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Maternal stress responses and anxiety during pregnancy: Effects on fetal heart rate
Abstract
This study examined the effect of an acute maternal stress response and anxiety on fetal heart rate. Seventeen healthy, 3rd-trimester pregnant women (mean age = 26 +/- 6 years) were instrumented for continuous electrocardiography, blood pressure (BP), respiration, and fetal heart rate (HR). Subjects completed the state anxiety subscale of the State Trait Personality Inventory (STPI), then rested quietly in a semirecumbent position for a 5-min baseline period, followed by either a 5-min arithmetic or Stroop color-word task. Over the entire 5-min stress period and when averaged across all subjects, the stressors led to significant increases in maternal systolic BP and respiratory rate but changes in maternal HR, diastolic BP, and fetal HR were not significant. However, when subjects were dichotomized into groups that had above or below average anxiety scores [ANX(+) and ANX(-)], both groups had similar respiration rate increases to the stressors, but the BP and fetal heart rate (FHR) responses were significantly different. Women in the ANX(-) group had significantly greater BP responses compared to women in the ANX(+) group whereas the fetuses of ANX(+) women showed significant HR increases and the fetuses of ANX(-) women exhibited nonsignificant decreases. These findings suggest that women's acute emotional reactivity during pregnancy can influence fetal HR patterns and that a stress-induced increase in maternal BP is not the primary signal by which a women's stress response is transduced to her fetus. The results are consistent with the hypothesis that maternal psychological variables may shape the neurobehavioral development of the fetus.
... In a sample of pregnant adolescents, Doyle et al. (2015) demonstrated that higher maternal negative mood was associated with lower FHRM among male but not female fetuses. In terms of FHR reactivity to stimulation, Monk and colleagues have shown that fetuses of women with elevated symptoms of depression and anxiety display a greater increase in FHR during women's exposure to a cognitive challenge (Monk et al., 2004;Monk et al., 2011Monk et al., , 2000Monk, Myers, Sloan, Ellman, & Fifer, 2003). Allister et al. (2001) demonstrated that fetuses of mothers with heightened depressive symptoms displayed a delay in FHR reactivity and return to baseline following vibroacoustic stimulation at 36 weeks' gestation. ...
... While one previous study reported higher late-gestation baseline FHRM in fetuses of mothers with elevated depressive symptoms (Allister et al., 2001), other studies either have demonstrated that elevated prenatal maternal psychological distress was associated with lower resting FHRM (Dieter et al., 2008;DiPietro et al., 2002b;Doyle et al., 2015) or have not found statistically significant associations between maternal distress and FHRM (DiPietro et al., 1996a;Monk et al., 2011Monk et al., , 2000Monk et al., , 2003Monk et al., , 2004. In addition, whereas other investigations have reported associations between maternal psychological distress and FHRV (DiPietro et al., 1996a;DiPietro et al., 2002b;DiPietro et al., 2010), we did not find associations between these variables. ...
... Specifically, fluctuations in the uterine sensory environment due to changes in maternal heart rate, respiration, blood pressure, and gastric motility may induce a fetal orienting response (DiPietro, 2010;Kinsella & Monk, 2009). Studies demonstrating alterations in fetal neurobehavioral activity in response to induced maternal sympathetic activation provide support for this hypothesis (DiPietro et al., 2003(DiPietro et al., , 2008Monk et al., 2011Monk et al., , 2000Monk et al., , 2003Monk et al., , 2004. Variations in uterine perfusion resulting from maternal vasoconstriction may also alter FHR activity (DiPietro et al., 2003;Kinsella & Monk, 2009). ...
Associations between prenatal maternal psychological distress and offspring developmental outcomes are well documented, yet relatively little research has examined links between maternal distress and development in utero , prior to postpartum influences. Fetal heart rate (FHR) parameters are established indices of central and autonomic nervous system maturation and function which demonstrate continuity with postnatal outcomes. This prospective, longitudinal study of 149 maternal–fetal pairs evaluated associations between prenatal maternal distress, FHR parameters, and dimensions of infant temperament. Women reported their symptoms of psychological distress at five prenatal visits, and FHR monitoring was conducted at the last three visits. Maternal report of infant temperament was collected at 3 and 6 months of age. Exposure to elevated prenatal maternal psychological distress was associated with higher late-gestation resting mean FHR (FHRM) among female but not male fetuses. Higher late-gestation FHRM was associated with lower infant orienting/regulation and with higher infant negative affectivity, and these associations did not differ by infant sex. A path analysis identified higher FHRM as one pathway by which elevated prenatal maternal distress was associated with lower orienting/regulation among female infants. Findings suggest that, for females, elevated maternal distress alters fetal development, with implications for postnatal function. Results also support the notion that, for both sexes, individual differences in regulation emerge prenatally and are maintained into infancy. Collectively, these findings underscore the utility of direct assessment of development in utero when examining if prenatal experiences are carried forward into postnatal life.
... Fetal responsivity, particularly fetal habituation, to external non-noxious stimuli has been studied extensively as a proxy marker of fetal central nervous system integrity and maturity (Leader, Baillie, Martin, & Vermeulen, 1982a, 1982b, and of fetal states of well-being including fetal oxygenation (Tucker, Miller, & Miller, 2009a, 2009b. Fetal habituation has been found to predict postnatal behavior at 18 and 36 months (Leader & Dore, 1979), and has been studied in the context of maternal prenatal depression and anxiety (DiPietro et al., 2003;DiPietro, Hodgson, Costigan, Hilton, & Johnson, 1996a, 1996bMonk et al., 2000Monk et al., , 2003. ...
... Similar findings associating prenatal maternal stress and elevated ACTH responses to stressors in offspring have been reported in animal literature (Takahashi et al., 1988(Takahashi et al., , 1992Takahashi & Kalin, 1991). Nevertheless, we acknowledge that the fetal results of the Solur Mother and Baby Project differ from a number of studies on Western populations that have reported linear associations between prenatal depression (and anxiety), and disturbances in FHR responsivity to a stressor (Allister, 2001;DiPietro et al., 2003;Monk et al., 2000Monk et al., , 2003. Moreover, we are not aware of any other studies directly reporting a U-shaped association between prenatal maternal depression and infant cortisol responsivity. ...
... Furthermore, the study was conducted in a prenatal population that reported no smoking, alcohol consumption, or recreational drug use before or during their pregnancy, and therefore the results are free from the confounding influences of these exposures on fetal brain development. There were a number of methodological strengths to the project that built upon preexisting literature in the field: (a) the prenatal assesment involved direct stimulation of the fetus with a VAS rather than the indirect stimulation of the fetus using maternal cognitive stressors utilized in previous work (DiPietro et al., 2003;Monk et al., 2000Monk et al., , 2003; (b) the fetal responsivity analysis utilized the measurement of areas under fetal responsivity curves rather than fluctuations in fetal heart rate and variability and as such were a more robust measure of total fetal response to stimulation than transient heart rate fluctuations; ...
This article extends the research focusing on the early origins of psychopathology into the prenatal period, by exploring the association between maternal prenatal depression and offspring (fetal and infant) neurobehavior. The sample is recruited from a rural population in South India where women in the third trimester of pregnancy were assessed for depression and the heart rate responses of their fetuses to extrinsically applied vibroacoustic stimuli were studied. At 2 months postbirth, infant temperament and cortisol responsivity to immunization were assessed. The association between maternal prenatal depression and fetal responsivity to vibroacoustic stimulation, and infant responsivity to immunization, was U shaped with higher levels of responsivity noted in the offspring of mothers with very high and very low depression scores, and lower levels noted in the offspring of mothers with moderate depression scores. Maternal prenatal depression was not associated with infant temperament. The findings highlight the importance of environmental influences in the developmental origins of neurobehavior, suggesting that such differences, not evident at baseline, may emerge upon exposure to stressors. The study also emphasizes the need for further investigation in low- and middle-income contexts by providing preliminary evidence of the differing patterns of association observed between high- and low-income populations.
... Although there are many explanations for fetal heart rate abnormalities that may benefit from medical intervention, one consideration is that maternal anxiety results in stress hormone production that affects fetal heart rate [46]. Continuous labor support helps to reduce maternal anxiety, which also reduces fetal stress, and may, in turn, reduce unnecessary interventions including surgical delivery [23]. ...
... Although not fully understood, oxytocin is believed to play a role in the initiation of labor, as well as maintaining contractions once labor has begun [46]. It is especially important in mother-infant bonding and lactation, being responsible for the let-down reflex that enables milk to flow when the infant suckles. ...
Cesarean section (surgical removal of a neonate through the maternal abdominal and uterine walls) can be a life-saving medical intervention for both mothers and their newborns when vaginal delivery through the birth canal is impossible or dangerous. In recent years however, the rates of cesarean sections have increased in many countries far beyond the level of 10-15% recommended as optimal by the World Health Organization. These 'excess' cesarean sections carry a number of risks to both mothers and infants including complication from surgery for the mother and respiratory and immunological problems later in life for the infants. We argue that an evolutionary perspective on human childbirth suggests that many of these 'unnecessary' cesarean sections could be avoided if we considered the emotionally supportive social context in which childbirth has taken place for hundreds of thousands or perhaps even millions of years of human evolution. The insight that human childbirth is usually a cooperative, even social event in which women are attended by familiar, supportive family and friends suggests that the harsh clinical environment in which women often give birth in the developed world is not the best setting for dealing with the strong emotional forces that usually accompany labor and delivery. We argue that providing a secure, supportive environment for laboring mothers can reduce the rate of 'unnecessary' surgical deliveries.
... Normally, fears and anxieties appear in her daily life, in relation to her state of health and that of her baby (Clark et al., 2009;Cantwell and Cox, 2003). It has been demonstrated that an association exists between maternal psychological well-being and foetal well-being during pregnancy (Monk et al., 2000). Studies exist which confirm that anxiety during pregnancy can be a risk factor for the development of alterations in the mental health of the pregnant woman, such as an increase in the probability of postnatal depression (Coelho et al., 2011;Austin et al., 2007) and of obstetric complications, like premature birth (Hobel et al., 1999) and decrease in the duration of the first stage of labour, as well as reduced cases of cesarean sections and an increase in non-medicated spontaneous deliveries (García et al., 2017a). ...
... Based on the results of similar studies (Teixeira et al., 2009;Monk et al., 2000) the variables which were studied as possible risk factors in the third trimester included: -Sociodemographic variables: maternal age, gestational age during NST, parity, average number of music sessions at home, socioeconomic status and marital status. -Variables related to childbirth: broken amniotic sac when admitted to hospital, foetal presentation, onset of labour, completion of birth and episiotomy. ...
... Life in utero is influenced by many factors, including the totality of the mother's functioning, genetic inheritance broadly construed, her external environment, and, the cultural norms of present and past generations. Fetal research (Piontelli, 1987(Piontelli, , 1992Monk et al., 2000Monk et al., , 2003Monk et al., , 2004Monk, 2001;O'Connor et al., 2014O'Connor et al., , 2016Ecklund-Flores et al., 2015) has indicated that life in utero is not only multifaceted, but that the uterine environment is neither isolated nor insulated as it has until recently been considered to be. In utero experience may have some impact on gender identity development (Meissner, 2005a(Meissner, , 2008. ...
... The fetus is impacted by the mother's chemical and affective life (Monk et al., 2000;Monk, 2001;Katz, 2002;Monk et al., 2003;Monk et al., 2004;O'Connor et al., 2014O'Connor et al., , 2016Ecklund-Flores et al., 2015). As such, as a part of the life and self of the mother, the fetus is living and developing as a functional part of a larger self-system. ...
... The current results are a first step towards providing better insight about the way psychosocial factors play a role in fostering a positive or negative birth experience. Previous research has shown that high levels of stress, anxiety and fear both before and during labour increase the risk of fetal distress and increase the need for medical interventions ( Monk et al., 2000;Nieminen et al., 2009;Ryding et al., 1998) which predicts a more negative experience for women ( Creedy et al., 2000;Waldenström et al., 2004) which in turn affects critical health decisions that women make such as delaying future pregnancies and requesting caesarean deliveries ( Bahl et al., 2004;Gottvall & Waldenström, 2002;Hildingsson et al., 2002;Waldenström et al., 2006). Clearly, then, women should aim to reduce stress and fear and increase feelings of capacity and control both for her own subjective experience and for fetal health. ...
... The current results are a first step towards providing better insight about the way psychosocial factors play a role in fostering a positive or negative birth experience. Previous research has shown that high levels of stress, anxiety and fear both before and during labour increase the risk of fetal distress and increase the need for medical interventions ( Monk et al., 2000;Nieminen et al., 2009;Ryding et al., 1998) which predicts a more negative experience for women ( Creedy et al., 2000;Waldenström et al., 2004) which in turn affects critical health decisions that women make such as delaying future pregnancies and requesting caesarean deliveries ( Bahl et al., 2004;Gottvall & Waldenström, 2002;Hildingsson et al., 2002;Waldenström et al., 2006). Clearly, then, women should aim to reduce stress and fear and increase feelings of capacity and control both for her own subjective experience and for fetal health. ...
Objective: In the current study, we explored the relationship between a woman’s personality, epidural use and perceptions of the labour and birth experience.
Background: Having a positive birthing experience is relevant to predicting a range of important outcomes including mother–infant bonding, fertility rates and delivery interventions. However, limited research has addressed the kinds of individual differences that may affect a woman’s subjective birthing experience.
Methods: One hundred and twenty-five women were surveyed about subjective aspects of the labour and birthing experience of their first-born child, including use of epidural, perceived pain, anxiety, self-capacity and positive experiences. The women also completed the Big Five personality inventory, which measures five dimensions of stable personality characteristics.
Results: Results show that four of the Big Five personality traits were found to correlate to the four different aspects of the labour and birth experience, and that these relationships were largely moderated by a woman’s decision to have an epidural.
Conclusion: These findings add to the limited body of research on the relationships between personality and the labour experience. They also highlight the importance of considering pain management decisions in understanding this relationship. Future research in this area may provide a new way for doctors, midwives and doulas to tailor support and intervention for women during the birthing process based on individual differences to help more women have positive birthing experiences.
... However, there is evidence for a significant interaction between maternal negative mood and fetal sex, with increased levels of maternal negative mood being associated with decreased baseline FHR in male fetuses only (Doyle et al., 2015). Furthermore, other studies have failed to find a significant relationship between maternal anxiety and baseline FHR (DiPietro et al., 2010;Groome et al., 1995;Monk et al., 2000Monk et al., , 2003Sjöström et al., 2002). However, two older studies showed evidence for a positive association between maternal anxiety and the duration of a FHR pattern that is typically seen in periods during which the fetus is highly active (Fetal Sate 4F), namely FHR pattern D; fetal HRV within FHR pattern D was also associated with maternal anxiety (Sjöström et al., 2002). ...
... However base level maternal state anxiety was related with fetal activity and associated FHR patterns B and D ( Van den Bergh et al., 1989). In other studies fetuses of depressed, anxious or anxio-depressive comorbid mothers tend to have significantly higher increases in FHR (Monk et al., 2011(Monk et al., , 2000(Monk et al., , 2003(Monk et al., , 2004 and fetal HRV (DiPietro et al., 2003) when the mother was introduced to a stress-inducing Stroop color-word task. ...
Accumulating research shows that prenatal exposure to maternal stress increases the risk for behavioral and mental health problems later in life. This review systematically analyzes the available human studies to identify harmful stressors, vulnerable periods during pregnancy, specificities in the outcome and biological correlates of the relation between maternal stress and offspring outcome. Effects of maternal stress on offspring neurodevelopment, cognitive development, negative affectivity, difficult temperament and psychiatric disorders are shown in numerous epidemiological and case-control studies. Offspring of both sexes are susceptible to prenatal stress but effects differ. There is not any specific vulnerable period of gestation; prenatal stress effects vary for different gestational ages possibly depending on the developmental stage of specific brain areas and circuits, stress system and immune system. Biological correlates in the prenatally stressed offspring are aberrations in neurodevelopment, neurocognitive function, cerebral processing, functional and structural brain connectivity involving amygdalae and (pre)frontal cortex, changes in hypothalamo-pituitary-adrenal (HPA)-axis and autonomous nervous system.
... Recent investigations have demonstrated the relationship between maternal psychological well-being and fetal welfare during pregnancy [1]. Around the fifth month of gestation, the brain can process sounds and the fetus reacts physically to sound in the uterus, high frequencies being more effective because they pass through the amniotic fluid more easily [2]. ...
... Based on the results of similar studies, [1,4] the variables studied as possible risk factors in the third trimester were: ...
Background:
Music has been used for medicinal purposes throughout history due to its variety of physiological, psychological and social effects.
Objective:
To identify the effects of prenatal music stimulation on the vital signs of pregnant women at full term, on the modification of fetal cardiac status during a fetal monitoring cardiotocograph, and on anthropometric measurements of newborns taken after birth.
Material and method:
A randomized controlled trial was implemented. The four hundred and nine pregnant women coming for routine prenatal care were randomized in the third trimester to receive either music (n = 204) or no music (n = 205) during a fetal monitoring cardiotocograph. All of the pregnant women were evaluated by measuring fetal cardiac status (basal fetal heart rate and fetal reactivity), vital signs before and after a fetal monitoring cardiotocograph (maternal heart rate and systolic and diastolic blood pressure), and anthropometric measurements of the newborns were taken after birth (weight, height, head circumference and chest circumference).
Results:
The strip charts showed a significantly increased basal fetal heart rate and higher fetal reactivity, with accelerations of fetal heart rate in pregnant women with music stimulation. After the fetal monitoring cardiotocograph, a statistically significant decrease in systolic blood pressure, diastolic blood pressure and heart rate in women receiving music stimulation was observed.
Conclusion:
Music can be used as a tool which improves the vital signs of pregnant women during the third trimester, and can influence the fetus by increasing fetal heart rate and fetal reactivity.
... Recent investigations have demonstrated the relationship between maternal psychological well-being and fetal welfare during pregnancy [1]. Around the fifth month of gestation, the brain can process sounds and the fetus reacts physically to sound in the uterus, high frequencies being more effective because they pass through the amniotic fluid more easily [2]. ...
... Based on the results of similar studies, [1,4] the variables studied as possible risk factors in the third trimester were: ...
Background. Many researchers have pointed out the strong relationship between maternal psychological well-being and fetal welfare during pregnancy. The impact of music interventions during pregnancy should be examined in depth, as they could have an impact on stress reduction, not only during pregnancy but also during the course of delivery, and furthermore induce fetal awareness.
Objective. This study aimed to investigate the effect of music on maternal anxiety, before and after a non-stress test (NST), and the effect of music on the birthing process.
Material and method. The four hundred and nine pregnant women coming for routine prenatal care were randomized in the third trimester to receive either music (n = 204) or no music (n = 205) stimulation during an NST. The primary outcome was considered as the maternal state anxiety score before and after the NST, and the secondary outcome was the birthing process
Results. Before their NST, full-term pregnant women who had received music intervention were found to have a similar state-trait anxiety score to those from the control group, with 38.10 ± 8.8 and 38.08 ± 8.2 respectively (p < 0.97). After the NST, the mean state-trait anxiety score of each group was recorded, with results of 30.58 ± 13.2 for those with music intervention, and 43.11 ± 15.0 for those without music intervention (p < 0.001). In the control group, the NST was followed by a statistically significant increase in the state-trait anxiety score (38.08 ± 8.2 versus 43.11 ± 15.0, p < 0.001). However, listening to music during the NST resulted in a statistically significant decrease in the state-trait anxiety score of the study group (38.10 ± 8.8 versus 30.58 ± 13.2, OR = 0.87, p < 0.001). Furthermore, the first stage of labor was shorter in women who received music stimulation (OR= 0.92, p < 0.004). They also presented a more natural delivery beginning (spontaneous) and less medication (stimulated and induced) than those who were not stimulated musically, with statistically significant differences (p < 0.01).
Conclusion. Prenatal music intervention could be a useful and effective tool to reduce anxiety in full-term pregnant women during an NST and improve the delivery process by reducing the first stage of labor in nulliparous women.
... Mood disturbances in pregnant women have been linked to changes in the physiological reactivity of the fetus, and they may condition the fetus's neurobehavioral development. Mothers suffering from depression or with high anxiety, had higher values in cardiac activity [12,13]. Music shows many positive effects on the organism of a women in pregnancy and in the postpartum period. ...
... Many studies conducted during pregnancy and in the neonatal stage indicated positive effects of musical therapy. Music has a sedative effect and it causes positive changes in the behavior of fetuses and neonates [1,7,10,12,13]. ...
Objective: The assessment of cardiac parameters of the fetus in cardiotocographic record of pregnant women listening to Classical music.
Study Design: 60 NST records with no musical stimulation and 30 NST records during a 15-minute auditive stimulation with Wolfgang Amadeus Mozart's “Turkish March” as well as 30 NST records during Johann Strauss's “Tritsch-Tratsch Polka” were performed for the study. The average stage of the responders' pregnancy was the 36rd week, the lowest – the 27th week, the highest – 41st.
Results: Following the listening to W.A. Mozart's composition, a significant increase was observed in values concerning: the number of fetal movements (p < 0.0001), accelerations >10 (p = 0.0063), accelerations >15 (p = 0.0011), high variability (p = 0.0019) and short-term variability (p < 0.0001). Meanwhile, parameters concerning baseline cardiac activity (p = 0.0003) and low variability (p = 0.0021) significantly decreased. The number of uterine contractions decreased insignificantly (p = 0.3718).
Following listening to J. Strauss's composition, the following parameters underwent increase: fetal movements (p = 0.0021) and short-term variability (p = 0.0025). The remaining parameters of the cardiotocographic record: accelerations, uterine contractions – underwent an improvement, but the changes were not significant.
Conclusion: Music therapy is a non-invasive and uncostly method, significantly improving wellbeing-indicative fetal parameters.
... Evidence from human and animal studies show that by-products of maternal health and health-related behaviors (e.g., maternal hormones and cytokines) can cross the placenta and influence fetal development (Seckl, 2004;Talge, Neal, Glover, & Early Stress, Translational Research and Prevention Science Network, 2007;Wadhwa, 2005;Weinstock, 2005;Welberg & Seckl, 2001); it is through biological mechanisms of this nature that qualities of pregnant women's lives are thought to impact the fetus. Support for this model comes from a range of research designs, including studies that show that pregnancy-specific states and experiences are associated with (a) infant and child development, even after controlling for confounding postnatal factors (Davis et al., 2007;Davis & Sandman, 2010;O'Connor, Heron, Golding, Glover, & ALSPAC Study Team, 2003); (b) adverse pregnancy outcomes that indicate differences in fetal growth and development, including preterm birth and lower birth weight (Dole et al., 2003;Spicer et al., 2013;Wadhwa, Sandman, Porto, Dunkel-Schetter, & Garite, 1993); and (c) variations in fetal neurobehavioral development (DiPietro, 2012;DiPietro, Hilton, Hawkins, Costigan, & Pressman, 2002;Glover, 2011;Monk et al., 2000Monk et al., , 2004Wadhwa, Sandman, & Garite, 2001), including indices of autonomic nervous system regulation such as fetal heart rate variability (HRV;DiPietro, Bornstein, Hahn, Costigan, & Achy-Brou, 2007;DiPietro, Hodgson, Costigan, Hilton, & Johnson, 1996;Doyle et al., 2015). Most of this data comes from studies investigating the prenatal effects of maternal psychological distress (see Glover, 2011;Kinsella & Monk, 2009, for reviews), yet research examining the consequences of women's abuse histories on children's development shows distinctly similar results. ...
... To rule out the possibility that these variables are exclusively responsible for any observed associations, we incorporated these as covariates in our investigation. Given that women with histories of interpersonal psychological trauma are at heightened risk for psychiatric difficulties during pregnancy (Seng, D'Andrea, & Ford, 2014), that depressed pregnant women tend to have more disturbed sleep (Field et al., 2007), and that prenatal depression has been associated with fetal neurobehavioral development (Field, Diego, & Hernandez-Reif, 2006;Monk et al., 2000Monk et al., , 2004, we also considered the role that maternal depressive symptoms may play in the association between women's childhood history of emotional abuse and fetal HRV. ...
The consequences of childhood maltreatment are profound and long lasting. Not only does the victim of abuse suffer as a child, but there is mounting evidence that a history of maltreatment places the next generation at risk for significant psychopathology. Research identifies postnatal factors as affecting this intergenerational transmission of trauma. However, emerging evidence suggests that part of this risk may be transmitted before birth, passed on via abuse-related alterations in the in utero environment that are as yet largely unidentified. To date, no study has directly assessed the influence of pregnant women's abuse history on fetal neurobehavioral development, nor considered trauma-associated poor sleep quality as a mediator reflecting established physiological dysregulation. Using data from 262 pregnant adolescents (ages 14–19), a population at elevated risk for childhood maltreatment, the current study examined maternal emotional abuse history and sleep quality in relation to third-trimester fetal resting heart rate variability, an index of parasympathetic nervous system functioning. The results indicate that maternal emotional abuse history is indirectly associated with lower fetal heart rate variability via abuse-related sleep disturbances. These data demonstrate an association between maternal abuse histories and fetal development, showing that at least part of the intergenerational transmission of risk occurs during pregnancy.
... Functional Fetal Autonomic Brain Age Score (fABAS) has been recently introduced which uses FHR patterns for multivariate analyses of universal developmental indices [5]. However, FHR is influenced by arrhythmias, fetal behavioral states, heart rate patterns and maternal conditions [8,9]. Fetal cardiac valve intervals are other measures which could be obtained from non-invasive, low cost and easyto-operate devices, and provide reliable markers for fetal development and wellbeing [10,11]. ...
... Results of this paper showed that the new method based on valve intervals outperforms the FHRbased method in estimating the GA although only time and frequency domain parameters and non identical populations were used. FHR is influenced by other factors such as behavioral states of the fetus and maternal physiological and psychological conditions [8,9]. However, the recordings used in this study are short and may not thoroughly represent the FHRV patterns which are used to evaluate the brain development [5]. ...
A new automated method for estimation of the gestational age is presented in this paper based on the intervals
between fetal cardiac valve timings and the Q-wave of fetal electrocardiogram (fECG). The intervals were estimated automatically from one-dimensional Doppler Ultrasound and noninvasive fECG. Among the intervals, Isovolumic Contraction Time, Electromechanical Delay Time, Ventricular Filling Time and their interactions were selected in a stepwise regression process. Compared with Crown-Rump Length as gold standard, a mean absolute error of 3.8 weeks was obtained using leave-one-out cross validation. This method also outperformed a fetal heart rate based approach. Since valve intervals reflect the autonomic function, this method provides a novel measure of the development of fetal autonomic nervous system that may be growth curve independent.
... These variables can be specifically accounted for in laboratory studies, but cannot be easily controlled in field experiments. Prior experience may include inherited factors (Crews et al., 2012) maternal effects (Monk et al., 2000) and prenatal experience (Monk et al., 2012), epigenetic modifications (Monk et al., 2012), natal habitat experience (Davis and Stamps, 2004;Stamps and Swaisgood, 2007), food preferences (Symonds et al., 2006), as well as recent encounters with habitats, predators, or conspecifics (Blumstein et al., 2002). Such prior experiences can be more specifically controlled in laboratory studies. ...
A better understanding of context in decision-making—that is, the internal and external conditions that modulate decisions—is required to help bridge the gap between natural behaviors that evolved by natural selection and more arbitrary laboratory models of anxiety and fear. Because anxiety and fear are mechanisms evolved to manage threats from predators and other exigencies, the large behavioral, ecological and evolutionary literature on predation risk is useful for re-framing experimental research on human anxiety-related disorders. We review the trade-offs that are commonly made during antipredator decision-making in wild animals along with the context under which the behavior is performed and measured, and highlight their relevance for focused laboratory models of fear and anxiety. We then develop an integrative mechanistic model of decision-making under risk which, when applied to laboratory and field settings, should improve studies of the biological basis of normal and pathological anxiety and may therefore improve translational outcomes.
... development of the infant (17). Hormones such as catecholamines cause placental artery contraction, which restricts fetal oxygen supply and nutrition, and by passing the placenta, catecholamines affect fetal brain development (18), causing developmental and psycho-cognitive disorders in infants (19). Also, high levels of anxiety during pregnancy make the child susceptible to future schizophrenia and affective disorders (20). ...
Background: As one of the most enjoyable life experiences, pregnancy may be accompanied by many physiological and psychological changes that make women susceptible to developing mental disorders such as anxiety. Non-pharmacological methods such as writing therapy are among the ways to deal with anxiety. Objectives: The present study aimed to determine the effect of writing therapy on anxiety in women during pregnancy. Methods: This randomized controlled trial was conducted on 70 pregnant women with a gestational age between 28 - 31 weeks. The participants were assigned to an intervention group and a control group using a randomized block design. The intervention group received three in-person writing therapy-based counseling sessions and two telephone calls between the sessions, while the control group received routine pregnancy care. The Beck anxiety inventory was completed before and six weeks after the intervention. Independent t-test and ANCOVA were used for data analysis. Results: There was no significant difference between the two groups in terms of socio-demographic variables and baseline anxiety scores. Based on ANCOVA with baseline score adjustment, the mean score of anxiety was significantly lower in the intervention group than in the control group after the intervention (adjusted mean difference = -6.8; 95%CI = -4.5 to -9.1; P < 0.001). Conclusions: According to the results, writing therapy can reduce anxiety in pregnant women; however, further studies are needed before a definitive conclusion.
... For example, A Swiss study was conducted primarily to assess maternal anxiety during pregnancy and their impact on obstetric, fetal and neonatal outcome. [15]Some American researchers have studied the effect of anxiety during pregnancy on fetal heart rate [20] and neurobehavioral development. [21]Another similar finding had been reported in British, where researchers explored that the serious consequences of pregnancy anxiety on the development of pregnant women and children. ...
Background
In recent years, there is a growing tendency for pregnant women suffered from anxiety, which not only affects the health of pregnant women and the development of children, but also poses a serious burden on families and society. However, few studies have focused on the factors that contribute to anxiety during pregnancy, especially among migrants.
Methods
A total of 400 pregnant women from a tertiary hospital in Jinan, the provincial capital of Shandong Province. Anxiety was used as dependent variable based on Self-Rating Anxiety Scale (SAS). Descriptive statistics were presented and a multi-logistic regression analysis were conducted to explore the factors associated with anxiety during pregnancy. STATA 14.2 software was used for analysis.
Results
The prevalence rate of anxiety in pregnant women is 25.7%. The multi-logistic regression indicates that pregnant women who have longer hospital stay (OR=1.15, p<0.05), who live in rural areas (OR=3.81, p<0.05) and who have pressure during pregnancy (OR=3.98, p<0.05) are more likely to have anxiety. Meanwhile, compared with the lowest income group, group Q2 and Q3 was significantly associated with higher odds of anxiety (OR=1.89, p<0.05; OR=3.37, p<0.05). Those who are local residents (OR=0.59, p<0.59) and who have higher social support points (OR=0.95, p<0.05) are less likely to have anxiety during pregnancy.
Conclusions
Pregnant women have poor anxiety, and the influencing factors are complex and varied. Therefore, Risk factors such as migrants, living in cities, more life stress, lower family income, longer hospital stays, and less social support should be taken into concern and individualized intervention should be adopted.
... Presenta además algunas ventajas sobre los cuestionarios o autoinformes tradicionales ya que no puede manipularse a voluntad del sujeto lo que permite su utilización como instrumento diagnóstico en aquellas situaciones donde hay un alto riesgo de negación de los síntomas por parte del sujeto o la capacidad de reconocerlos. Esta ignorancia o falta de consciencia sobre elementos perturbadores es especialmente relevante en el proceso del embarazo, razón por la que se ha considerado incluir la evaluación de estos posibles sesgos atencionales para ofrecer una imagen más completa y de mayor alcance explicativo, diagnóstico y preventivo, en la línea de recientes trabajos sobre el tema específico del embarazo o la comorbilidad con otros trastornos como la alexitimia o las disfunciones de la conducta alimenticia (Beales y Dolton, 2000;Blais y Becker, 2000;Monk, Fifer, Myers, Sloan, Trien y Hurtado, 2000;Tarabusi, Matteo, Volpe y Facchinetti, 2000;Monk, Fifer, Sloan, Myers, Bagiella, Ellman y Hurtado, 2001;Cabaco, Capataz, González, Fernández-Rivas y Fernández, 2002;Cabaco, Capataz, Fernández, González y Fernández-Rivas, 2003). ...
... Esta alteración se manifiesta por ansiedad, irritabilidad culpabilidad, ira o depresión. La ansiedad (rasgo-estado), como emoción anticipatoria hacia los cambios biopsicosociales que origina el proceso del embarazo, y la depresión como emoción que se produce por los esfuerzos derivados de afrontamiento contra el estrés y ansiedad derivados de la valoración cognitiva que la mujer realiza del proceso de gestación, han sido las alteraciones más prevalentes manifestadas por mujeres gestantes y por tanto hablaremos de ellas en el apartado de indicadores de riesgo emocional (Reeve, 1994;Monk, Fifer, Myers, Sloan, Trien y Hurtado, 2000;Sánchez, Bermúdez y Buela-Casal, 2000). ...
... Providing psychosocial care during pregnancy is very important for maintaining the health of both pregnant woman and fetus [30,31]. To improve the quality of psychosocial care, factors that affect psychosocial health during pregnancy should be identified [9,14,[32][33][34]. The relevant literature also states that spouses of pregnant women have an important place among the factors affecting psychosocial health during pregnancy as well [8,9,13,14,35,36]. ...
Purpose: The aim of this study was to determine the relationship between psychosocial health status and social support, which has important effects on pregnancy, and to determine the factors related to both psychosocial health and social support.
Method: The research was planned to be a descriptive study. The sample of the study consisted of 393 pregnant women. ‘Personal Information Form’, ‘Pregnancy Psychosocial Health Assessment Scale (PPHAS)’, and ‘Multidimensional Scale of Perceived Social Support (MSPSS)’ were used to collect data, and Student’s t-test, ANOVA and Tukey’s HSD tests were used for the data analysis. The relationship between the two continuous variables was evaluated according to the Pearson correlation coefficient.
Results: Psychosocial health conditions and perceived social supports of pregnant women whose spouses were working were determined to be significantly higher (p < .05), and at a lower level (p < .05) in pregnant women with two or more children. As MSPSS total mean scores of the pregnant women increased, their PPHAS total mean scores were weakly affected in the positive direction (r = 0.393, p < .01).
Conclusions: It is recommended that health care needs of pregnant women should be evaluated not only in terms of physical health but also together with their psychosocial health and social supports. Furthermore, this assessment should be done in their own home environment with their spouses and other family members.
... Results that third-trimester fetuses in the PHSG relative to the HG evidenced reductions in fetal heart rate and movement coupling may suggest slower central nervous system development, as greater third-trimester coupling has been associated with faster auditory-evoked responses among newborns measured within 2 wk of birth (92). Results suggesting that third-trimester PSYG fetuses had a heart rate increase during maternal exposure to an acute laboratory stressor while HG fetuses had a (nonsignificant) heart rate decrease are consistent with our prior studies showing greater FHR reactivity among fetuses of women with elevated trait anxiety and diagnosed anxiety and depression (15,16,20,93). ...
Significance
Despite decades of prenatal programming research showing that “the womb may be more important than the home” with respect to offspring health outcomes, no studies of which we are aware have considered multiple indicators of maternal stress to identify the types of maternal stress that most influence developing offspring. This study’s key contributions include the use of a data-driven procedure to specify types of maternal stress—psychological and subclinical physical health indicators—that predict offspring outcomes including sex at birth, risk of preterm birth, and fetal neurodevelopment. Social support is a key factor differentiating the stress groups and a malleable intervention target to improve offspring outcomes.
... Furthermore, elevated PNSE has been shown to increase levels of proinflammatory markers across pregnancy (85), which has been linked to decreased FA in the uncinate fasciculus of newborn offspring and decreased cognition at 12 months of age (86). In addition, PNSE is associated with physiological changes including alterations in fetal heart rate (87). Indeed, a recent study assessing structural and functional connectivity in infants exposed to maternal depression suggested that alterations in fetal heart rate may influence the development of the amygdala-prefrontal circuit (88). ...
Background:
Maternal prenatal stress exposure (PNSE) increases risk for adverse psychiatric and behavioral outcomes in offspring. The biological basis for this elevated risk is poorly understood but may involve alterations to the neurodevelopmental trajectory of white matter tracts within the limbic system, particularly the uncinate fasciculus. Additionally, preterm birth is associated with both impaired white matter development and adverse developmental outcomes. In this study we hypothesized that higher maternal PNSE was associated with altered uncinate fasciculus microstructure in offspring.
Methods:
In this study, 251 preterm infants (132 male, 119 female) (median gestational age = 30.29 weeks [range, 23.57-32.86 weeks]) underwent brain magnetic resonance imaging including diffusion-weighted imaging around term-equivalent age (median = 42.43 weeks [range, 37.86-45.71 weeks]). Measures of white matter microstructure were calculated for the uncinate fasciculus and the inferior longitudinal fasciculus, a control tract that we hypothesized was not associated with maternal PNSE. Multiple regressions were used to investigate the relationship among maternal trait anxiety scores, stressful life events, and white matter microstructure indices in the neonatal brain.
Results:
Adjusting for gestational age at birth, postmenstrual age at scan, maternal age, socioeconomic status, sex, and number of days on parenteral nutrition, higher stressful life events scores were associated with higher axial diffusivity (β = .177, q = .007), radial diffusivity (β = .133, q = .026), and mean diffusivity (β = .149, q = .012) in the left uncinate fasciculus, and higher axial diffusivity (β = .142, q = .026) in the right uncinate fasciculus.
Conclusions:
These findings suggest that PNSE is associated with altered development of specific frontolimbic pathways in preterm neonates as early as term-equivalent age.
... Dynamic changes in RSA across a stress paradigm reflect an individual's ability both to mobilize biological resources in response to a challenge and to return to a regulated state after the stressor is addressed. Development of RSA stress responsivity profiles, including both reactivity and recovery, begins in utero (Monk et al., 2000). Therefore, changes to the intrauterine environment, as a consequence of maternal life-course experiences, have the potential to impact the developmental trajectory of RSA profiles. ...
... The ability to distinguish critical aspects of emotion dysregulation among neonates may ultimately uncover perinatal prevention targets to ameliorate childhood psychopathology risk. One such target may be an expectant mother's own emotion dysregulation, as the neurobehavioral consequences of prenatal maternal mood are already apparent among fetuses and neonates (Alder, Fink, Bitzer, Hösli, & Holzgreve, 2007;DiPietro, Costigan, Nelson, Gurewitsch, & Laudenslager, 2008;Field et al., 2003;Monk et al., 2000). ...
We investigated whether neurobehavioral markers of risk for emotion dysregulation were evident among newborns, as well as whether the identified markers were associated with prenatal exposure to maternal emotion dysregulation. Pregnant women ( N = 162) reported on their emotion dysregulation prior to a laboratory assessment. The women were then invited to the laboratory to assess baseline respiratory sinus arrhythmia (RSA) and RSA in response to an infant cry. Newborns were assessed after birth via the NICU Network Neurobehavioral Scale. We identified two newborn neurobehavioral factors—arousal and attention—via exploratory factor analysis. Low arousal was characterized by less irritability, excitability, and motor agitation, while low attention was related to a lower threshold for auditory and visual stimulation, less sustained attention, and poorer visual tracking abilities. Pregnant women who reported higher levels of emotion dysregulation had newborns with low arousal levels and less attention. Larger decreases in maternal RSA in response to cry were also related to lower newborn arousal. We provide the first evidence that a woman's emotion dysregulation while pregnant is associated with risks for dysregulation in her newborn. Implications for intergenerational transmission of emotion dysregulation are discussed.
... Dynamic changes in RSA across a stress paradigm reflect an individual's ability both to mobilize biological resources in response to a challenge and to return to a regulated state after the stressor is addressed. Development of RSA stress responsivity profiles, including both reactivity and recovery, begins in utero (Monk et al., 2000). Therefore, changes to the intrauterine environment, as a consequence of maternal life-course experiences, have the potential to impact the developmental trajectory of RSA profiles. ...
Objective
To test alterations in placental cellular aging as one pathway by which maternal early adversity influences physiologic development in her offspring.
Methods
Maternal report of her adverse childhood experiences (ACE) was obtained prenatally along with measures of prenatal stress and demographic information. Placentas (N = 67) were collected at birth and telomere length (TL) was measured in four separate fetally-derived placental tissues: amnion, chorion, villus, and umbilical cord. At four months of age, infants completed the still-face paradigm (SFP) during which respiratory sinus arrhythmia (RSA) data were collected; RSA reactivity and RSA recovery was available from 44 and 41 infants respectively. Multi-level mixed effects models examined the impact of maternal ACE score on placental TL. Generalized linear models tested the relation between composite placental TL and infant RSA, as well as the moderation of maternal ACE score and infant RSA by composite placental TL.
Results
Higher maternal ACE score significantly predicted shorter placental TL across tissues (β = −0.015; P = 0.036) and infant RSA across the SFP. No direct relation was found between placental TL and RSA, however composite placental TL moderated the relation between ACE score and both infant RSA reactivity (β = 0.025; P = 0.005) and RSA recovery (β = −0.028; P = 0.032). In infants with shorter composite placental TL, higher ACE score predicted greater RSA suppression during the still-face epoch relative to play period 1 and greater RSA augmentation during play period 2 relative to the still-face epoch.
Conclusions
These data are the first, to our knowledge, to report that changes in placental TL influence the transgenerational impact of maternal early life adversity on the development of her offspring’s autonomic nervous system.
... Changes in fetal heart rate (FHR) during a stress test undergone by the mother (Stroop task) were significantly and positive correlated to the maternal trait anxiety score, while the changes in FHR were not related to the maternal physiological activity, nor was the maternal physiological reaction to the task related to their anxiety scores (Monk, Myers, Sloan, Ellman, & Fifer, 2003). An older study of the same research group already showed significant increases in FHR in the group of pregnant women with high maternal state anxiety compared to the group with below average state anxiety (Monk et al., 2000). ...
This thesis investigated perceived stress (PS), depressive mood and anxiety and their psy- chobiological correlates in pregnant women (second trimester). Study 1 examined PS and coping strategies utilized in pregnancy during (1) amniocentesis (AC), (2) a rest condition and (3) a follow-up examination during the third trimester of pregnancy. A higher use of emotional coping (EC) strategies was demonstrated for AC induced MS. Moreover, higher use of avoidance-oriented coping was positively correlated with higher PS caused by the delay between AC and test reports. During the third tri- mester, higher levels of birth anxiety were related to higher use of EC. Task-oriented cop- ing used at this time was associated with lower levels of depression. Differential investiga- tions of coping strategies might help develop preventive counseling for pregnant women. Study 2 was concerned with PS and anxiety as well as the corticotropin-releasing hormone (CRH) and urocortin (UCN) in amniotic fluid. CRH and UCN were assessed at AC; psy- chological variables were measured during AC and the rest condition. CRH was inversely correlated with PS both during the AC and the waiting period for the results. CRH was also negatively related to trait anxiety. No such relations were found for UCN. The inverse as- sociations of CRH and PS/anxiety were surprising at first, but current research confirms that pathways of PS related hormones, as well as its biomarkers during pregnancy, are still poorly understood. Diese Arbeit befasste sich mit wahrgenommenem Stress (WS), depressiver Stimmung und Angst und deren psychobiologischen Korrelaten in der Schwangerschaft (zweites Tri-menon). Studie 1 untersuchte WS und Copingstrategien in der Schwangerschaft während (1) einer Amniozentese (AZ), (2) einer Ruhebedingung und (3) einem Follow-Up im dritten Tri- menon. Es zeigte sich erhöhter WS aufgrund der AZ im Zusammenhang mit vermehrtem Gebrauch von emotionsregulierendem Coping (EC). Vermeidendes Coping war positiv mit höherem WS aufgrund des Wartens auf die Resultate der AZ. Im dritten Trimester waren höhere Werte in Geburtsangst mit höherem Gebrauch von EC assoziiert. Aufgabenorien- tiertes Coping zu diesem Zeitpunkt korrelierte hingegen mit niedrigeren Depressions- Werten. Weitere Studien könnten helfen Beratungsprogramme für schwangere Frauen zu entwickeln. Studie 2 beschäftigte sich mit WS und Angst sowie Corticotropin-Releasing Hormon (CRH) und Urocortin (UCN) im Fruchtwasser. CRH und UCN wurden während der AZ erhoben, die Angst und WS während der AZ und einer Ruhebedingung. CRH war sowohl mit WS während der AZ als auch während des Wartens auf das Resultat der AZ invers korreliert. CRH korrelierte auch negativ mit Trait-Angst. Es wurden keine Zusammenhän- ge mit UCN gefunden. Die inverse Korrelation von CRH und WS/Angst mag paradox er- scheinen, die aktuelle Forschung bestätigt aber, dass die Wege von Stresshormonen und die Biomarker von WS in der Schwangerschaft noch zu wenig geklärt sind.
... Measures of change in the fetal autonomic system (ANS) activity, which is modulated by fetal behavioral state, serve as a practical and non-invasive index for assessment of fetal brain functional development. These measures have also been implemented to study the impact of maternal clinical disorders, exposures, or other occurrences during gestation such as maternal depression [13], maternal stress [14], maternal smoking [15][16][17][18][19], maternal alcohol consumption [20][21][22][23], and the effect of aerobic exercise on the developing fetus [24]. Measures of FHR, HRV, and movement vary significantly by fetal behavioral state [25,26], therefore accounting for state is imperative for the identification of potential developmental abnormalities. ...
Objective:
To determine normative values for heart rate patterns in healthy fetuses.
Methods:
This research is from the Safe Passage Study conducted by the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network. A standardized protocol assessed fetal heart rate (FHR), heart rate variability (HRV), and movement from 1655 fetuses at three-time points during gestation (20-24 weeks, 28-32 weeks, 34-38 weeks gestation).
Results:
FHR decreased while HRV increased over gestation. At the latter two ages, males had significantly lower FHR than females while there were no sex differences in FHR at 20-24 weeks. When accounting for the fetal state during late gestation (34-28 weeks), we found that males had significantly lower FHR than females in the active fetal state only.
Conclusion:
Results demonstrate significant state, gestational age, and sex-related changes in cardiac activity, somatic activity, and autonomic function as the fetus approaches birth.
... Nevertheless, studies that examined stress reactivity in foetuses of depressed pregnant women directly have provided evidence for an independent prenatal causal component of maternal mood on development and function of the fetal autonomic system. Pregnant women with anxiety that completed the Stroop colour-word test exhibited greater fetal heart rate (fHR) increase during stress as well as greater fHR decrease in the recovery period compared to less anxious women (Monk et al., 2011(Monk et al., , 2004(Monk et al., , 2003(Monk et al., , 2000. Studies with direct fetal stress exposure through a vibroacoustic stimulus reported an increase in fHR from baseline to stimulation in depressed compared to non-depressed women (Dieter et al., 2008), and a 3.5 fold delay in return to baseline fHR after the stressor (Allister et al., 2001). ...
Depression is a common condition affecting up to 20% of all pregnant women, and is associated with subsequent developmental and behavioral problems in children, such as conduct disorder and ADHD. One proposed mechanism underlying these associations is modification of the fetal hypothalamic pituitary adrenal (HPA)-axis and the autonomic nervous system (ANS), resulting in altered responses to stress. This review examined the evidence regarding altered HPA-axis and ANS reactivity in children prenatally exposed to high maternal depressive symptoms. A systematic search was conducted in the electronic databases MEDLINE, EMBASE and PsycINFO, for studies published till 25 July 2017. A total of 13 studies comprising 2271 mother-infant dyads were included. None of the studies were suitable for meta-analysis. Risk of bias assessment showed low risk for four studies. Only three studies described an independent association between exposure to high maternal prenatal depressive symptoms and altered stress reactivity in children. There is limited evidence of an independent association between prenatal exposure to maternal depression and altered HPA or ANS reactivity in children.
... 52,54 Moreover, an association between maternal psychopathology during pregnancy and increased fetal heart rate (HR) has been reported. 55,56 However, this association, along with other cardi- ovascular outcome factors in childhood, was not found in two large prospective cohort studies. 57,58 Although fetal exposure to increased glucocorticoid levels has been linked to adult hyper- tension, studies do not find an association between maternal psychological distress and child hypertension. ...
Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.
... This adaptation may permanently alter the set points of these physiological systems [48]. Research has shown that women's acute emotional reactivity during pregnancy can influence fetal HR patterns [49,50]. ...
Objective: The aim of this study was to perform a systematic review of the publications that have examined cardiac auto-nomic modulation and to verify how the relationship between mothers and preterm infants can influence cardiac autonomic parameters. Method: The articles identified by the search strategy were assessed independently and blinded by two researchers, strictly adhering to the next inclusion criteria: (1) published between 01/01/2004 and 06/02/2014; (2) written in English; (3) had an available abstract; and (4) pertained to the mothers and/or their premature babies. Results: Of 83 publications originally found, 5 eligible studies were ultimately identified. Of these five articles pertaining to Heart Rate Variability, two articles studied preterm infants, two articles studied a sample of mothers and one article evaluated the association between Heart Rate Variability and mothers of preterm infants. Conclusion: Mothers and their relationships with their preterm infants are essential for increased cardiac autonomic modulation .
... Stress hormones cross the placenta causing dramatic rise in fetal heart rate and activity level. 46 They may permanently alter fetal neurological functioning, thereby heightening stress reactivity in later life. 47 It has also been observed that there is decreased DNA methylation of the corticotrophin -releasing -factor (CRF) gene promoter and increased methylation of glucocorticoid receptor (GR) exon I7 promotor region in hypothalamic tissue of adult male mice born to gestationally stressed female mice. ...
... Mothers with this vulnerability have also been reported to have greater difficulty in discerning between different types of cries, i.e., hunger, pain, fatigue, or fear (40). Maternal autonomic hyperactivity in response to crying infant has been negatively correlated with the degree of maternal sensitivity and has been associated with a potential risk for intergenerational transmission of maltreatment and interpersonal violence exposure (41,42). ...
Human and animal models suggest that maternal hormonal and physiological adaptations during pregnancy shape maternal brain functioning and behavior crucial for offspring care and survival. Less sensitive maternal behavior, often associated with psychobiological dysregulation and the offspring's behavioral and emotional disorders, has been observed in mothers who have experienced adverse childhood experiences. Strong evidence shows that children who are exposed to domestic violence (DV) are at risk of being abused or becoming abusive in adulthood. Yet little is known about the effect of childhood exposure to DV on the expecting mother, her subsequent caregiving behavior and related effects on her infant. Thus, the present study examined the association of maternal exposure to DV during childhood on prenatal maternal attachment, maternal heart rate reactivity to an infant-crying stimulus and post-natal infant emotional regulation. Thirty-three women with and without exposure to DV during childhood were recruited during the first trimester of pregnancy and followed until 6-month after birth. The Maternal Antenatal Attachment Scale (MAAS) was used to measure prenatal attachment of the mother to her fetus during the second trimester of pregnancy, maternal and fetal heart rate reactivity to an infant-crying stimulus was assessed at the third trimester of pregnancy, and the Infant Behavior Questionnaire-Revised (IBQ-R) was used to assess infant emotional regulation at 6-months. Results showed that pregnant women that were exposed to DV during childhood had a poorer quality of prenatal attachment of mother to fetus, regardless of whether they also experienced DV during adulthood. In addition, maternal exposure to DV during childhood was associated with increased maternal heart rate to infant-crying stimulus and worse infant emotional regulation. These findings highlight the importance of prenatal screening for maternal exposure to DV during childhood as a risk factor for disturbances in the development of maternal attachment, dysfunctional maternal behavior and emotion dysregulation.
... Increased CORT has been suggested to increase basal metabolic rate (Damjanovic et al., 2009;Wack et al., 2012). The increased CORT in eggs of CORT-treated mothers could have increased metabolic rate of embryos via increased heart rate (Monk et al., 2000;Owen, unpublished). As birds and reptiles have been shown to hatch after a relatively fixed number of heart beats (Du et al., 2009;Giesing et al., 2011), this increased heartrate could increase the developmental rate of the offspring, allowing them to hatch earlier. ...
1.While biomedical researchers have long appreciated the influence of maternally-derived glucocorticoids on offspring phenotype, ecologists have only recently begun exploring its impact in wild animals. Interpreting biomedical findings within an ecological context has posited that maternal stress, mediated by elevations of maternal glucocorticoids, may play an adaptive role preparing offspring for a stressful or rigorous environment. Yet, the influence of maternal stress on offspring phenotype has been little studied in wild animals. 2.We experimentally elevated glucocorticoids to ecologically-relevant levels (mimicking glucocorticoid increases in maternal stress hormones following a non-lethal predator encounter, a heat challenge, or a chasing or confinement stressor) in female eastern fence lizards (Sceloporus undulatus) during gestation. We tested the hypothesis that maternally-derived stress hormones themselves are sufficient to alter offspring phenotype. Specifically, we examined the effects of experimentally elevated maternal glucocorticoids on fitness-relevant traits of the mother, her eggs, and her subsequent offspring. 3.We found that daily maternal glucocorticoid elevation: a) increased maternal antipredator behaviours and post-laying glucose levels; b) had no effect on egg morphology or caloric value, but altered yolk hormone (elevated glucocorticoid) and nutrient content; and c) altered offspring phenotype including stress-relevant physiology, morphology, and behaviour. 4.These findings reveal that maternally-derived glucocorticoids alone can alter offspring phenotype in a wild animal; changes that may be mediated via maternal behaviour, and egg hormone and nutrient content. Understanding the ecological consequences of these effects under different environmental conditions will be critical for determining the adaptive significance of elevated maternal glucocorticoids for offspring. This article is protected by copyright. All rights reserved.
... Hypoxemia, or an increase in carbon dioxide (hypercapnia), however triggers a vagal response to decrease FHR and increase blood pressure, as typically observed in a cord compression event. The FHRV can be affected by several factors such as gestational age, fetal movement, fetal sleep state, acidemia (low blood pH) and hypoxia (decreased oxygen in tissue) and even the maternal physiological and psychological state (Mantel et al. , 1991;Ivanov et al. , 2009;Marzbanrad et al. , 2015b;Monk et al. , 2000). ...
One-dimensional Doppler ultrasound (1D-DUS) provides a low-cost and simple method for acquiring a rich signal for use in cardiovascular screening. However,
despite the use of 1D-DUS in cardiotocography (CTG) for decades, there are still challenges that limit the effectiveness of its users in reducing fetal and neonatal morbidities and mortalities. This is partly due to the noisy, transient, complex and non-stationary nature of the 1D-DUS signals. Current challenges also include lack of efficient signal quality metrics, insufficient signal processing techniques for extraction of fetal heart rate and other vital parameters with adequate temporal resolution, and lack of appropriate clinical decision support for CTG and Doppler interpretation. Moreover, the almost complete lack of open research in both hardware and software in this field, as well as commercial pressures to market the much more expensive and difficult to use Doppler imaging devices, has hampered innovation.
This paper reviews the basics of fetal cardiac function, 1D-DUS signal generation and processing, its application in fetal monitoring and assessment of fetal development and wellbeing. It also provides recommendations for future development of signal processing and modeling approaches, to improve the application of 1D-DUS in fetal monitoring, as well as the need for annotated open databases.
... The autonomic nervous system (ANS) is one of the earliest developing stress response systems, with evidence of reactivity even in utero (Monk et al., 2000). ANS reactivity indexes an individual's adaptability to the environment and reactivity patterns are differentially associated with risks for both physical and mental illness across the life span (Boyce and Ellis, 2005;Graziano and Derefinko, 2013;Porges, 2007; and recovery to the challenge. ...
Objective:
To examine the impact of polymorphic variation in the solute carrier family 5 member 7 (SLC5A7) gene on autonomic nervous system (ANS) reactivity indexed by respiratory sinus arrhythmia (RSA) and heart rate (HR) in infants during a dyadic stressor, as well as maternal report of infant self-regulation. Given evidence of race differences in older individuals, race was specifically examined.
Methods:
RSA and HR were collected from 111 infants during the still-face paradigm (SFP). Mothers completed the Infant Behavior Questionnaire-Revised short-form. Multi-level mixed effects models examined the impact of SLC5A7 genotype on RSA and HR across the SFP. Linear models tested the influence of genotype on the relation between RSA, HR, and maternal report of infant self-regulation.
Results:
SLC5A7 genotype significantly predicted RSA stress responsivity (β = -0.023; p = 0.028) and HR stress responsivity (β = 0.004; p = 0.002). T-allele carriers exhibited RSA suppression and HR acceleration in response to stress while G/G homozygotes did not suppress RSA and exhibited less HR acceleration. All infants exhibited modest RSA augmentation and HR deceleration during recovery. Race-stratified analyses revealed that White T-allele carriers drove the overall results for both RSA (β = -0.044; p = 0.007) and HR (β = 0.006; p = 0.008) with no relation between SLC5A7 genotype and RSA or HR in Black infants. Maternal report of infant orienting/regulation was predicted by the interaction of SLC5A7 genotype and both RSA recovery (β = 0.359; p = 0.001) and HR recovery (β = -1.659; p = 0.020). RSA augmentation and HR deceleration during recovery were associated with higher maternal reports of self-regulation among T-allele carriers, a finding again primarily driven by White infants.
Conclusions:
Early in development, genetic contributions to ANS are evident and predict maternal report of infant self-regulation within White infants, consistent with prior literature. The lack of associations in Black infants suggest that race differences in physiological reactivity and self-regulation are emerging during the first year of life potentially providing early evidence of disparities in health risk trajectories.
... However, these changes can leave profound alterations in the structure and functions of the organism, especially affecting neurodevelopment. 68 Triggers that alter the intrauterine environment, such as maternal undernutrition or placental insufficiency, 68 as well as painful stimuli, 69 severe maternal emotional stress or stressful life events, [70][71][72] can cause fetal stress. It has been shown that raised endogenous glucocorticoids are known mediators of growth restriction and as such are found in IUGR pregnancies 73 with increased fetal cortisol levels. ...
The fascinating journey of the human life begins with two cells merging and continuing to grow into a perfectly designed apparatus comprised of multiple systems working together. Even before one draws his first breath, our nervous system plays the key role of creating a synergy in every single action and process. It all begins during fetal development, which can nowadays be observed and studied through modern imaging technologies, such as ultrasound. This gives the reader an insight on how every part of the nervous system develops and correlates with the developing body using a minimally invasive approach. This article gives an assessment of the knowledge we have regarding fetal neurophysiology and what has been learned about fetal motor and sensory development so far, as well as memory and learning, behavior and emotions and fetal cognitive functions reviewed for selected sections. Furthermore, the article provides a review of how different external factors can harm the fetus and how fetal stress presents a potential threat in fetal neurodevelopment with lasting consequences on brain structure and function. The complexity and maturation processes build up during pregnancy and continue postnatally, allowing further accommodation and development to show the astonishing capacity of brain to learn and adapt. © 2018, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
... The fetal heart rate, a primary accessible indicator of prenatal development, changes with the physiological and psychological state of the mother: fetal heart rate variability and body movement substantially decrease with hypooxygenation of maternal arterial blood; increased maternal stress and anxiety levels correlate with increased mean fetal heart rate (Monk et al. 2000); during the night the mean hourly fetal heart rate decreases in synchrony with the mean maternal heart rate (Patrick et al. 1982). This correlated behavior in the mean heart rates suggests certain coupling between the cardiac systems of mother and fetus. ...
It is now generally accepted that human beings are naturally, possibly even essentially, intersubjective. This chapter offers a robust defence of an enhanced and extended intersubjectivity, criticising the paucity of individuating notions of agency and emphasising the community and reciprocity of our affective co-existence with other living organisms and things. I refer to this modified intersubjectivity, which most closely expresses the implicit intricacy of our pre-reflective neuro-muscular experiential entanglement, as ‘enkinaesthesia’. The community and reciprocity of this entanglement is characterised as dialogical, and in this dialogue, as part of our anticipatory preparedness, we have a capacity for intentional transgression, feeling our way with our world but, more particularly, co-feeling our way with the mind and intentions of the other. Thus we are, not so much ‘mind’-reading, as ‘mind’-feeling, and it is through this enkinaesthetic ‘mind’-feeling dialogue that values-realising activity originates and we uncover the deep roots of morality.
... Baseline maternal ECG was collected from a standard adult heart rate monitor prior to three separate protocols examining the association between maternal heart rate, blood pressure, respiration rate, and fetal heart rate in response to a psychological challenge (e.g., Stroop Task) (Monk et al., 2010;Monk et al., 2004;Monk et al., 2000). Maternal data were collected while resting quietly in a semi-recumbent position during a 5 min baseline period prior to the beginning of the cognitive task. ...
Previous research of maternal depression during pregnancy suggests an association with low birth weight in newborns. Review of these studies reveals predominant comorbidity with premature birth. This current study examines antenatal depression and birth weight in term, medically low-risk pregnancies. Maternal physiological and demographic measures were collected as well. In total, 227 pregnant women were recruited to participate in four experimental protocols at Columbia University Medical Center. Results indicate that depressed pregnant women who carry to term had significantly higher heart rates, lower heart rate variability, and gave birth to heavier babies than those of pregnant women who were not depressed. Low income participants had significantly higher levels of depression, as well as significantly higher heart rates and lower heart rate variability, than those in higher income groups. In full-term infants, maternal prenatal depression appears to promote higher birth weight, with elevated maternal heart rate as a likely mediating mechanism.
... The prevalence of any anxiety disorder during pregnancy varies between 4.4 and 39% (Goodman et al., 2014). Anxiety during pregnancy has been associated with adverse obstetric and neonatal outcomes (Dayan et al., 2002;Hedegaard et al., 1993;van Batenburg-Eddes et al., 2009;Monk et al., 2000). It is important to treat anxiety during pregnancy, but the use of medications in pregnancy could also have potential risks for a mother and her developing child. ...
Benzodiazepines and benzodiazepine-related medications (BBRMs) are anxiolytics and hypnotics acting on γ-amino butyric acid (GABA)A receptors. BBRMs are assumed to have a low potential for major congenital malformations, but research on more subtle and protracted developing symptoms of these medications is lacking. Therefore, we prospectively investigated the association between BBRM use in pregnancy and long-term effects on child behavior in a large population-based cohort study. The study population consisted of 104 children prenatally exposed to BBRM, 527 children exposed to maternal prenatal anxiety or phobic anxiety symptoms (without exposure to BBRM), and 5609 control children. At child age, 6 years, Oppositional Defiant Disorder (ODD), Aggressive Behavior and Anxiety Problems were assessed by the Child Behavior Checklist (CBCL) reported by the mother and the Teacher Report Form (TRF). Children prenatally exposed to BBRM had higher scores of ODD and aggressive behavior, but not of anxiety. However, these associations were explained by maternal anxiety symptoms during pregnancy. Moreover, prenatal exposure to anxiety (without exposure to BBRM) was associated with increased scores of child ODD, aggressive behavior, and anxiety. In conclusion, the current study demonstrates that prenatal BBRM exposure was not independently associated with ODD and aggressive behavior in childhood when prenatal anxiety symptoms were taken into account.
... Altered behavior can be observed as early as the fetal period providing compelling support for a role of the prenatal environment in shaping neurodevelopment. Fetal exposure to maternal psychological distress is associated with greater fetal reactivity to a challenge (DiPietro et al., 2009;Monk et al., 2000). DiPietro and colleagues have demonstrated that fetal responses are predictive of infant behavior. ...
Why do some individuals succumb to stress and develop debilitating psychiatric deseases including depression and posttraumatic disorders, whereas others adapt well in the face of adverse events? Resilience is the ability to cope with, learn from, and thrive in the face of adversity. Resilience is built over the life course, beginning early in life, and is based on the remarkable plasticity of the developing and adult brains to a continuously changing environment. Understanding the neural bases of individual and sex differences in responses to stress on brain development and functions is essential to the development of better pharmaceuticals to either promote coping mechanisms (preventive care) or mitigate maladaptive stress responses (curative care). After describing the new view of epigenetics that adds to the old notion that “biology is destiny,” this chapter summarizes some of the underlying mechanisms of stress effects upon the brain and the body and provides a perspective on the emerging contribution of high-throughput technologies and next-generation interventions to develop and enhance resilience.
... However, reductions in cardiovascular stress responsivity are less likely to occur among pregnant women who report high levels of psychological distress. In fact, in women with high psychological distress in pregnancy, physiological reactivity to psychological distress has been shown to be of greater magnitude and duration, which increases the risk of significant vasoconstriction occurring during pregnancy [65]. Vasoconstriction in pregnancy can affect the uteroplacental blood flow and, furthermore, reduces the amount of oxygen and nutrients delivered to the developing fetus [66,67]. ...
Background:
Clinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy.
Methods:
A randomized controlled trial (RCT) design with repeated measures will be used to evaluate the effectiveness of MBCT to treat psychological distress in pregnancy. A sample of 60 consenting pregnant women aged 18 years and above will be enrolled and randomized to the experimental (MBCT) or control (treatment as usual) condition. Primary (e.g., symptoms of stress, depression, and anxiety), secondary (cortisol, blood pressure (BP), heart rate variability (HRV), and sleep) and other outcome data (e.g., psychological diagnoses) will be collected via a combination of laboratory visits and at-home assessments from both groups at baseline (T1), immediately following the intervention (T2), and at 3 months postpartum (T3). Descriptive statistics will be used to describe sample characteristics. Data will be analyzed using an intention-to-treat approach. Hierarchical linear models will be used to test intervention effects on primary and secondary outcomes.
Discussion:
The trial is expected to improve knowledge about evidence-based treatments for psychological distress experienced in pregnancy and to evaluate the potential impact of mindfulness-based interventions on maternal physiology.
Trial registration:
ClinicalTrials.gov: NCT02214732 , registered on 7 August 2014. Protocol Version 2.0., 5 September 2016.
... These data are consistent with previous results in human beings as well as in cattle with high risk pregnancies due to maternal diseases . 17,[44][45][46] The nonsignificant results might be related to the small experimental numbers per groups. 45,46 Intrauterine fetal growth depends on many factors including maternal, fetal, placental and genetically predetermined growth potential. ...
Objective: The objective of this prospective study was to investigate whether Doppler-and B-mode sonography could be used to assess a possible influence of maternal temperament on fetal and pregnancy-related end points in small ruminants. Method: On the basis of behavioural testing related to an anxiety-eliciting stimulus (arena test), 10 sheep and 9 goats were divided into two groups, namely more reactive/ anxious (MR: 6 sheep/7 pregnancies; 5 goats/7 pregnancies) and less reactive/anxious (LR: 4 sheep/6 pregnancies; 4 goats/6 pregnancies). After mating, several end points were assessed by transrectal and/or transabdominal ultrasonography every 2 weeks (wk) from breeding to wk 20 of pregnancy. The resistance index (RI) as well as the pulsatility index (PI) of the maternal uterine (UtA) and the fetal umbilical arteries (UMA) were measured with non-invasive Doppler sonography. Additionally the fetal heart rate (FHR) was determined. Further parameters were measured with B-mode ultrasonography: diameter of amniotic vesicles (AVD; only wk 2-8), diameters of placentomes (PLD), umbilicus (UMD), fetal chest (FCHD) and orbita (FOD), as well as bi-orbital breadth (FBO), fetal occipito-snout length (FOSL), and metacarpal length (MCL). Results: In sheep, UtA-PI was significantly higher in MR compared to LR ewes at pregnancy wk 6 (P>0.01), 10 (P>0.05) and 12 (P>0.05), while a tendency was recognized at wk 14 (P=0.054). The same was true for UtA-RI during the first 8 wk of pregnancy (P<0.03) when MR and LR animals were compared. Similarly, UMA-RI was higher in fetuses of MR than LR ewes at wk 14 (P< 0.0003) and 20 (P< 0.02) of pregnancy. The differences in UMA-PI reached significance at wk 6, 8, 10 and 20 (P< 0.05–0.003). Furthermore, AVD (P< 0.03, wk 2-8), FCHD (P<0.002, wk 8-18) as well as the UMD (P<0.054, wk 8-18) were higher in LR than MR pregnant ewes. In goats, UtA-RI and-PI were significantly influenced by reactivity/anxiety 58 of the dam (increase in MR, resp.; RI: wk 6, 16, 18 and 20, (P<0.05 – 0.0001; PI: = wk 4, 8, 18 59 and 20, P<0.05-0.01). Both UMA-RI and UMA-PI (wk 8-20, P<0.01 and<0.02, resp.) were higher in MR than LR animals. B-mode end points were similar to those in sheep: AVD (P<0.01, until wk 8), FCHD, PLD (P<0.05-0.005), and FMCL (P<0.01) were larger in LR than in MR goats during wk 8-18. Other fetometric parameters were not affected by temperament of the pregnant dam. Conclusion: Using Doppler-and B-mode sonography, effects of maternal temperament on fetal growth, as well as maternal and umbilical blood flow in sheep and goats could be successfully demonstrated.
... However previous studies [11] reported that FHRV changes with the physiological and psychological states of the mother. Examples include decreased FHRV with hypo-oxygenation of maternal arterial blood [7]; increased mean FHR with increased maternal stress and anxiety levels [16] and decreased mean FHR in synchrony with decreased mean maternal heart rate during night time [20]. This correlative and interactive behavior indicates that a possible coupling could be present between maternal and fetal cardiac systems. ...
Maternal psycho-physiological activities affect the fetal heart rate and heart rate variability. However, directions and patterns of maternal and fetal heartbeat coupling are still poorly understood. The aim of this study was to quantify the direction of short-term maternal–fetal cardiac coupling in early, mid and late gestation fetuses by using partial directed coherence (PDC) analysis approach. The analysis was based on fetal electrocardiograms (fECGs) of 66 healthy fetuses; 22 from early gestation 16–25 weeks, 22 from mid gestation 26–30 weeks and 22 from late gestation 32–41 weeks. Results of analyzing PDC demonstrated a causal influence of fetal on maternal heart rate in the early gestation, while it significantly decreased from early to mid gestation along with a significant increase of maternal to fetal coupling strength. The causal influence of maternal on fetal heart rate was the strongest in the mid gestation and remained dominant in the late gestation. In conclusion, the application of PDC revealed detailed information about short-term maternal–fetal cardiac couplings and regulatory mechanisms (patterns) of developing autonomic nervous system function.
Background:
The US opioid epidemic has resulted in an increase of infants at risk for developing neonatal abstinence syndrome (NAS). Traditionally, treatment has consisted of pharmacological interventions to reduce symptoms of withdrawal. However, nonpharmacological interventions (eg, skin-to-skin contact, holding) can also be effective in managing the distress associated with NAS.
Purpose:
The purpose of this study was to examine whether infant carrying or "babywearing" (ie, holding an infant on one's body using cloth) can reduce distress associated with NAS among infants and caregivers.
Methods:
Heart rate was measured in infants and adults (parents vs other adults) in a neonatal intensive care unit (NICU) pre- (no touching), mid- (20 minutes into being worn in a carrier), and post-babywearing (5 minutes later).
Results:
Using a 3-level hierarchical linear model at 3 time points (pre, mid, and post), we found that babywearing decreased infant and caregiver heart rates. Across a 30-minute period, heart rates of infants worn by parents decreased by 15 beats per minute (bpm) compared with 5.5 bpm for infants worn by an unfamiliar adult, and those of adults decreased by 7 bpm (parents) and nearly 3 bpm (unfamiliar adult).
Implications for practice:
Results from this study suggest that babywearing is a noninvasive and accessible intervention that can provide comfort for infants diagnosed with NAS. Babywearing can be inexpensive, support parenting, and be done by nonparent caregivers (eg, nurses, volunteers).
Implications for research:
Close physical contact, by way of babywearing, may improve outcomes in infants with NAS in NICUs and possibly reduce the need for pharmacological treatment.See the video abstract for a digital summary of the study.Video Abstract Available at: https://journals.lww.com/advancesinneonatalcare/pages/videogalleryaspx?autoPlay=false&videoId=38.
Bu çalışmada üreme çağı, gebe ve postpartum dönem kadınlarının sağlıklı yaşam biçimi davranışlarının (SYBD) karşılaştırılması amaçlanmıştır. Kesitsel tipte bu çalışma Eylül 2015-Temmuz 2016 tarihleri arasında, … Devlet Hastanesi ile … Aile Sağlığı Merkezlerine başvuran 474 kadın (üreme çağı=158; gebe=158; postpartum=158) üzerinde yürütülmüştür. Veriler; kişisel özellikleri sorgulayan bir anket formu ve Sağlıklı Yaşam Biçimi Davranışları Ölçeği-II (SYBDÖ-II) kullanılarak toplanmıştır. Verilerin analizinde; Student-t testi, Tek Yönlü Varyans Analizi, Kruskal Wallis test, Ki-Kare test yöntemleri kullanılmıştır. Çalışmaya katılan n=474 kadının BKI ortalamasının, üreme çağı kadınlarında 24.2±4.6, gebe 27.3±5.3 ve postpartum dönem kadınlarında 26.1±4.6 olduğu bulunmuştur (p<0.001). Üreme çağı kadınlarının (% 36,7), gebe (%13,3) ve postpartum dönem kadınlarına (%22,2) göre daha fazla sigara kullandığı belirlenmiştir (p<0.001). Üreme çağı kadınlarının (%7,0), gebe (%0,6) ve postpartum dönem (%3,8) kadınlarına göre daha fazla alkol kullandığı saptanmıştır (p=0.013). Üreme çağı, gebe ve postpartum dönem kadınların SYBDÖ-II toplam puan ortalamaları iyi düzey olup aralarında anlamlı farklılık bulunmamıştır (p=0.364). Grupların SYBDÖ-II “sağlık sorumluluğu” (p=0.006), “fiziksel aktivite” (p=0.013), “manevi gelişim” (p=0.042), “stres yönetimi” (p=0.009) alt boyutları puan ortalamaları arasında anlamlı farklılık bulunmuştur. Üreme çağı kadınları kilolu olma sınırına yakındır. Gebelikte kilo alımı ile BKI artmaktadır. Postpartum dönemde kilolu olma durumu da devam etmektedir. Üreme çağı kadınları, gebe ve postpartum dönem kadınlarına göre daha fazla sigara ve alkol kullanmaktadır. Gebe ve postpartum dönem kadınlarının sağlık sorumlulukları iyi, üreme çağı kadınlarının fiziksel aktiviteleri orta, gebe kadınların stres yönetimi iyi düzeydedir.
Background and aims:
Previous studies suggest that psychological distress during pregnancy may lead to fetal developmental adaptations, which programme cardio-metabolic disease of the offspring. We examined the associations of maternal overall psychological distress, depression and anxiety during pregnancy with cardio-metabolic risk factors in 10-year-old children and explore potential sex-specific differences.
Methods and results:
In a population-based prospective cohort study among 4,088 mothers and their children, information about overall psychological distress, including depression and anxiety was obtained through the Brief Symptom Inventory during pregnancy. We measured child blood pressure and heart rate and insulin, glucose, serum lipids and C-reactive protein blood concentrations at 10 years. Analyses were performed in the total group and in boys and girls separately. Psychological distress during pregnancy was associated with higher childhood heart rate among boys only (differences 0.34 (95% Confidence Interval (CI) 0.18, 0.50) standard deviation scores (SDS), 0.22 (95% CI 0.06, 0.38) SDS, 0.33 (95% CI 0.19, 0.48) SDS, for overall psychological distress, depression and anxiety, respectively). Maternal anxiety during pregnancy was associated with higher childhood triglycerides among girls (difference 0.35 (95% CI 0.17, 0.53) SDS). Maternal psychological distress was not associated with childhood blood pressure, cholesterol, insulin, glucose and C-reactive protein concentrations.
Conclusions:
Maternal psychological distress may influence their offspring heart rate and triglycerides concentrations. Further studies are needed to replicate these findings and assess the long-term cardio-metabolic consequences of maternal psychological distress.
Monitoring fetal heart rate in an important aspect in evaluating fetal well being. Maternal-fetal interaction has shown evolution during fetal maturation. In this work, we studied maternal-fetal heart rate synchronization in early and late gestation fetuses. We also evaluated variations in the synchronization due to congenital heart defect (CHD). Maternal-fetal heart rate synchronization for 22 early gestation (Age < 32 weeks), $late gestation (Age >32 weeks) and 7 CHD fetuses (5 of them with gestational age < 32 weeks). The synchronization ratio between the mother and the fetus was more localized at certain fetus heart rate in the early gestation group while it was spreading over more fetal heart rate for the late group. For example, for maternal primary cycle of 3 beat- to-beat (m=3), the synchronization ratio of 5 fetus beats (n=5) contributed 60±30% of the whole coupling ratios for the early group while it contributed 30°30% for the late group (p< 0.01). On the other hand, the coupling ratio of m:n=3:7 contributed 4±17% of the early group and 13±24% for the late group (p< 0.05). The standard deviation of the phase coherence index $(\lambda_{-\mathrm{S}\mathrm{D}})$ for both the late and the CHD groups were significantly higher than the early group at different values. For example, $\lambda -\mathrm{S}\mathrm{D} was 0.006\pm 0.004$ for the early group while it was 0.009±0.008 for the late group (p< 0.01) and 0.01± 0.002 for the CHD group (p< 0.01) for m=3. The variation between the early and late normal groups might indicate a healthy development of the autonomic nervous system while the higher variation in the CHD group could be a good marker for impairment of the cardiac autonomic activity. Further coupling analysis with more abnormal cases is needed to verify these findings.
Recent studies have shown that occasional short term coupling between fetal and maternal cardiac systems occurs. Fetal magnetocardiography (fMCG) is a non-invasive technique that records the magnetic fields associated with the electrical activity of the fetal heart through sensors placed over the maternal abdomen. The fMCG allows accurate estimation of fetal heart rates (fHR) due to its high signal-to-noise ratio (SNR) and temporal resolution. In this study, we analyzed coupling between fHR and maternal heart rates (mHR) using Transfer Entropy (TE). TE determines coupling between two variables by quantifying the information transferred between them in both directions. In this work, we used 74 fMCG recordings to compute TE in both directions over 1-minute disjoint time windows (TW). We examined the effect of fetal movement (FM) as a factor of influence on the TE analysis. We identified 21 subjects with FM during the recording and separated them into two gestational age (GA) groups (GA1<32 and GA2≥32 weeks). Next, TE values were compared between TWs containing non- FM with TWs containing FM using Wilcoxon Signed-Rank test. In addition, we compared TE calculations for non-FM segments obtained from the 74 subjects using Rank-Sum test in the two GA groups. Our results showed that TE values from TWs containing FM are not significantly different than those computed for TWs of non-FM. In both directions, we found that TE values obtained from the 74 subjects did not show any significant difference between GA1 and GA2 which is consistent with previous studies. Our study suggests that FM does not affect the TE computations.
This study investigated the correlation between maternal anxiety and blood flow changes through the fetal middle cerebral artery (MCA) after defined acoustic stimulation in 43 normotensive (C) and 40 gestational hypertensive (GH) subjects. Neonatal outcomes (gestational age at birth, Apgar score, birth weight) in the C and GH groups were analyzed. State (STAI-S) and trait (STAI-T) anxiety was assessed using Spielberger's questionnaire. The MCA blood flow was assessed once between 28 and 41 weeks of gestation using color Doppler ultrasound before and after application of defined acoustic stimulus. Relative size of the Pulsatility index (Pi) change (RePi) was calculated. The general hypotheses were: (1) women in GH group would have higher anxiety; (2) higher anxiety correlates with higher RePi change and poorer neonatal outcome; (3) fetuses from the GH group would have poorer neonatal outcome. Subjects from the GH group had higher STAI-T and RePi compared to the C group. A positive correlation between RePi and STAI-S, STAI-T, and systolic/diastolic blood pressure was found in both groups. There were more preterm deliveries in the GH group compared to the C group. A significant effect of STAI-T on body weight was observed in the C and GH group. There was a predictive effect of STAI-T and RePi on the C group, and STAI-S, STAI-T, diastolic blood pressure, and RePi on the GH group in terms of neonatal body weight. This study demonstrates an association between antenatal anxiety in GH women and increased fetal cerebral circulation in response to defined auditory stimulation.
An automated method to assess the fetal physiological development is introduced which uses the component intervals between fetal cardiac valve timings and the Q-wave of fetal electrocardiogram (fECG). These intervals were estimated automatically from one-dimensional Doppler Ultrasound and noninvasive fECG. We hypothesize that the fetal growth can be estimated by the cardiac valve intervals. This hypothesis was evaluated by modeling the fetal development using the cardiac intervals and validating against the gold standard gestational age identified by Crown-Rump Length (CRL). Among the intervals, electromechanical delay time, isovolumic contraction time, ventricular filling time and their interactions were selected in a stepwise regression process that used gestational age as the target in a cohort of 57 fetuses. Compared with the gold standard age, the newly proposed regression model resulted in a mean absolute error of 3.8 weeks for all recordings and 2.7 weeks after excluding the low quality recordings. Since Fetal Heart Rate Variability (FHRV) has been proposed in the literature for assessing the fetal development, we compared the performance of gestational age estimation by our new valve-interval based method, versus FHRV, while assuming the CRL as the gold standard. The valve interval-based method outperformed both the model based on FHRV. Results of evaluation for 30 abnormal cases showed that the new method is less affected by arrhythmias such as tachycardia and bradycardia compared to FHRV, however certain types of heart anomalies cause large errors (more than 10 weeks) with respect to the CRL-based gold standard age. Therefore, discrepancies between the regression based estimation and CRL age estimation could indicate the abnormalities. The cardiac valve intervals have been known to reflect the autonomic function. Therefore the new method potentially provides a novel approach for assessing the development of fetal autonomic nervous system, which may be growth curve independent.
Très tôt, l'enfant est capable de bouger en rythme, quand sa mère lui parle, ou quand il entend une musique, mais également de vocaliser en réponse aux paroles maternelles. Cette synchronisation lui permet de communiquer et d'interagir avec son environnement. Cette capacité précoce de synchronisation est considérée comme un des fondements des interactions sociales et serait spécifique aux espèces animales capables d'utiliser les apprentissages vocaux pour communiquer...
It is well known that the hypothalamo-pituitary-adrenal (HPA) axis is altered by early environmental experiences, particularly in the perinatal period. This may be one mechanism by which the environment changes the physiology of the animal such that individual differences in adult adaptative capabilities, such as behavioral reactivity and memory performance, are observable. To determine the origin of these behavioral individual differences, we have investigated whether the long-term influence of prenatal and postnatal experiences on emotional and cognitive behaviors in adult rats are correlated with changes in HPA activity. To this end, prenatal stress of rat dams during the last week of gestation and postnatal daily handling of rat pups during the first 3 weeks of life were used as two environmental manipulations. The behavioral reactivity of the adult offspring in response to novelty was evaluated using four different parameters: the number of visits to different arms in a Y-maze, the distance covered in an open field, the time spent in the corners of the open field, and the time spent in the open arms of an elevated plus-maze. Cognitive performance was assessed using a water maze and a two-trial memory test. Adult prenatally stressed rats showed high anxiety-like behavior, expressed as an escape behavior to novelty correlated with high secretion of corticosterone in response to stress, whereas adult handled rats exhibited low anxiety-like behavior, expressed as high exploratory behavior correlated with low secretion of corticosterone in response to stress. On the other hand, neither prenatal stress nor handling changed spatial learning or memory performance. Taken together, these results suggest that individual differences in adult emotional status may be governed by early environmental factors; however, perinatal experiences are not effective in influencing adult memory capacity.
The ontogeny of fetal autonomic, motoric, state, and interactive functioning was investigated longitudinally in a sample of 31 healthy fetuses from 20 weeks through term. Fetal heart rate and movement data were collected during 50 min of Doppler-based fetal monitoring at 6 gestational ages. Measures of fetal heart rate and variability, activity level and vigor, behavioral state, and reactivity were derived from these digitized data. Weighted least squares analyses were conducted to model the developmental patterns and to examine the role of maternal and fetal covariates. With advancing gestation, fetuses displayed slower heart rate, increased heart rate variability, reduced but more vigorous motor behavior, coalescence of heart rate and movement patterns into distinct behavioral states, and increasing cardiac responsivity to stimulation. Male fetuses were more active than female fetuses, and greater maternal stress appraisal was associated with reduced fetal heart rate variability. An apparent period of neurobehavioral transition exists between 28 and 32 weeks. Fetal research methods are evaluated.
This study documents the development of fetal heart rate (FHR) change in response to fetal movement (FM) in healthy fetuses from 20 weeks' gestational age through term. Thirty-one fetuses received 50 min of Doppler-based monitoring at 20, 24, 28, 32, 36 and 38–39 weeks. FHR and FM were continuously digitized. A coupling index was computed as the percentage of FMs associated with increases in FHR of 5 beats/min or more within −5 or +15 s of movement onset. The latency between FM onset and FHR change was also computed, as were the amplitude and duration of all movements. FM and FHR became more integrated with advancing gestation. Coupling increased and the latency between FM and FHR changes decreased. Maternal age, blood pressure and fetal sex did not affect FM-FHR coupling, but fetuses of women who reported greater stress in their daily lives and had faster heart rates displayed reduced coupling. These data suggest that the development of FM-FHR coupling reflects the development of the central nervous system during gestation, and that development may be affected by maternal factors.
The adrenal glucocorticoids and catecholamines comprise a frontline of defense for mammalian species under conditions which threaten homeostasis (conditions commonly referred to as stress). Glucocorticoids represent the end product of the hypothalamic-pituitary-adrenal (HPA) axis and along with the catecholamines serve to mobilize the production and distribution of energy substrates during stress. The increased secretion of pituitary-adrenal hormones in response to stress is stimulated by the release of corticotropin-releasing hormone (CRH) and/or arginine vasopressin (AVP) from neurons in the nucleus paraventricularis. In this way, a neural signal associated with the stressor is transduced into a set of endocrine and sympathetic responses. The development of the HPA response to stressful stimuli is altered by early environmental events. Animals exposed to short periods of infantile stimulation or handling show decreased HPA responsivity to stress, whereas maternal separation, physical trauma and endotoxin administration enhance HPA responsivity to stress. In all cases, these effects persist throughout the life of the animal and are accompanied by increased hypothalamic levels of the mRNAs for CRH and often AVP. The inhibitory regulation of the synthesis for these ACTH releasing factors is achieved, in part, through a negative feedback loop whereby circulating glucocorticoids act at various neural sites to decrease CRH and AVP gene expression. Such inhibitory effects are initiated via an interaction between the adrenal steroid and an intracellular receptor (either the mineralocorticoid or glucocorticoid receptor). We have found that these early environmental manipulations regulate glucocorticoid receptor gene expression in the hippocampus and frontal cortex, regions that have been strongly implicated as sites for negative-feedback regulation of CRH and AVP synthesis. When the differences in glucocorticoid receptor density are transiently reversed, so too are those in HPA responses to stress. Taken together, our findings indicate that the early postnatal environment alters the differentiation of hippocampal neurons. This effect involves an altered rate of glucocorticoid receptor gene expression, resulting in changes in the sensitivity of the system to the inhibitory effects of glucocorticoids on the synthesis of CRH and AVP in hypothalamic neurons. Changes in CRH and AVP levels, in turn, determine the responsivity of the axis to subsequent stressors; increased releasing factor production is associated with increased HPA responses to stress. Thus, the early environment can contribute substantially to the development of stable individual differences in HPA responsivity to stressful stimuli. These data provide examples of early environmental programming of neural systems. One major objective of our research is to understand how such programming occurs within the brain.
It is well known that the hypothalamo-pituitary-adrenal (HPA) axis is altered by early environmental experiences, particularly in the perinatal period. This may be one mechanism by which the environment changes the physiology of the animal such that individual differences in adult adaptative capabilities, such as behavioral reactivity and memory performance, are observable. To determine the origin of these behavioral individual differences, we have investigated whether the long-term influence of prenatal and postnatal experiences on emotional and cognitive behaviors in adult rats are correlated with changes in HPA activity. To this end, prenatal stress of rat dams during the last week of gestation and postnatal daily handling of rat pups during the first 3 weeks of life were used as two environmental manipulations. The behavioral reactivity of the adult offspring in response to novelty was evaluated using four different parameters: the number of visits to different arms in a Y-maze, the distance covered in an open field, the time spent in the corners of the open field, and the time spent in the open arms of an elevated plus-maze. Cognitive performance was assessed using a water maze and a two-trial memory test. Adult prenatally stressed rats showed high anxiety-like behavior, expressed as an escape behavior to novelty correlated with high secretion of corticosterone in response to stress, whereas adult handled rats exhibited low anxiety-like behavior, expressed as high exploratory behavior correlated with low secretion of corticosterone in response to stress. On the other hand, neither prenatal stress nor handling changed spatial learning or memory performance. Taken together, these results suggest that individual differences in adult emotional status may be governed by early environmental factors; however, perinatal experiences are not effective in influencing adult memory capacity.
: This study was designed to determine whether obstetrical factors such as complications and labor time are related to maternal anxiety. The IPAT Anxiety Scale and other tests were administered at the beginning of the third trimester. Patients were classified as normal or abnormal by means of pregnancy, deliveryroom, and postpartum records. These groups were comparable with regard to age, intelligence, total pregnancies, and first pregnancies. The abnormal group obtained significantly higher anxiety scores than the normal group; also, obsessive rumination was characteristic of the former, while denial and repression were used by the latter group. Total labor times and birth weights were significantly positively correlated with anxiety, although the groups themselves did not differ on these variables. Copyright (C) 1963 by American Psychosomatic Society
The relationship of anxiety and anger to blood pressure was studied in hypertensive patients under environmental conditions by having them take their own blood pressure 4 times daily for 7 weeks and rate their anxiety and anger at those times on simple analog scales. Anxiety was more highly correlated to blood pressure than anger. Within-subject correlations between anxiety and systolic blood pressure were r = 0.05-0.79 with a median of 0.36; between anxiety and diastolic blood pressure r = -0.05-0.66 with a median of 0.27; between anger and systolic blood pressure r = -0.01-0.51 with a median of 0.19; between anger and diastolic blood pressure r = -0.07-0.51 with a median of 0.17. The effect of diazepam on blood pressure was also investigated. Diazepam had no observable effect on blood pressure, but neither, at the dose used (15 mg/day), did it lower anxiety in these mildly anxious subjects.
Literature is reviewed demonstrating the impact of maternal depression on early infant interactions and development. Infants of depressed mothers (a) develop a depressed mood style as early as 3 months; (b) this mood generalizes to interactions with nondepressed women; (c) it persists over the first year if the mother's depression persists; and (d) it affects growth and Bayley developmental scores by the end of the first year. Other data are reviewed on individual differences including maternal depression styles of withdrawal and intrusion, negative behavior matching, and distorted perceptions of behavior. Finally, genetic, intrauterine, and extrauterine environment effects are discussed and interventions are suggested for altering the mother's depressed behavior and distorted perceptions. The review concludes that a developmental psychopathology perspective is needed to better understand the development of early depression.
Eighty-three newborns (M GA = 37 weeks) were assigned to depressed (N = 47) and nondepressed mother (N = 36) groups based on Beck Depression Inventory (BDI) scores. The Brazelton Neonatal Assessment Scale was administered to the infants within 24 hours after birth. Infants of depressed mothers demonstrated poorer performance on the orientation cluster. Further analysis of the orientation cluster items revealed inferior orientation to the inanimate stimuli. Infants of depressed mothers also showed less motor tone and activity and more irritability and less robustness and endurance (unavailability, lethargy, and stress behaviors) during the examination.83 nouveaux-nés (M GA = 37 semaines) ont été assignés á des groupes de mères déprimées (N = 47) et de meres non-dtprimkes (N = 36), groupes à partir de scores D'Inventaire de Dépression Beck (Beck Depression Inventory). L'Echelle d'Evaluation Néonatale Brazelton a été administrée aux nourrissons dans les 24 heures près la naissance. Les nourrissons de méres déprimées se sont avérés moins per-formants pour ce qui est de la mesure d'orientation. Des analyses plus poussées des mesures d'orientation groupées ont révélé une orientation moindre aux stimuli inanimés. Les nourrissons de mères déprimées manifestaient également moins de tonicité et d'activité motrices, plus d'irritabilité, moins de robustesse et d'endurance (comportements de retrait et de stress et comportement léthargique) durant l'examen.
OBJECTIVE: Our purpose was to determine whether various measures of poor psychosocial status in pregnancy are associated with spontaneous preterm birth, fetal growth restriction, or low birth weight. STUDY DESIGN: Anxiety, stress, self-esteem, mastery, and depression were assessed at 25 to 29 weeks in 2593 gravid women by use of a 28-item Likert scale. Scores for each psychosocial subscale were determined, and an overall psychosocial score was calculated. Scores were divided into quartiles, and the lowest quartile scores were used to define poor psychosocial status. The percent spontaneous preterm birth, low birth weight, and fetal growth restriction in women with low and high psychosocial scores were compared. Logistic regression analyses provided the odds ratios and 95% confidence intervals. RESULTS: Analyses revealed that stress was significantly associated with spontaneous preterm birth and with low birth weight with odds ratios of 1.16, p = 0.003, and 1.08, p = 0.02, respectively, for each point on the scale. A low score on the combined scale or on any subscale other than stress did not predict spontaneous preterm birth, fetal growth restriction, or low birth weight. After multivariate adjustment was performed for psychosocial status, substance use, and demographic traits, black race was the only variable significantly associated with spontaneous preterm birth, fetal growth restriction, and low birth weight; stress and low education were associated with spontaneous preterm birth and low birth weight. CONCLUSION: Stress was associated with spontaneous preterm birth and low birth weight even after adjustment for maternal demographic and behavioral characteristics. Black race continues to be a significant predictor of spontaneous preterm birth, fetal growth restriction, and low birth weight even after adjustment for stress, substance use, and other demographic factors. (Am J Obstet Gynecol 1996;175:1286-92.)
This prospective study investigated whether mild maternal stress during pregnancy could influence performance on a variety of developmental measures in rhesus monkey infants (Macaca mulatta). Twenty-four infants were tested during the first month of life for interactive, neuromotor, and temperamental characteristics and capabilities using instruments adapted directly from human neonatal assessments. Twelve infants were derived from mothers exposed during pregnancy to a mild stressor in the form of a daily 10-min removal from home cage and exposure to three unpredictable noise stimuli. Twelve infants were derived from mothers undisturbed during pregnancy. Prenatally stressed infants had lower birthweights, were delayed in self-feeding, were more distractible, and had lower scores on a Motor Maturity composite score when compared to offspring from undisturbed pregnancies. Close inspection of the Motor Maturity score revealed that low muscle tonus, poor coordination, and slow response speed characterized the prenatally stressed offspring.
Systolic and diastolic blood-pressure was significantly higher in 44 male industrial workers with a noise-induced auditory impairment (greater than or equal to 65 dB at 3000, 4000, or 6000 Hz) than in 74 males of the same age with normal hearing. Moreover, significantly more individuals with hypertension (resting recumbent blood-pressure greater than or equal to 160/100 mm Hg) were found in the group with noise-induced loss of hearing. It is suggested that replaced and prolonged exposure to a stressful stimulus (industrial noise severe and prolonged enough to cause a permanent loss of hearing at the relevant frequencies) may be a contributing factor to the rise in blood-pressure through a mechanism involving structural adaption of blood-vessels in response to repeated peaks of raised blood-pressure.
The purpose of the study was to evaluate the effect of the substantial changes in female reproductive hormones that occur during normal pregnancy on cardiovascular responses to psychological and physical challenges. Twenty-one healthy normotensive women performed serial subtraction, mirror image tracing, and isometric handgrip exercise tasks prior to pregnancy and again during the second trimester of pregnancy. A control group of 34 healthy women who did not intend to become pregnant and were nonpregnant were also tested in the same protocol twice, 6-10 months apart. Results showed that the pregnant women exhibited a reduced diastolic blood pressure response to all three tasks, relative to their pre-pregnancy levels, whereas nonpregnant controls did not change in their diastolic blood pressure response across time. These results are consistent with the hypothesis that elevations in female reproductive hormones diminish blood pressure responses during challenge because of dampened sympathetic nervous system activity.
Previous experiments revealed that 14-day-old prenatally stressed rats have significantly elevated concentrations of plasma adrenocorticotrophic hormone (ACTH) and corticosterone suggesting these animals have an overactive hypothalamic-pituitary-adrenal (HPA) system. In these studies, however, stress-induced hormone levels were determined only immediately after exposure to an acute stressor. Therefore, in the current study, we examined in postnatal days 7, 14 and 21 prenatally stressed rats the stress-induced time course of this pituitary-adrenal hormone elevation. Plasma ACTH and corticosterone were measured in the basal state and at 0.0, 0.5, 1.0, 2.0 and 4.0 h after a 10-min exposure period to foot shocks administered in the context of social isolation. Results indicated that at all 3 ages, plasma ACTH in prenatally stressed rats was significantly elevated. Corticosterone concentrations were also significantly higher in prenatally stressed than in control rats, especially in day 14 rats. Analysis of stress-induced hormone fluctuations over time indicated that by 14 days of age, both prenatally stressed than in control and control rats had significant increases in plasma ACTH and corticosterone after exposure to stress. Furthermore, although prenatally stressed rats had significantly higher pituitary-adrenal hormone concentrations than control animals, the post-stress temporal patterns of decline in ACTH and corticosterone levels were similar between groups. Results suggest that throughout the preweaning period, prenatal stress produces an HPA system that functions in a manner similar to that of controls but at an increased level.
It was hypothesized that type A behavior in pregnant women would be associated with increased neonatal crying and differential reports of infant temperament at 3 months. Type A behaviors during pregnancy were measured in a self-selected cohort of 72 healthy, primiparous, middle-class women. Their newborns were assessed at 48 hours of age and the women completed an infant temperament questionnaire at 3 months. Women who were classified as type A on the Job Involvement scale of the Jenkins Activity Survey had infants who cried more during a standardized neurobehavioral assessment compared with infants of women who were type B on the same scale. Women who were type A for Job Involvement rated their 3-month-old infants as more intense and less predictable in their responses to the environment. They were also more likely to be breast-feeding their infants at 3 months. This is the first study to examine the prevalence and nature of maternal type A behaviors during pregnancy and to show their relationship to neonatal crying behavior, to maternal report of early infant temperament, and to maternal breast-feeding.
Central hemodynamic response to position change was assessed in 10 normotensive primiparous patients between 36 and 38 weeks' gestation. Studies were repeated between 11 and 13 weeks post partum. Compared with the left lateral position, we observed a mean 9% fall in cardiac output in the supine position and an 18% fall when patients were standing. When standing, these patients had a 30% increase in pulse and a 21% fall in left ventricular stroke work index. The orthostatic response after pregnancy was much more labile than that during the third trimester. These findings have important descriptive implications for the understanding of the human response to orthostasis during pregnancy, as well as clinical implications for patients at risk of uteroplacental insufficiency and for working women during pregnancy.
Maternal depression is associated with a wide range of adverse outcomes for children, including poor mother-infant interactions at 3 months post-partum. The aim of this study is to determine whether maternal depressive symptoms during pregnancy are associated with neonatal neurobehavioral functioning, as measured by the Neurologic and Adaptive Capacity Scale. The study population consists of 1,123 mothers and their term infants who were participants in a larger study of maternal health and infant outcomes. Women were administered the Center for Epidemiologic Studies-Depression (CES-D) questionnaire for depressive symptoms during their pregnancy. Their infants were subsequently assessed by a pediatrician blind to their CES-D scores. The CES-D score was associated with unconsolability and excessive crying (p less than 0.01). The higher the mother's CES-D score, the more likely it was that the infant would be unconsolable or cry excessively. Mothers with CES-D scores at the 90th percentile were 2.6 times more likely to have unconsolable newborns, compared with women with CES-D scores at the 10th percentile (95% C.I. = 1.54, 4.23). When potentially confounding variables, such as cigarette smoking, alcohol, marijuana, and cocaine use, poor weight gain, income, birth weight, and other drug use, were controlled, the relationship between CES-D score and newborn unconsolability and excessive crying remain unchanged. The results of this study suggest that the relationship between early childhood problems and maternal depressive symptoms may be part of a sequence that starts with depressive symptoms during pregnancy.
A rational strategy for the automated detection of artifacts in heart period data is outlined and evaluated. The specific implementation of this approach for heart period data is based on the distribution characteristics of successive heart period differences. Because beat-to-beat differences generated by artifacts are large, relative to normal heart period variability, extreme differences between successive heart periods serve to identify potential artifacts. Critical to this approach are: 1) the derivation of the artifact criterion from the distribution of beat differences of the individual subject, and 2) the use of percentile-based distribution indexes, which are less sensitive to corruption by the presence of artifactual values than are least-squares estimates. The artifact algorithms were able to effectively identify artifactual beats embedded in heart period records, flagging each of the 1494 simulated and actual artifacts in data sets derived from both humans and chimpanzees. At the same time, the artifact algorithms yielded a false alarm rate of less than 0.3%. Although the present implementation was restricted to heart period data, the outlined approach to artifact detection may also be applicable to other biological signals.
The purpose of our work was to study blood pressure variations during pregnancy in a normal Latin American population from Argentina and Uruguay; to investigate blood pressure variations according to maternal age, parity, or pregnancy weight gain; and to correlate diastolic blood pressure levels in the last trimester of pregnancy with newborn birth weight. This prospective study included follow-up throughout gestation of 249 normal pregnant women (129 nulliparous and 120 multiparous) with a weekly blood pressure control under the same experimental conditions. Our results demonstrate that there is only a low correlation between maternal age and diastolic blood pressure, but no correlation was found with systolic blood pressure; maternal weight gain correlates with blood pressure changes; no correlation was found between gestational age and blood pressure, although an increasing tendency in systolic and diastolic blood pressure was found toward the end of gestation; and a significant correlation was observed between birth weight and average diastolic blood pressure during the third trimester. These findings demonstrate the potential significance of the use of standard blood pressure data from normal pregnant women for the future clinical evaluation of our population.
Left lateral recumbent blood pressures were studied throughout pregnancy in all nulliparous women presenting for prenatal care at a single outpatient clinic. Six percent of these women developed preeclampsia. The incidence of preeclampsia was markedly higher among teens (13.6%). Diastolic blood pressure among normal women declined by less than 5 mm Hg from the first trimester to midgestation. During the third trimester the diastolic pressure returned to first-trimester levels. No significant difference was detected in the first- and early-second-trimester group mean blood pressure between normals and women later developing preeclampsia. However, by 25-28 weeks, before the onset of overt preeclampsia, blood pressures were significantly higher among preeclamptics.
A group of pregnant women received video and verbal feedback during three ultrasound examinations. This group was compared with a no-feedback group on measures of pregnancy anxiety, fetal activity, and neonatal outcome. The feedback appeared to reduce pregnancy anxiety and fetal activity, particularly for the primiparous women. These women also experienced fewer obstetric complications and gave birth to neonates who were greater weight, more appropriate weight-for-length, less active and irritable, and showed better performance on the Brazelton neonatal behavior assessment.
In the search for reliable, easily applicable mental stressors many researchers have investigated the propensity of mental arithmetic and Stroop color discrimination tasks to elicit a physiological stress response; some researchers have added noise interference with the expectation of larger response magnitudes. The present study investigates a number of previously untested questions by directly comparing cardiovascular responses to mental arithmetic or the Stroop task with and without noise interference in a sample of 66 young adults. Half of all subjects were exposed to the additional noise interference, all subjects responded to both types of mental stressors. Blood pressure responses did not discriminate among the stressors but noise interference consistently augmented heart rate responses during mental arithmetic. Response to the second, repeated stressor was associated with highly significant response habituation effects for blood pressure. Furthermore, when mental arithmetic was presented first, both tasks elicited comparable and large responses; when the Stroop test was presented first both tasks triggered smaller responses but of comparable magnitude. Subjective evaluations of the stressors were not predictive of overall physiological response.
Cardiac vagal tone is proposed as a novel index of stress and stress vulnerability in mammals. A model is described that emphasizes the role of the parasympathetic nervous system and particularly the vagus nerve in defining stress. The model details the importance of a branch of the vagus originating in the nucleus ambiguus. In mammals the nucleus ambiguus not only coordinates sucking, swallowing, and breathing, but it also regulates heart rate and vocalizations in response to stressors. In mammals it is possible, by quantifying the amplitude of respiratory sinus arrhythmia, to assess the tonic and phasic regulation of the vagal pathways originating in the nucleus ambiguus. Measurement of this component of vagal tone is proposed as a method to assess, on an individual basis, both stress and the vulnerability to stress.
To examine the hypothesis that the pathologic features of obsessive-compulsive disorder (OCD) are facilitated by abnormal levels of arousal, we compared patients with OCD with controls on self-reports and psychophysiologic measures.
Twenty-three patients with OCD were compared with 21 controls on rating scales and on psychophysiologic measures (ie, heart interbeat interval, skin conductance, respiration, blood pressure, and electromyographic activity) during rest and during two psychologically stressful tasks.
Patients rated themselves higher on psychic and somatic anxiety scales. Mean physiologic activities were not elevated at rest. During tasks, changes in electrodermal, cardiovascular (except blood pressure), and muscle activities were smaller in patients with OCD, indicating decreased physiologic flexibility.
Hyperarousal, measured peripherally, is not an essential pathologic feature of OCD. Decreased physiologic flexibility indicates an anxiety-related, but not OCD-specific, impairment of psychophysiologic reactivity to one's environment.
