DOI: https://doi.org/10.18370/2309-4117.2020.53.82-85

Delayed neurological maturation is a cause for distress during fetal growth restriction

I. V. Lakhno, S. E. Malikova

Abstract


Theory of fetal programming contributes to a better understanding of the relationship of many human diseases with antenatal period pathology. Regulatory impact of nervous system is of great importance. Fetal growth restriction (FGR) is a convenient model for investigation of the abnormalities of fetal neurodevelopment. Fetal heart rate variability is a well-known approach for fetal autonomic function detection.

The aim of the study was to detect several patterns of autonomic nervous regulation in FGR complicated by fetal distress or without fetal distress.

Materials and methods. Totally 64 patients at 26–28 weeks of gestation were enrolled. 23 patients had normal fetal growth and were included in the Group I (control). 20 pregnant women with FGR without fetal distress were observed in Group II. 21 patients with FGR and fetal distress were included in Group III. Fetal heart rate variability and conventional cardiotocographic patterns were obtained from the RR-interval time series registered from the maternal abdominal wall via non-invasive fetal electrocardiography.

Results. Suppression of the total level of heart rate variability with sympathetic overactivity was found in FGR. The maximal growth of sympathovagal balance was found in Group

III. Fetal deterioration was associated with an increased quantity of decelerations, reduced level of accelerations, and decreased of short term variations and low term variations. But a decelerative pattern before 26 weeks of gestation was normal. Therefore fetal autonomic malfunction could be a result of persistent neurological immaturity in FGR. The approach based on the monitoring of fetal autonomic maturity in the diagnosing of its well-being should be tested in further studies.

Conclusion. Fetal heart rate variability variables and beat-to-beat variations parameters could be the sensitive markers of neurological maturation and good predictors for fetal deterioration.


Keywords


fetal distress; fetal growth restriction; fetal non-invasive electrocardiography; neurodevelopment

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References


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Hoyer, D., Zebrowski, J., Cysarz, D., et al. “Monitoring fetal maturation-objectives, techniques and indices of autonomic function.” Physiol Meas 38 (2017): 61–88.

Hoyer, D., Kowalski, E.M., Schmidt, A., et al. “Fetal autonomic brain age scores, segmented heart rate variability analysis, and traditional short term variability.” Front Hum Neurosci 8 (2014): 948.

Hoyer, D., Tetschke, F., Jaekel, S., et al. “Fetal functional brain age assessed from universal developmental indices obtained from neuro-vegetative activity patterns.” PloS One 8 (2013): e74431.

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GOST Style Citations


1.            Crespi, B.J. “Why and How Imprinted Genes Drive Fetal Programming.” Front Endocrinol (Lausanne) 10 (2020): 940.

2.            Hoyer, D., Zebrowski, J., Cysarz, D., et al. “Monitoring fetal maturation-objectives, techniques and indices of autonomic function.” Physiol Meas 38 (2017): 61–88.

3.            Hoyer, D., Kowalski, E.M., Schmidt, A., et al. “Fetal autonomic brain age scores, segmented heart rate variability analysis, and traditional short term variability.” Front Hum Neurosci 8 (2014): 948.

4.            Hoyer, D., Tetschke, F., Jaekel, S., et al. “Fetal functional brain age assessed from universal developmental indices obtained from neuro-vegetative activity patterns.” PloS One 8 (2013): e74431.

5.            Hoyer, D., Schmidt, A., Gustafson, K.M., et al. “Heart rate variability categories of fluctuation amplitude and complexity: diagnostic markers of fetal development and its disturbances.” Physiol Meas 40.6 (2019): 064002.

6.            Velayo, C.L., Funamoto, K., Silao, J.N., et al. “Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction.” Front Physiol 8 (2017): 437.

7.            Lakhno, I. “Fetal non-invasive electrocardiography contributes to better diagnostics of fetal distress: a cross-sectional study among patients with preeclampsia.” Annals of the Academy of Medicine Singapore 44.11 (2015): 519–23.

8.            Arias-Ortega, R., Echeverria, J.C., Gusman-Huerta, M., et al. “Respiratory sinus arrhythmia in growth restricted fetuses with normal Doppler hemodynamic indices.” Early Hum Dev 93 (2015): 17–26.

9.            Guzman-Velazquez, P., Lakhno, I.V., Diaz-Mendez, A. “HRV Descriptors for Fetal Distress Assessment in Pregnancy with Fetal Growth Restriction.” In: Proceedings of the 2018 International Conference on Biomedical Engineering & Science BIOENG'18. CSREA Press (2018): 13–7.

10.          May, L.E., Scholtz, S.A., Suminski, R., Gustafson, K.M. “Aerobic exercise during pregnancy influences infant heart rate variability at one month of age.” Early Human Development 90.1 (2014): 33–8.

11.          May, L.E., Suminski, R.R., Langaker, M.D., et al. “Regular maternal exercise dose and fetal heart outcome.” Medicine and science in sports and exercise 44.7 (2012): 1252–8.

12.          DiPietro, J., Kivlighan, K., Costigan, K., et al. “Prenatal antecedents of newborn neurological maturation.” Child Dev 81 (2010): 115–30.

13.          Behar, J., Andreotti, F., Zaunseder, S., et al. “A practical guide to non-invasive foetal electrocardiogram extraction and analysis.” Physiol meas 37 (2016): R1–R35.

14.          Ashwal, E., Shinar, S., Aviram, A., et al. “A novel modality for intrapartum fetal heart rate monitoring.” J Matern Fetal Neonatal Med 32.6 (2019): 889–95.

15.          Hernandez Castro, R., Spiel, M. “Early Fetal Growth Restriction.” Neoreviews 21.3 (2020): e203–e209.

16.          Frusca, T., Todros, T., Lees, C., Bilardo, C.M.; TRUFFLE Investigators. “Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe.” Am J Obstet Gynecol 218.2S (2018): S783–S789.

17.          Monier, I., Ancel, P.Y., Ego, A., et al. “Gestational age at diagnosis of early-onset fetal growth restriction and impact on management and survival: a population-based cohort study.” BJOG 124.12 (2017): 1899–906.

18.          Miescu, M., Carbunaru, O., Constantin, C., et al. “Importance of Follow-Up and Early Detailed Evaluation in Early Onset Growth Restricted Fetuses.” Curr Health Sci J 45.3 (2019): 333–8.

19.          American College of Obstetricians and Gynecologycts. “ACOG Practice Bulletin No. 204: Fetal Growth Restriction.” Obstet Gynecol 133.2 (2019): e97–e109.

20.          Graatsma, E.M., Mulder, E.J.H., Vasak, B., Visser, H.A. “Average acceleration and deceleration capacity of the fetal heart rate in normal pregnancy and in pregnancies complicated by fetal growth restriction.” J Matern Fetal Neonatal Med 25/12 (2012): 2517–22.

21.          Nardozza, L.M., Caetano, A.C., Zamarian, A.C., et al. “Fetal growth restriction: current knowledge.” Arch Gynecol Obstet 295.5 (2017): 1061–77.

22.          Dall'Asta, A., Brunelli, V., Prefumo, F., et al. “Early onset fetal growth restriction.” Matern Health Neonatol Perinatol 3 (2017): 2.

23.          Aziz, W., Schlindwein, F.S., Wailoo, M., et al. “Heart rate variability analysis of normal and growth restricted children.” Clin Auton Res 22.2 (2012): 91–7.

24.          Sholapurkar, S.L. “Is fetal heart rate ‘deceleration area’ the silver bullet for detection of acidemia?” Am J Obstet Gynecol 219.5 (2018): 510–2.

25.          Mannella, P., Billeci, L., Giannini, A., et al. “Feasibility study on non-invasive fetal ECG to evaluate prenatal autonomic nervous system activity.” Eur J Obstet Gynecol Reprod Biol 246 (2020): 60–6.





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