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

• DOI: 10.1007/s00404-019-05390-8
• Publication Date: 2019-11-28T11:03:02Z
• Authors: Silvia M. Lobmaier; A. Müller; C. Zelgert; C. Shen; P. C. Su; G. Schmidt; B. Haller; G. Berg; B. Fabre; J. Weyrich; H. T. Wu; M. G. Frasch; M. C. Antonelli
• Keywords: Adult; Hypothalamo-Hypophyseal System; Hydrocortisone; Pregnancy Trimester, Third; Mothers; Pituitary-Adrenal System; PS; Gestational Age; Anxiety; Autonomic Nervous System; Quantitative Biology - Quantitative Methods; Electrocardiography; 03 medical and health sciences; PRENATAL STRESS; 0302 clinical medicine; Pregnancy; https://purl.org/becyt/ford/1.6; FSI; FETAL AUTONOMIC NERVOUS SYSTEM; Humans; Prospective Studies; BPRSA; https://purl.org/becyt/ford/1; Fetal Movement; FETAL HEART RATE; BIVARIATE PHASE-RECTIFIED SIGNAL AVERAGING; Heart Rate, Fetal; 3. Good health; Pregnancy Complications; Case-Control Studies; FETAL STRESS INDEX; ANS; Female; Stress, Psychological

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.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.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].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.Clinical trial registration: NCT03389178.