Assessment of the association of heart rate variability and baroreflex sensitivity with depressive symptoms and stress experienced by women in pregnancy

Shah, Zinkal; Pal, Pravati; Pal, Gopal Krushna; Dasari, Papa; Bharadwaj, Balaji

doi:10.1016/j.jad.2020.08.039

Cited by 12 publications

(8 citation statements)

References 41 publications

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“…In one study, no significant association was found between fear of childbirth and HRV among pregnant women at 32 to 34 weeks of gestation [ 47 ]. However, higher self-perceived stress and lower HRV was reported among pregnant women between 12 and 30 weeks of gestation [ 48 ]. The literature also shows mixed results about HRV patterns during pregnancy, with and without intervention [ 49 - 51 ].…”

Section: Discussionmentioning

confidence: 99%

A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

Jimah¹,

Borg²,

Kehoe³

et al. 2021

JMIR Form Res

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Background The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user’s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app–based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.

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Section: Discussionmentioning

confidence: 99%

A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

Jimah¹,

Borg²,

Kehoe³

et al. 2021

JMIR Form Res

View full text Add to dashboard Cite

show abstract

“…Studies examining HRV during pregnancy and the postpartum period have been scarce and have primarily shown associations between altered autonomic activity and symptoms of depression and stress in pregnant women [ 47 , 48 ]. Other studies have reported significantly altered HRV indices among pregnant women with current and past anxiety disorders and symptoms of current anxiety [ 8 , 49 , 50 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating heart rate variability measures during pregnancy as predictors of postpartum depression and anxiety: an exploratory study

Eriksson,

Kimmel,

Furmark

et al. 2024

Transl Psychiatry

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Perinatal affective disorders are common, but standard screening measures reliant on subjective self-reports might not be sufficient to identify pregnant women at-risk for developing postpartum depression and anxiety. Lower heart rate variability (HRV) has been shown to be associated with affective disorders. The current exploratory study aimed to evaluate the predictive utility of late pregnancy HRV measurements of postpartum affective symptoms. A subset of participants from the BASIC study (Uppsala, Sweden) took part in a sub-study at pregnancy week 38 where HRV was measured before and after a mild stressor (n = 122). Outcome measures were 6-week postpartum depression and anxiety symptoms as quantified by the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Anxiety Inventory (BAI). In total, 112 women were included in a depression outcome analysis and 106 women were included in an anxiety outcome analysis. Group comparisons indicated that lower pregnancy HRV was associated with depressive or anxious symptomatology at 6 weeks postpartum. Elastic net logistic regression analyses indicated that HRV indices alone were not predictive of postpartum depression or anxiety outcomes, but HRV indices were selected as predictors in a combined model with background and pregnancy variables. ROC curves for the combined models gave an area under the curve (AUC) of 0.93 for the depression outcome and an AUC of 0.83 for the anxiety outcome. HRV indices predictive of postpartum depression generally differed from those predictive of postpartum anxiety. HRV indices did not significantly improve prediction models comprised of psychological measures only in women with pregnancy depression or anxiety.

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“…Also, it has been reported that the prenatal depression in GDM is linked to post-partum depression for a longer duration and adverse cardiovascular (CV) consequences 15 , 16 . Recently we have reported the decreased heart rate variability (HRV) and cardiovagal modulation associated with depression in women during antenatal period, which exposes them to CV risks 17 . However, till date the mechanism that causes CV risks in GDM have not been well studied and the association of CV risks to mental illness in GDM has not been reported.…”

Section: Introductionmentioning

confidence: 99%

Inflammation and decreased cardiovagal modulation are linked to stress and depression at 36th week of pregnancy in gestational diabetes mellitus

Renugasundari

Pal

Chaturvedula

et al. 2023

Sci Rep

Self Cite

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Stress and depression have been reported in gestational diabetes mellitus (GDM). Though inflammation and oxidative stress are associated with depression, there are no reports of link of cardiometabolic risks (CMR) to stress and depression in GDM. Normal pregnant women (control group, n = 164) and women with GDM (study group, n = 176) at 36th week of gestation were recruited for the study. Blood pressure (BP), body composition, heart rate variability (HRV), glycated hemoglobin (HbA1C), markers of insulin resistance, oxidative stress, inflammation and endothelial dysfunction, were assessed. Perceived stress score (PSS), quality of life (QoL) scale, Indian diabetic risk score (IDRS) and Edinburg postnatal depression score (EPDS) were assessed. Association of potential contributors to PSS and EDPS were assessed by correlation and regression analyses. There was significant increase in PSS, EPDS, IDRS scores, HbA1C, malondialdehyde (MDA) (oxidative stress marker) and high-sensitive C-reactive protein and interleukin-6 (inflammatory markers), and significant decrease in total power (TP) of HRV (marker of cardiovagal modulation), QoL and nitric oxide (endothelial dysfunction marker) in study group compared to control group. Though many cardiometabolic risk parameters were correlated with PSS and EPDS, the significant independent association was observed for TP, HbA1C, MDA and interleukin-6. However, interleukin-6 had maximum contribution to PSS (β = 0.550, p < 0.001) and EPDS (β = 0.393, p < 0.001) as demonstrated by multiple regression analysis. Inflammation, oxidative stress, glycation status and decreased cardiovagal modulation are associated with stress and depression at 36th week of gestation in GDM.

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Assessment of the association of heart rate variability and baroreflex sensitivity with depressive symptoms and stress experienced by women in pregnancy

Cited by 12 publications

References 41 publications

A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study

Investigating heart rate variability measures during pregnancy as predictors of postpartum depression and anxiety: an exploratory study

Inflammation and decreased cardiovagal modulation are linked to stress and depression at 36th week of pregnancy in gestational diabetes mellitus

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