Brain sparing effect in growth‐restricted fetuses is associated with decreased cardiac acceleration and deceleration capacities: a case–control study

Stampalija, Tamara; Casati, D.; Monasta, Lorenzo; Sassi, Roberto; Rivolta, Massimo W.; Muggiasca, M. L.; Bauer, Axel; Ferrazzi, E.

doi:10.1111/1471-0528.13607

Cited by 46 publications

(30 citation statements)

References 23 publications

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“…Interestingly, recent reports involving other non-invasive abdominal FECG systems have shown promising results for the use of phase-rectified signal averaging measurements (PRSA) and fetal heart rate variability (FHRV) in IUGR fetuses (Stampalija et al, 2015a,b). PRSA signals are representative of the current maturation status of the fetal autonomic nervous system (ANS) where lower acceleration capacity (AC) and deceleration capacity (DC) signals have been observed in IUGR fetuses with or without brain sparing.…”

Section: Discussionmentioning

confidence: 99%

“…PRSA signals are representative of the current maturation status of the fetal autonomic nervous system (ANS) where lower acceleration capacity (AC) and deceleration capacity (DC) signals have been observed in IUGR fetuses with or without brain sparing. One study found a significant association between either AC and DC and the middle cerebral artery pulsatility index (PI; p = 0.01; p = 0.005) (Stampalija et al, 2015a). With FHRV, short term variability (STV) evaluation is known to reflect the status of the fetal oxygen supply, therefore indicating the fetal acid-base status.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

et al. 2017

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Objectives: This descriptive study was performed to evaluate the capability of a non-invasive transabdominal electrocardiographic system to extract clear fetal electrocardiographic (FECG) measurements from intrauterine growth restricted (IUGR) fetuses and to assess whether abdominal FECG parameters can be developed as markers for evaluating the fetal cardiac status in IUGR.Methods: Transabdominal FECG was attempted in 20 controls and 15 IUGR singleton pregnancies at 20+0−33+6 weeks gestation. Standard ECG parameters were compared between the study groups and evaluated for their correlation. Accuracy for the prediction of IUGR by cut off values of the different FECG parameters was also determined.Results: Clear P-QRST complexes were recognized in all cases. In the IUGR fetuses, the QT and QTc intervals were significantly prolonged (p = 0.017 and p = 0.002, respectively). There was no correlation between ECG parameters and Doppler or other indices to predict IUGR. The generation of cut off values for detecting IUGR showed increasing sensitivities but decreasing specificities with the prolongation of ECG parameters.Conclusion: The study of fetal electrocardiophysiology is now feasible through a non-invasive transabdominal route. This study confirms the potential of FECG as a clinical screening tool to aid diagnosis and management of fetuses after key limitations are addressed. In the case of IUGR, both QT and QTc intervals were significantly prolonged and thus validate earlier study findings where both these parameters were found to be markers of diastolic dysfunction. This research is a useful prelude to a test of accuracy and Receiver Operating Characteristics (ROC) study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

et al. 2017

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“…In the obstetrical field, DC was able to identify a lower ANS reactivity in IUGR fetuses, and proved to be superior to short term variability in discriminating IUGR fetuses from controls [22][23][24]. Furthermore, we previously observed that the DC of the fetal heart, derived from PRSA analysis of fetal ta-ECG in IUGR fetuses from 25 weeks of gestation to term, was associated with middle cerebral artery pulsatility index, a consistent index of brain sparing adaptation [25]. The analysis of maternal ECG recorded trans-abdominally could be challenging due to the signal-to-noise ratio.…”

Section: Strengths and Limitationsmentioning

confidence: 91%

Maternal cardiac deceleration capacity: a novel insight into maternal autonomic function in pregnancies complicated by hypertensive disorders and intrauterine growth restriction

Casati

Stampalija

Ferrazzi

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

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Women with pregnancy complicated by severe placental failure, such as HDP-IUGR and severe IUGR, show significant autonomic alterations, as indicated by elevated cardiac DC. On the contrary, pregnancy complications such as HDP-AGAf and mild IUGR show no impact on maternal autonomic balance. We present a new approach to explore maternal autonomic cardiovascular regulation that might reflect the severity of placental vascular insufficiency.

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“…(Rivolta et al, 2014) Even more interestingly, it has been shown that IUGR fetuses with brain sparing (fetal adaptive mechanism to chronic hypoxemia) have a lower acceleration and deceleration capacities than growth restricted foetuses without brain sparing. (Stampalija et al, 2016) This intimate inter-relation between brain perfusion and FHR is thought to be mediated via ANS (aortic chemoreceptors and carotid baro-and chemoreceptors). Newer data also show an activation of ANS in fetuses affected by maternal gestational diabetes which could not be seen using conventional techniques.…”

Section: A)mentioning

confidence: 99%

Non-invasive biomarkers of fetal brain development reflecting prenatal stress: An integrative multi-scale multi-species perspective on data collection and analysis

Frasch

Lobmaier

Stampalija

et al. 2020

Neuroscience & Biobehavioral Reviews

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Prenatal stress (PS) impacts early postnatal behavioural and cognitive development. This process of 'fetal programming' is mediated by the effects of the prenatal experience on the developing hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). We derive a multi-scale multi-species approach to devising preclinical and clinical studies to identify early non-invasively available pre- and postnatal biomarkers of PS. The multiple scales include brain epigenome, metabolome, microbiome and the ANS activity gauged via an array of advanced non-invasively obtainable properties of fetal heart rate fluctuations. The proposed framework has the potential to reveal mechanistic links between maternal stress during pregnancy and changes across these physiological scales. Such biomarkers may hence be useful as early and non-invasive predictors of neurodevelopmental trajectories influenced by the PS as well as follow-up indicators of success of therapeutic interventions to correct such altered neurodevelopmental trajectories. PS studies must be conducted on multiple scales derived from concerted observations in multiple animal models and human cohorts performed in an interactive and iterative manner and deploying machine learning for data synthesis, identification and validation of the best non-invasive detection and follow-up biomarkers, a prerequisite for designing effective therapeutic interventions.

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Brain sparing effect in growth‐restricted fetuses is associated with decreased cardiac acceleration and deceleration capacities: a case–control study

Abstract: Brain sparing in IUGR fetuses is associated with decreased acceleration and deceleration capacities of the heart.

Cited by 46 publications

References 23 publications

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction

Maternal cardiac deceleration capacity: a novel insight into maternal autonomic function in pregnancies complicated by hypertensive disorders and intrauterine growth restriction

Non-invasive biomarkers of fetal brain development reflecting prenatal stress: An integrative multi-scale multi-species perspective on data collection and analysis

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