Differences in the sleep states of IUGR and low-risk fetuses: An MCG study

Sriram, Bhargavi; Mencer, Margret A.; McKelvey, Samantha S.; Siegel, Eric R.; Wilson, James D.; Preißl, Hubert; Eswaran, Hari; Govindan, Rathinaswamy B.

doi:10.1016/j.earlhumdev.2013.07.002

Cited by 15 publications

(19 citation statements)

References 30 publications

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“…. Two investigations could be identified that took sleep state information into account when analyzing the difference in HRV metrics in IUGR and normal fetuses . Both found their respective metrics under investigation to be lower in growth‐restricted compared with normal fetuses and both included fetuses of less than 36 weeks of gestation.…”

Section: Discussionsupporting

confidence: 89%

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Doppler‐based fetal heart rate analysis markers for the detection of early intrauterine growth restriction

Stroux

Redman

Georgieva

et al. 2017

Acta Obstet Gynecol Scand

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Introduction One indicator for fetal risk of mortality is intra-uterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler-derived heart rate signal, would be suitable in its detection antenatally were studied. Material and Methods We used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation and gender. We assessed the discriminative power of short-term variability (STV) and long-term variability (LTV) of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth-restricted fetuses from controls. Metrics characterizing the sleep state distribution within a trace were also considered for inclusion into an IUGR detection model. Results Significant differences in the risk markers comparing growth-restricted with healthy fetuses were found. When used in a logistic regression classifier, their performance for identifying IUGR was considerably superior before 34 weeks gestation. LTV in active sleep was superior to STV (AUROC of 72% compared to 71%). Most predictive was the number of minutes in high variation per hour (AUROC of 75%). A multivariate IUGR prediction model improved the AUROC to 76%. Conclusion We suggest that heart rate variability markers together with surrogate information on sleep states can contribute to the detection of early-onset IUGR.

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Section: Discussionsupporting

confidence: 89%

“…This has also been observed by Sriram et al. . Two investigations could be identified that took sleep state information into account when analyzing the difference in HRV metrics in IUGR and normal fetuses .…”

Section: Discussionmentioning

confidence: 99%

Doppler‐based fetal heart rate analysis markers for the detection of early intrauterine growth restriction

Stroux

Redman

Georgieva

et al. 2017

Acta Obstet Gynecol Scand

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“…The authors found an increase of up to 4.5 hours and/or three more naps per day to be predictive of length growth suggesting an underlying biological system. In turn, growth restriction or growth-rate reduction as early as in utero (intrauterine growth restriction, IUGR) alters sleep patterns 56,57. IUGR fetuses have decreased amounts of active sleep and increased amounts of quiet sleep and indeterminate sleep compared to appropriately grown fetuses.…”

Section: Resultsmentioning

confidence: 99%

Infant sleep and its relation with cognition and growth: a narrative review

Tham¹,

Schneider²,

Broekman³

2017

NSS

115

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ObjectiveInfant sleep development is a highly dynamic process occurring in parallel to and in interaction with cognitive and physical growth. This narrative review aims to summarize and discuss recent literature and provide an overview of the relation between infant sleep and cognitive development as well as physical growth.MethodsWe conducted online literature search using MEDLINE, Embase, and Cochrane Library databases. We considered original research on humans published in the English language from January 2005 to December 2015. Search terms included “sleep” AND “infant” AND “cognition” OR “memory” OR “executive functioning”, OR “growth” OR “obesity” OR “growth hormone” OR “stunting”, and combinations thereof.ResultsTen studies on infant sleep and cognition were included in this review. Overall, findings indicated a positive association between sleep, memory, language, executive function, and overall cognitive development in typically developing infants and young children. An additional 20 studies support the positive role of infant sleep in physical growth, with the current literature focusing largely on weight gain and obesity rather than healthy growth. Existing evidence in both the domains is mainly based on cross-sectional designs, on association studies, and on parental reports. In contrast, there were limited studies on longitudinal sleep trajectories and intervention effects, or studies have not used more objective sleep measures such as actigraphy and polysomnography.ConclusionThe reviewed studies support a critical and positive role of infant sleep in cognition and physical growth. Future studies should consider key environmental and parental confounders, include a combination of more objective (actigraphy) and subjective measures (sleep diaries and questionnaires), and move towards longitudinal trajectory designs of infant sleep and development.

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“…Growth restriction is the result of insufficient transport of oxygen and nutrients across the placenta, and although pregnancy complications such as preeclampsia can result in IUGR, most instances are of unknown origin. Compared to their normally growing counterparts, growth restricted fetuses display reduced heart rate variability (Graatsma et al, 2012; Nijhuis et al, 2000; Sriram et al, 2013), reduced cardiac responsiveness to external stimulation (Gagnon, Hunse, Fellows, Carmichael, & Patrick, 1988), and make fewer general movements (Bekedam, Visser, de Vries, & Prechtl, 1985; Vindla, James, Sahota, & Coppens, 1997). A report that a characteristic pattern of responsivity to external stimuli in mid-gestation is expressed by fetuses who ultimately are in the lowest third of the distribution of birth weight suggests that fetal growth associations with neurobehavior may span a broader portion of the continuum (Sandman, Cordova, Davis, Glynn, & Buss, 2011)…”

Section: Chapter 11 Deviations From Normal Developmentmentioning

confidence: 99%

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DiPietro¹,

Costigan²,

Voegtline³

2015

Monographs Society Res Child

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Among the earliest volumes of this Monograph series was a report by Lester Sontag and colleagues, of the esteemed Fels Institute, on the heart rate of the human fetus as an expression of the developing nervous system. Here, some 75 years later, we commemorate this work and provide historical and contemporary context on knowledge regarding fetal development, as well as results from our own research. These are based on synchronized monitoring of maternal and fetal parameters assessed between 24 and 36 weeks gestation on 740 maternal-fetal pairs compiled from eight separate longitudinal studies, which commenced in the early 1990s. Data include maternal heart rate, respiratory sinus arrhythmia, and electrodermal activity and fetal heart rate, motor activity, and their integration. Hierarchical linear modeling of developmental trajectories reveals that the fetus develops in predictable ways consistent with advancing parasympathetic regulation. Findings also include: within-fetus stability (i.e., preservation of rank ordering over time) for heart rate, motor, and coupling measures; a transitional period of decelerating development near 30 weeks gestation; sex differences in fetal heart rate measures but not in most fetal motor activity measures; modest correspondence in fetal neurodevelopment among siblings as compared to unrelated fetuses; and deviations from normative fetal development in fetuses affected by intrauterine growth restriction and other conditions. Maternal parameters also change during this period of gestation and there is evidence that fetal sex and individual variation in fetal neurobehavior influence maternal physiological processes and the local intrauterine context. Results are discussed within the framework of neuromaturation, the emergence of individual differences, and the bidirectional nature of the maternal-fetal relationship. We pose a number of open questions for future research. Although the human fetus remains just out of reach, new technologies portend an era of accelerated discovery of the earliest period of development.

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Differences in the sleep states of IUGR and low-risk fetuses: An MCG study

Cited by 15 publications

References 30 publications

Doppler‐based fetal heart rate analysis markers for the detection of early intrauterine growth restriction

Doppler‐based fetal heart rate analysis markers for the detection of early intrauterine growth restriction

Infant sleep and its relation with cognition and growth: a narrative review

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