which intrinsic homeostatic response is the fetus demonstrating
Sleep disorders in pregnancy. This phenomenon has the potential of altering ANS in three ways, especially in preterm or vulnerable infants. In fetal surveillance, the situation is very different. doi: 10.1111/j.1749-6632.1992.tb22857.x, Buss, C., Davis, E. P., Class, Q. doi: 10.1159/000307075, Walusinski, O. (2015). During pregnancy, the maturation pattern of fetal gonads must be taken into account. Front. Using fetal oximetry probes many centers reported images of deep decelerations with little or no change in fetal oxygen saturation. 47, 373386. The hallmark of a negative feedback loop is that it counteracts a change, bringing the value of a parametersuch as temperature or blood sugarback towards it set point. 1983 Jun 15;146(4):456-62. Cardiovasc. doi: 10.1111/j.1471-0528.1998.tb10206.x, Senturk, M. B., Cakmak, Y., Gndogdu, M., Polat, M., and Atac, H. (2015). 10:922. doi: 10.3389/fphys.2019.00922, Ouellet-Morin, I., Dionne, G., Lupien, S. J., Muckle, G., Ct, S., Prusse, D., et al. Moreover, excessive light can impair visual development, thus increasing SNS and HPA axis activation (Weber and Harrison, 2019). Perspect. doi: 10.1161/JAHA.119.012629, Norman, G. J., Cacioppo, J. T., Morris, J. S., Malarkey, W. B., Berntson, G. G., and Devries, A. C. (2011). (2017). Fetal scalp electrodes can also be used to directly measure pH during childbirth, but this technique, being even more invasive, is not yet fully accepted and also has some complications (Sabir et al., 2010). doi: 10.1152/ajpregu.00120.2012, Hoyer, D., Schmidt, A., Gustafson, K. M., Lobmaier, S. M., Lakhno, I., van Leeuwen, P., et al. Figure 3: Two proposed pathways with late decelerations, adapted from Freeman et al. However, theres no clinical evidence suggesting its effectiveness when used alone in women with adequate oxygen levels. The degree of oxygen saturation of fetal hemoglobin can be estimated based on the different absorption of red and near infrared light by oxygenated and deoxygenated fetal hemoglobin. Lastly, even electromagnetic field (EMF) radiations during pregnancy, due to overexposure to mobile phones, diagnostic instruments, or occupation, seem to be a risk factor for preterm delivery (Rou et al., 2016) and to have effects on ANS development (Rezk et al., 2008). Acta Obstet. World Inst. (2007). Synchronous caregiving from birth to adulthood tunes humans' social brain. Beyond the headlines: fetal movement awareness is an important stillbirth prevention strategy. Crit. Indeed, low cortisol levels could fail in regulating postnatal inflammation, e.g., necrotizing enterocolitis (NEC), which could induce cell death in the vagal brainstem centers (Fritze et al., 2014). A possible critical event during the first stage of labor is certainly the risk of cardiac events. This effect is believed to benefit the fetus by temporarily reducing myocardial work to compensate for diminished oxygen availability.3-6 A third consequence of chemoreceptor activation of the sympathetic system causes release of other substances such as adrenal catecholamines and vasopressin. Intrapartum care. doi: 10.2139/ssrn.3441806, Bernardes, J., Gonalves, H., Ayres-de-Campos, D., and Rocha, A. P. (2008). Birth Defects Res. Res. In adult cardiology, ECG changes are very helpful to diagnose myocardial infarction because there is a direct relationship, precisely defined by anatomy and electromagnetic physics, linking the presence of Q waves in the 12-lead ECG to the location of injured myocardium. doi: 10.3390/nu7085315, Zhou, L., and Xiao, X. 32, 16851695. Gynecol. None of these guidelines specify what level of metabolic acidemia or degree of reliability they mean. Neonatal Med. (1991). Decelerations were present when there was mild hypertension during the compression but they were also present when marked hypotension accompanied the compression. (2019). 465, 573584. Fetal origin of sensorimotor behavior. 33, 909912. Eur J Obstet Gynecol Reprod Biol. (2016). They do not make assumptions about linear relationships or require independent effects and they can consider trends over time. A., Cook, R. A., and Nikolovski, J. As the 3rd trimester advances, specific nociceptive event-related potentials in the brain increasingly develop until 3537 WGA (Verriotis et al., 2016). 134, 396408. (2020). 125, 28. Behav. Uterine tachsystole B. Maternal hypotension C. Prolapsed cord Ann. Perinatol. Cahill AG, Tuuli MG, Stout MJ, Lpez JD, Macones GA. A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. Bistoletti P, Lagercrantz H, Lunell NO. Other cardiovascular compensatory mechanisms include changes in blood pressure, cardiac stroke volume, local vasoconstriction or vasodilation to promote redistribution of blood flow and alterations in hemoglobin-oxygen dissociation to increase oxygen extraction. Evidence of a non-vagal (intrinsic myocardial) source of deceleration was demonstrated in experiments with complete vagotomy. Fetal Neonatal Ed. Sci. J. Dev. Cardiovasc. 24, 474481. Fetal programming of neuropsychiatric disorders. Consequently, a cerebral alteration, caused by a brain injury, affects the ANS including the vagus. 56, 3539. Res. Auton. Regarding the PNS, the vagus nerve has been recognized as a fundamental afferent pathway for sensing the milieu interior in peripheral tissues, thus allowing the organism to respond by activating complex networks involving the whole ANS, endocrine, metabolic, innate, and adaptive immune systems (Frasch et al., 2018b; Bonaz et al., 2021). The consequences can be quite severe: from apnea to hypoxemia, from sleep disruption to decreased growth, from immunity impairment to neuroendocrine alterations (Almadhoob and Ohlsson, 2020). doi: 10.1016/j.earlhumdev.2017.07.003, Desrosiers, T. A., Lawson, C. C., Meyer, R. E., Stewart, P. A., Waters, M. A., Correa, A., et al. (2016). Castel, A., Burns, P. M., Benito, J., Liu, H. L., Kuthiala, S., Durosier, L. D., et al. Vasoconstriction is mediated through the -adrenergic receptors in liver, kidney, skin and gut, and vasodilation is mediated through adrenergic receptors in skeletal muscle. Med. (2007). Monogr. Other work by Bennet et al has also challenged common teaching about the relationship between hypertension and decelerations. Fetal heart rate and variability: stability and prediction to developmental outcomes in early childhood. We . Selye, H. (1950). Male fetuses show a more reactive ANS and less complexity in control systems than female ones, with a more linear and significantly less complex fHR activity (Bernardes et al., 2008). The above-mentioned studies show us what impact labor can have on the ANS and the vagus nerve. Moreover, a recent pilot study described that in utero ZIKV-affected babies display HRV metrics abnormalities. (2017). During labor, the recommended fetal heart rate assessment interval for auscultation is every A. Med. Indeed, several animal studies and even some human studies have shown that many factors (e.g., malnutrition, high level of stress, toxic exposure) during early, mid, and late gestation can impair brain and ANS development/regulation, thus inducing biological and behavioral alterations. 196: Communication of Fetal Heart Monitoring Information . Area postrema undergoes dynamic postnatal changes in mice and humans: dynamic postnatal changes of area postrema. Pediatrics 139, S38S49. doi: 10.1016/j.earlhumdev.2018.02.011, Vermani, E., Mittal, R., and Weeks, A. At 56 WGA, the 12 cranial nerves appear (Moore et al., 2016). J. Obstet. doi: 10.1289/ehp.99107475, Derbyshire, S. W., and Bockmann, J. C. (2020). 2004 Jan;190(1):118-23. Homeostasis (article) | Human body systems | Khan Academy Vagal regulation of heart rate in the prediction of developmental outcome for very low birth weight preterm infants. A., Lieblich, S. E., Bodnar, T. S., Weinberg, J., and Galea, L. A. M. (2019). In the absence of improvement, immediate delivery is a strong possibility. Obstet Gynecol. It is therefore legitimate to argue that a decreased possibility/capacity to express movements by the fetus, that is related to an impairment of the sensory stimulation, could interfere with the normal neurodevelopmental pattern of ANS and vagus nerve itself. Ramsey, P. S., and Rouse, D. J. Can. (1986). doi: 10.1016/S1701-2163(15)30382-0, Newbern, J. M. (2015). (2018). 78, 17881798. doi: 10.1016/j.neubiorev.2018.05.026, Frasch, M. G., Mller, T., Hoyer, D., Weiss, C., Schubert, H., and Schwab, M. (2009a). In particular, the subplate (a central hub for cortical connectivity) becomes visible and begins to receive connection from the thalamus, basal forebrain, and brainstem. RadioGraphics 35, 21352148. (2021). Neonatal Nurs. Am. Indeed, it is known to increase with worsening acidemia (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996; Frasch et al., 2007, 2009a,b; Durosier et al., 2014). which intrinsic homeostatic response is the fetus demonstrating Am. Clark SL, Hamilton EF, Garite TJ, Timmins A, Warrick PA, Smith S. The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia. For instance, too high oxygenation can easily induce lung injury, thus increasing inflammation and stressing the already immature CAP, whereas too low oxygenation can cause neurodevelopmental impairment and HIE (Rantakari et al., 2021). doi: 10.3399/bjgpopen19X101674, Mackenzie, J., Murray, E., and Lusher, J. Maternal cigarette-smoking during pregnancy disrupts rhythms in fetal heart rate. J. Calif. Perinat. doi: 10.1038/s41390-019-0320-0, Reid, N., Moritz, K. M., and Akison, L. K. (2019). Gynecol. doi: 10.1016/j.midw.2013.01.002, Brown, C. A., Lee, C. T., Hains, S. M. J., and Kisilevsky, B. S. (2008). J. Physiol. doi: 10.7363/040237, Busnel, M., Granier-Deferre, C., and Lecanuet, J. J. Meas. J. Perinat. doi: 10.1126/scitranslmed.3008599, Abdel-Haq, R., Schlachetzki, J. C. M., Glass, C. K., and Mazmanian, S. K. (2018). 2017 Feb;216(2):163.e1-163.e6. doi: 10.1136/medethics-2019-105701, Dereymaeker, A., Pillay, K., Vervisch, J., De Vos, M., Van Huffel, S., Jansen, K., et al. Appearance and transient expression of oxytocin receptors in fetal, infant, and peripubertal rat brain studied by autoradiography and electrophysiology. Women Birth 32, 12. Smoke and alcohol exposure can induce in premature newborns higher sympathetic function, lower parasympathetic function, and had less cardiac autonomic adaptability (Mulkey and du Plessis, 2019). Caton Alissa, R., Bell Erin, M., Druschel Charlotte, M., Werler Martha, M., Lin Angela, E., Browne Marilyn, L., et al. (2007). Prior studies have catalogued extensive molecular alterations associated with homeostatic scaling. 176, 112118. Infect. Prenatal nicotine exposure alters the nicotinic receptor subtypes that modulate excitation of parasympathetic cardiac neurons in the nucleus ambiguus from primarily 32 and/or 6X to 34. Struggling with daily life and enduring pain: a qualitative study of the experiences of pregnant women living with pelvic girdle pain. doi: 10.1016/j.mehy.2008.09.033, Cahill, A. G., Mathur, A. M., Smyser, C. D., Mckinstry, R. C., Roehl, K. A., Lpez, J. D., et al. Am J Obstet Gynecol. The fetal inflammatory response syndrome. doi: 10.1159/000501906. hypothesized, through the use of an algorithm based on RMSSD, the possibility of identifying the precise moment, during labor, when fetuses begin to lose maintenance of cardiac output, that is, when they show a hypotensive pattern of pathological arterial blood pressure (ABP). As supporting evidence, complications including fetal growth restriction alter sleep stages by reducing active sleep (Aldrete-Cortez et al., 2019). doi: 10.1016/j.earlhumdev.2015.11.003, Sabir, H., Stannigel, H., Schwarz, A., and Hoehn, T. (2010). Fetal heart rate variability is suppressed by factors that depress fetal brain function. J. Perinatol. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Metab. 33, 1923819242. 22, 337358. doi: 10.1097/00063198-200311000-00005, Sanghavi, M., and Rutherford, J. D. (2014). Rest assured, however, that babies who receive prompt treatment have an excellent outcome. doi: 10.1038/s41372-019-0342-9, Siddiqui, S., Fifer, W. P., Ordonez-Retamar, M., Nugent, J. D., and Williams, I. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. which intrinsic homeostatic response is the fetus demonstrating. Antihypertensive medication use during pregnancy and the risk of cardiovascular malformations. Paediatr. Univ. A., Tsai, A. S., Ghaemi, M. S., Han, X., Ando, K., et al. The Developing Human: Clinically Oriented Embryology, 10th Edn. (2006). Norepinephrine binds to beta receptors in the heart causing an increase in heart rate, contractility and stroke volume. Drugs 2, 419436. In fact, the role of fHR monitoring (electronic fetal monitoring, EFM, to be precise), despite being used in over 90% of hospitals during delivery, remains controversial (Schifrin, 2020). Gender differences in neurodevelopment and epigenetics. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor. (2021). Hypotheses 67, 614. [Epub ahead of print]. Perinatol. J Dev Physiol. American College of Obstetricians and Gynecologists. Best Pract. Med. Lastly, early pain reactivity measured through HRV in alcohol-exposed newborns seems to be blunted, suggesting different responsiveness to environmental stimuli even after birth (Oberlander et al., 2010). Med. Design of a light stimulator for fetal and neonatal magnetoencephalography. Birt. The effect of antenatal steroid treatment on fetal autonomic heart rate regulation revealed by fetal magnetocardiography (fMCG). 12, 354356. doi: 10.1055/s-0036-1597135, Caez, M. S., Reed, K. L., and Shenker, L. (1987). (14), Shallow gradual deceleration that are late in timing and accompanied by a normal baseline and moderate baseline variability are inconsistent markers of low Apgar scores or metabolic acidosis. 59: Techniques for Fetal Heart Assessment . Res. Physiol. Provided the repetition of these episodes was relatively infrequent, the healthy fetus could adapt for many hours. 39:100703. doi: 10.1016/j.dcn.2019.100703, Martens, D. S., Capozzoli, M., Cox, B., and Nawrot, T. S. (2019). The size, shape and timing of decelerations induced by cord compression or uterine artery compression tend to converge in the presence of marked fetal acidemia. World J. Pediatr. In particular, metabolic and cardiovascular pathologies, like obesity, diabetes, hypertension, and preeclampsia, can disrupt vagus nerve development (Brown et al., 2008; Russell et al., 2016; Moors et al., 2020). Neurosci. Porges, S. W. (2011). The hypothalamic-pituitary-adrenal axis and the fetus. Neuropharmacology 144, 7081. Since this review focuses on the role of ANS in human fetuses and newborns, the discussed time spans regarding gestational age are related to human development. J. Steroid Biochem. The effects of epidural anesthesia on electronic fetal heart rate monitoring. Natl. Physiol. Neuropsychopharmacol. (2014). A clinical perspective of necrotizing enterocolitis: past, present, and future. Psychoneuroendocrinology 30, 10501058. The variations in ambient and core temperature appear to impact newborns HRV (Massaro et al., 2017): in particular, extreme variations seem to affect the autoregulatory capacities of the cardiac system and, consequently, HRV, possibly due to a dysregulated release of excitatory neurotransmitters (Tsuda et al., 2018). 130, 403407. Summary of the HRV metrics cited in the main text (Brndle et al., 2015; Massaro et al., 2017; Oliveira et al., 2019; Patural et al., 2019; Frasch et al., 2020a). Viral infections during pregnancy. J. Mol. At 1819 WGA, nociceptive neurons and the typical hormonal response to pain appear (Borsani et al., 2019; Chen et al., 2021), thus hinting that primitive pain perception might begin at this stage. General movements quality, as well as their variability and modulation in intensity and velocity, could be valid indicators of fetal neurodevelopment, in particular concerning supra-spinal control on motor activity (Moreira Neto and Porovic, 2018). J. Obstet. Obstet. Care 26, 534.e9534.e17. Its dominance results in what effect to the FHR baseline? Coregulated approach to feeding preterm infants with lung disease: effects during feeding. Cardiovascular System - Spleen Development - Embryology. doi: 10.1038/jp.2017.15, Amarasekara, R., Jayasekara, R. W., Senanayake, H., and Dissanayake, V. H. W. (2015). Pediatr. Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG. (2007). Endogenous circadian control of the human autonomic nervous system. J. Pediatr. U.S.A. 108, 34613462. Circadian variation of heart rate variability. Infant stress reactivity and prenatal alcohol exposure. Clin. Moreover, the prolonged administration of MgSO4 seems to be associated with a change in fetal breathing movements (Peaceman et al., 1989) and to affect fHRV dose-dependently (Cardosi and Chez, 1998; Kamitomo et al., 2000). 40, 445456. (2000). A., Parisi, V. M., and Creasy, R. K. (1989). Firstly, by directly affecting brain development, as the skull has a low bone density that fails in adequately protecting newborns' brain from EMF (Besset et al., 2020). Social interactions, including skin-to-skin contact between mother and newborns, help increase ANS maturation as well as stress responsivity and circadian rhythms, in particular in preterm infants (Ulmer Yaniv et al., 2021). Med. Is less noise, light and parental/caregiver stress in the neonatal intensive care unit better for neonates? Res. Garabedian C, De Jonckheere J, Butruille L, Deruelle P, Storme L, Houfflin-Debarge V. Understanding fetal physiology and second line monitoring during labor. doi: 10.1016/0304-3959(86)90223-X, Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine (2016). Heart rate variability in hypertensive pregnancy disorders: a systematic review. J Obstet Gynaecol Can. PLoS ONE 12:e0180167. Autonomic nervous system immaturity due to fetal or postnatal complications (e.g., maternal pathologies, birth difficulties) could then impair the whole brain development and, therefore, behavior, stress response, and mood regulation, with negative consequenceseven serious neurological or psychological pathologiesin infants, adolescent, and adult life (Mulkey et al., 2018; Mulkey and du Plessis, 2019). (2017). Furthermore, without uterus protection, newborns can be particularly sensitive to sounds, which usually overcome the 45 dB limit recommended by the American Academy of Pediatrics (Almadhoob and Ohlsson, 2020), thus resulting in toxic stress (Weber and Harrison, 2019). Res. In fact, one could consider that the substantial reduction the rates of intrapartum-related neonatal encephalopathy seen in numerous regions around the world demonstrate a remarkable achievement. (2021). Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J. Perinatol. On the other hand, the ANS activity, as measured through heart rate variability (HRV)a non-invasive biomarker evaluating the variability of the time intervals between successive heartbeatsis affected by the developmental and health conditions of both fetus and infant. by Emily Hamilton, MDCM and Philip Warrick, Ph.D. Fetal heart rate acceleration in response to light Stimulation s a clinical measure of fetal well-being. (12), Over that last decade mounting evidence based on recent animal experimentation with very sensitive sensors and finer time resolution, has produced more information about hand chemoreceptors and their role in the production of decelerations.
which intrinsic homeostatic response is the fetus demonstrating