic prophylaxis. Surv. Pediatrics 137:e20154271. Fetal scalp electrodes can also be used to directly measure pH during childbirth, but this technique, being even more invasive, is not yet fully accepted and also has some complications (Sabir et al., 2010). Hum. 98, 160164. doi: 10.1016/j.ecl.2019.08.011, Crudo, A., Suderman, M., Moisiadis, V. G., Petropoulos, S., Kostaki, A., Hallett, M., et al. Physiol. Sleep and brain development: the critical role of sleep in fetal and early neonatal brain development. University of Erlangen Nuremberg, Germany. Biol. A., Cox, M. J., Karchmar, E. J., McGrath, M. J., Pancham, S. R., and Piercy, W. N. (1981). Consequently, the fetal and infant capacity to homeostatically adapt to the environment could be impaired (Van den Bergh and Mulder, 2012). (2007). About Gynecol. Long-term neurodevelopmental outcome of children born to prospectively followed pregnancies of women with systemic lupus erythematosus and/or antiphospholipid syndrome. The placenta harbors a unique microbiome. Endocrinol. As revealed by HRV analysis, the ANS constantly develops. The hypothalamic-pituitary-adrenal axis and the fetus. Reprod. doi: 10.1073/pnas.1100329108, Dierckx, B., Tulen, J. H. M., van den Berg, M. P., Tharner, A., Jaddoe, V. W., Moll, H. A., et al. Fluoxetine during pregnancy: impact on fetal development. Moreover, through the production of corticotropin-releasing hormone (CRH), the placenta stimulates adrenocorticotropic hormone release in the anterior pituitary of the fetus, affecting both fetal HPA axis and amygdala development (Seckl and Meaney, 2004). Turk. Lastly, this feto-maternal pro-inflammatory state could interfere with the set point of the fetal vagal regulatory system through CAP dysregulation, thus impairing fetal intestinal permeability and integrity (Garzoni et al., 2013). Res. Pregnancy Hypertens. Early Hum. Ann. U.S.A. 118:e2012900118. Although preterm infants may reach good ANS maturation after 23 years (De Rogalski Landrot et al., 2007), ANS impairment tends to remain even later in life and to be accompanied by SNS and HPA regulation impairment, both during wakefulness and sleep (Haraldsdottir et al., 2018; Urfer-Maurer et al., 2018).
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