Cord compression does cause rapid fetal heart rate changes but so does a rapid change in pO2 and both of these mechanisms can produce their effect on the heart via the vagus nerve. Pregnancy and autoimmune diseases. doi: 10.1016/j.neuropharm.2006.03.001, Kamendi, H. W., Cheng, Q., Dergacheva, O., Gorini, C., Jameson, H. S., Wang, X., et al. Endocrinol. Category II Application J. R. Soc. Influence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population. Placental vascular calcification and cardiovascular health: it is time to determine how much of maternal and offspring health is written in stone. doi: 10.1016/j.earlhumdev.2015.11.003, Sabir, H., Stannigel, H., Schwarz, A., and Hoehn, T. (2010). 84, 433439. J. Neurosci. Argent. (2020). As the nervous system of the fetus develops, around 3639 WGA a different fHRV pattern is detectable according to different acoustic stimuli, as for example human speech (Lecanuet et al., 1992; Krueger and Garvan, 2019). This results in an overexposure of the fetus to maternal cortisol, that in turn may produce an overactive fetal cortisol response and may be a predisposing factor to develop disorders related to elevated HPA axis activity, which could lead to impairments in environmental stimuli adaptability by ANS in newborns (Nugent and Bale, 2015). (2010). (2018). The fetal heart rate pattern we observe is the combined results of many physiological actions. 15, 448455. (2019). Neuroscientist 13, 241256. doi: 10.1007/s00281-019-00772-1, Pien, G. W., and Schwab, R. J. Table 1. Pediatr. Gynecol. India 15, 382386. (2014). Decelerations were present when there was mild hypertension during the compression but they were also present when marked hypotension accompanied the compression. Sleep disturbances in pregnancy. doi: 10.1016/S0029-7844(98)00212-9, Carvajal de la Osa, J., Santana Gonzlez, J., Herrera Galn, M., Snchez Grau, A., and Prez Almirall, I. Brief report: can a composite heart rate variability biomarker shed new insights about autism spectrum disorder in school-aged children? 51, 2535. Even if the light-dark cycle does not seem to significantly affect the fetal circadian rhythm, there are age-dependent fHRV patterns after transabdominal fetal stimulation with halogen light, similarly to the VAS (Peleg and Goldman, 1980), which seem increasingly definite in the later stages of pregnancy, when the fetal optic pathways and ANS control on the cardiac activity reach maturity (Thanaboonyawat et al., 2006). doi: 10.1080/j.1600-0412.2002.811003.x, Lange, S., Van Leeuwen, P., Geue, D., Hatzmann, W., and Grnemeyer, D. (2005). (2009). (1997). Howland, M. A., Sandman, C. A., Davis, E. P., and Glynn, L. M. (2020). Microbiome of the placenta in pre-eclampsia supports the role of bacteria in the multifactorial cause of pre-eclampsia. (Paris). Am. This cardiac-orienting response does not seem to be detectable before the functional maturity of the fetal autonomic system, which occurs around 32 WGA (Krueger and Garvan, 2019). (2018). Early Hum. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2015.06.018 Biosci. Microbiome 4:29. doi: 10.1186/s40168-016-0172-3, Laursen, M. F., Bahl, M. I., Michaelsen, K. F., and Licht, T. R. (2017). Physiologists continue to elucidate the important role of fetal chemoreceptors and their effect on fetal heart rate. (2). Sleep and sleep disorders in pregnancy. Horne, R. S. (2018). doi: 10.2139/ssrn.3441806, Bernardes, J., Gonalves, H., Ayres-de-Campos, D., and Rocha, A. P. (2008). 6:237ra65. Dis. From 12 to 13 WGA, fHRV-FMs coupling becomes heavily affected by external factors: therefore, its analysis could shed more light on how the fetus is affected by maternal and environmental factors (DiPietro et al., 2015). BJOG Int. The onset of fetal breathing movements, in particular, induces a variation in the main vagal nerve activity parameters: RMSSD and HF power increase, while LH/HF power decreases. Since cortisol is an efferent agent in anti-inflammatory neural reflexes like the CAP (Bonaz et al., 2021), its reduced production may alter the CAP development itself. (2003). Clin. (2018). A prominent CNS response to fetal chemoreceptor stimulation is increased sympathetic activity, inducing peripheral vasoconstriction and favoring preferential blood flow to vital organs. Williams KP, Galerneau F. Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia. Am J Obstet Gynecol. doi: 10.1016/j.psyneuen.2011.05.007, Gartstein, M. A., and Skinner, M. K. (2018). (2015). Soc. Intervention minimizing preterm infants' exposure to NICU light and noise. 130, 403407. Nutrients 11:1823. doi: 10.3390/nu11081823, Kozar, M., Tonhajzerova, I., Mestanik, M., Matasova, K., Zibolen, M., Calkovska, A., et al. (2007). Particularly warmer- or colder-than-average temperatures seem to be associated with increased systemic inflammation and alteration in placental blood flow (Martens et al., 2019; Sun et al., 2019), leading to dysregulation of metabolic and immune substrates of the fetus, and possibly influencing the regulatory functions of ANS. Towards a definition of life. At 1819 WGA, nociceptive neurons and the typical hormonal response to pain appear (Borsani et al., 2019; Chen et al., 2021), thus hinting that primitive pain perception might begin at this stage. Ikenoue T, Martin CB Jr, Murata Y, Ettinger BB, Lu PS. Since we have seen that amniotic flow and fetal growth restriction can affect vagal development, their effects could then be mediated by FMs. 85, 120126. 296, R702R707. If the fetal heart rate pattern is atypical, then your obstetrician will initially try to determine the underlying problem. A study with autonomic blocking agents in fetal lambs. ArXiv210207768 Phys. doi: 10.3945/jn.109.116327, Christifano, D. N., Taylor, M. K., Carlson, S. E., Colombo, J., and Gustafson, K. M. (2020). Semin Perinatol. Early Hum. (2017). Sleep 35, 177186. Research on the ovine species, reproducing the conditions of human labor, is indeed leading to the discovery and evidence of different algorithms to prevent pathological complications (Frasch et al., 2011; Wang et al., 2014). Maternal micronutrient deficiency, fetal development, and the risk of chronic disease. Gynecol. doi: 10.1002/bdrc.21139, Facco, F. L., Kramer, J., Ho, K. H., Zee, P. C., and Grobman, W. A. 10:922. doi: 10.3389/fphys.2019.00922, Ouellet-Morin, I., Dionne, G., Lupien, S. J., Muckle, G., Ct, S., Prusse, D., et al. 5:2377960819861486. doi: 10.1177/2377960819861486, Kruepunga, N., Hikspoors, J. P. J. M., Hlsman, C. J. M., Mommen, G. M. C., Khler, S. E., and Lamers, W. H. (2020). Nurs. Furthermore, without uterus protection, newborns can be particularly sensitive to sounds, which usually overcome the 45 dB limit recommended by the American Academy of Pediatrics (Almadhoob and Ohlsson, 2020), thus resulting in toxic stress (Weber and Harrison, 2019). Synchronous caregiving from birth to adulthood tunes humans' social brain. doi: 10.1016/j.ajog.2016.01.193, Prins, J. R., Eskandar, S., Eggen, B. J. L., and Scherjon, S. A. Pediatr. Clin. ANS, autonomic nervous system; CAN, central autonomic network; fHRV, fetal heart rate variability; FM, fetal movement; GM, general movement; PNS, parasympathetic nervous system; WGA, weeks gestational age. Therefore, the present paper aims to review the fetal and perinatal development by focusing on the development of the ANS and, in particular, of the vagus nerve to identify possible critical windows that could impact their maturation. Characterized by a gradual reduction in fetal heart rate (FHR) patterns that is visually detectable, late decelerations warrant a closer look. 127, 159169. Aagaard, K., Ma, J., Antony, K. M., Ganu, R., Petrosino, J., and Versalovic, J. Microbiota and neurodevelopmental windows: implications for brain disorders. 33, 747748. A decrease in the heart rate The vagus nerve begins maturation 26 to 28 weeks. doi: 10.1016/j.molmed.2014.05.002, Borsani, E., Della Vedova, A. M., Rezzani, R., Rodella, L. F., and Cristini, C. (2019). 188, 524531. doi: 10.1016/j.spen.2018.05.004, Mulkey, S. B., and du Plessis, A. J. Assoc. J. Perinat. Pathol. Health Perspect. doi: 10.1016/j.pharmthera.2012.03.008, Ozawa, M., Sasaki, M., and Kanda, K. (2010). Autonomic cardiorespiratory physiology and arousal of the fetus and infant, in SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future, eds J. R. Duncan and R. W. Byard (Adelaide, AU: University of Adelaide Press). Should one of them be damaged, the other one alone could not regulate the body's homeostasis efficiently anymore. Sleep and prematurity: sleep outcomes in preterm children and influencing factors. Ter. 90, 131139. The Physiology and Pathology of Exposure to Stress, 1st Edn. Indeed, several metrics related to both SNS and PNS (e.g., SDNN, CSI, HFn, LFn, TP, SD2, HRV Index, and Parseval Index) change right after birth and in the following months, with the PNS modulation that takes predominance (e.g., lower LF/HF and higher RMSSD and HF) during the following 2 years (Oliveira et al., 2019; Patural et al., 2019) to better regulate the increasingly social interactions the infant encounters (Porges, 2011). Another unexpected mechanism that buffers the raise in intrinsic activity is the presence of the ether-a-go-go-related gen K + channel since its activation is illustrated to increase with size reduction. Res. Despite knowing that the CAN coordinates autonomic function and that left and right hemispheres modulate PNS and SNS tone, respectively (Mulkey et al., 2021), we have conflicting results on how the brain precisely controls ANS in newborns. (2011). (2021). 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. (2020). 1993 Feb;461:431-49. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. (2019). Meas. which intrinsic homeostatic response is the fetus demonstrating Assessments of heart rate and sympathetic and parasympathetic nervous activities of normal mouse fetuses at different stages of fetal development using fetal electrocardiography. 596, 55035504. doi: 10.1111/j.1471-0528.1998.tb10011.x, Olaniyi, K. S., Moodley, J., Mahabeer, Y., and Mackraj, I. This association is important because all contemporary EFM classification methods place high reliance upon baseline fetal heart rate variability to exclude the presence of metabolic acidosis.23-30 The 2008 NICHD Update publication in which the Category I, II, III classification method was first described includes a statement that moderate variability reliably predicts the absence of metabolic acidemia at the time that it is observed.24 This concept was softened in the 2009 ACOG Practice Bulletin 106 with the statement The data relating FHR variability to clinical outcomes, however, are sparse.25 This practice bulletin endorsed the 3-level categorization of tracings where the third level required absent baseline variability. Fetal heart rates decelerated rapidly and well before sustained hypertension developed. Assoc. J. Neurosci. Res. Manag. Transl. Available online at: https://embryology.med.unsw.edu.au/embryology/index.php/Neural_System_Development (accessed April 23, 2021). doi: 10.1016/j.earlhumdev.2019.01.011, Nordenstam, F., Norman, M., and Wickstrm, R. (2019). Pregnancy Hypertens. Summary of the HRV metrics cited in the main text (Brndle et al., 2015; Massaro et al., 2017; Oliveira et al., 2019; Patural et al., 2019; Frasch et al., 2020a). Antonelli, M. C., Frasch, M. G., Rumi, M., Sharma, R., Zimmermann, P., Molinet, M. S., et al. 237, 655671. Two-year infant neurodevelopmental outcome after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity. 1977;7(6):373-6. A dually homeostatic adaptive exponential leaky integrate-and-fire (AdEx) neuron is simulated with four different combinations of control functions and goals. Autonomic nervous system activity in premature and full-term infants from theoretical term to 7 years. Toxics 6:38. doi: 10.3390/toxics6030038, Kasahara, Y., Yoshida, C., Nakanishi, K., Fukase, M., Suzuki, A., and Kimura, Y. Prenatal opioid exposure: neurodevelopmental consequences and future research priorities. J. Perinat. RadioGraphics 35, 21352148. Clin. Microbiol. 28, 377382. J. Afr. C Embryo Today Rev. Ingemarsson, I., and Lamont, R. F. (2003). doi: 10.1523/JNEUROSCI.3846-13.2013, Khedun, S. M., Maharaj, B., and Moodley, J. doi: 10.1002/bdra.23045, Lattimore, K. A., Donn, S. M., Kaciroti, N., Kemper, A. R., Neal, C. R., and Vazquez, D. M. (2005). (2020). doi: 10.1055/a-0713-1058, Koletzko, B., Godfrey, K. M., Poston, L., Szajewska, H., van Goudoever, J. https://www.acog.org/~/media/For%20Patients/faq015.pdf In fact, one could consider that the substantial reduction the rates of intrapartum-related neonatal encephalopathy seen in numerous regions around the world demonstrate a remarkable achievement. 66, 201209. Physiol. Pharmacol. doi: 10.1152/ajpregu.90474.2008, Frasch, M. G., Mller, T., Weiss, C., Schwab, K., Schubert, H., and Schwab, M. (2009b). doi: 10.1016/j.neubiorev.2018.05.026, Frasch, M. G., Mller, T., Hoyer, D., Weiss, C., Schubert, H., and Schwab, M. (2009a). Effects of antihypertensive drugs on the unborn child. Several studies have also shown a major change in fHRV in women given an analgesic agent such as lidocaine (Boehm et al., 1975; Lavin, 1982). Clinicians depend upon the heart rate to infer the condition of another organ, namely the fetal brain. Nat. Perinatal hypoxia contributes significantly to the possibility of perinatal brain injury (Gotsch et al., 2007). Progressive increase in arterial oxygen tension from 20 to 220 mm Hg resulted in progressive decrease in baseline heart rate and baseline arterial blood pressure indicating presence of chemoreceptor activity over this wide range of arterial oxygen tension. doi: 10.1111/j.1530-0277.2009.01137.x, Oguch, O., and Steer, P. (1998). Dev. Many postnatal pathologiese.g., hyperbilirubinemia, congenital heart disease, respiratory distress syndrome, respiratory syncytial virus, NEC, and sepsiscan lead to ANS impairment, probably due to inflammatory cytokines and toxins that can bypass the brain-blood barrier and induce neural death in areas paramount to ANS control (Fritze et al., 2014; Al-Shargabi et al., 2017; Bonaz et al., 2021). 82, 438443. That is, the machine (computer) learns from the actual data. Dev. There are many observed effects of this medication on fHRV and fetal breathing patterns, mostly transient and dose-/time-dependent (van Geijn et al., 1980; Kariniemi and Mml, 1981; Low et al., 1981; Viscomi et al., 1990; Capogna, 2001; Mattingly et al., 2003; Shekhawat et al., 2020). Neurosci. Am J Obstet Gynecol. Front. For this reason, before birth neuroendocrine signaling (e.g., catecholamines, cortisol, thyroid hormones, and renin-angiotensin) surges, and SNS outflow from CAN (e.g., hypothalamus, cortical, and brainstem centers) greatly increases. doi: 10.1016/j.ajog.2014.12.041, Aplin, J. D., Myers, J. E., Timms, K., and Westwood, M. (2020). Gynecol. 123, 1116. Identified Q&As 100+ Solutions available. Reprod Fertil Dev. Sleep-disordered breathing during pregnancy.
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