Insulin and insulin-like growth factor-1 increased in preterm neonates following massage therapy.

OBJECTIVE: To determine if massage therapy increased serum insulin and insulin-like growth factor-1 (IGF-1) in preterm neonates. STUDY DESIGN: Forty-two preterm neonates who averaged 34.6 weeks (M = 29.5 wk gestational age; M birth weight = 1237 g) and were in the "grower" (step-down) nursery were randomly assigned to a massage therapy group (body stroking and passive limb movements for three, 15-minute periods per day for 5 days) or a control group that received the standard nursery care without massage therapy. On Days 1 and 5, the serum collected by clinical heelsticks was also assayed for insulin and IGF-1, and weight gain and kilocalories consumed were recorded daily. RESULTS: Despite similar formula intake, the massaged preterm neonates showed greater increases during the 5-day period in (1) weight gain; (2) serum levels of insulin; and (3) IGF-1. Increased weight gain was significantly correlated with insulin and IGF-1. DISCUSSION: Previous data suggested that preterm infant weight gain following massage therapy related to increased vagal activity, which suggests decreased stress and gastric motility, which may contribute to more efficient food absorption. The data from this study suggest for the first time that weight gain was also related to increased serum insulin and IGF-1 levels following massage therapy. CONCLUSION: Preterm infants who received massage therapy not only showed greater weight gain but also a greater increase in serum insulin and IGF-1 levels, suggesting that massage therapy might be prescribed for all growing neonates.

Maternal depression and anxiety effects on the human fetus: Preliminary findings and clinical implications.

Newborns of depressed and anxious mothers show biobehavioral abnormalities suggesting that maternal psychological distress has negative effects on the fetus. Two studies examined the fetuses of depressed and nondepressed mothers: (a) a cross-sectional investigation of fetal activity during the second and third trimesters and (b) an examination of behavioral and heart rate response to vibratory stimulation in late-gestation fetuses. Fetuses of depressed mothers were more active during the fifth, sixth, and seventh gestational months. Assessment of late-term fetuses consisted of a baseline, trials of vibratory stimulation directed towards measuring habituation, and a poststimulation period. During baseline, the fetuses of depressed mothers exhibited a lower heart rate. During stimulation trials, they showed less total movement and appeared to habituate more often. Approximately 35% of the variance in fetal behavior was accounted for by the mothers' depression and anxiety symptoms. Maternal depression may be linked to greater fetal activity during the second and third trimesters and decreased behavioral responsivity during late gestation. The response of late-term fetuses of depressed mothers to vibratory stimulation may reflect "receptor adaptation/effector fatigue" and not true habitation. Future studies should examine the value of clinical interventions provided to the pregnant mother.

Maternal depression and psychotropic medication effects on the human fetus.

Ultrasound studies examined fetuses of depressed and nondepressed mothers. Fetuses of depressed mothers were more active during mid-gestation and exhibited lower baseline heart rate and moved less during late-term vibratory stimulation. Mid-gestation heightened activity and late-term diminished responsivity may be a prenatal manifestation of the "general adaptation syndrome." Color Doppler technology measured blood flow velocity in the middle cerebral artery of fetuses whose mothers were prescribed SSRIs or lithium. SSRIs were associated with velocity increases and lithium with velocity decreases. The effects of psychotropic medications on prenatal neurobehavioral development require further study to document potential benefits and adverse effects.

Stable preterm infants gain more weight and sleep less after five days of massage therapy.

OBJECTIVE: To examine the effects of 5 days of massage therapy on the weight gain and sleep/wake behavior of hospitalized stable preterm infants. METHODS: Massage therapy (body stroking/passive limb movement for three 15-minute periods per day) was provided to 16 preterm neonates (mean gestational age, 30.1 weeks; mean birth weight, 1359 g), and their weight gain, formula intake, kilocalories, stooling, and sleep/wake behavior were compared with a group of 16 control infants (mean gestational age, 31.1 weeks; mean birth weight, 1421 g). RESULTS: The massage group averaged 53% greater daily weight gain than the control group. The massage group spent less time sleeping at the end of 5 treatment days than the control group and more time in the drowsy state. CONCLUSIONS: Healthy, low-risk preterm infants gained more weight and slept less with just 5 days of massage, in contrast to 10 days in previous studies. Results support the continued use of massage as a cost-effective therapy for medically stable preterm infants.

Fetal activity following stimulation of the mother's abdomen, feet, and hands.

Fetal activity during midgestation (M age=19.8 weeks) was studied in response to vibratory stimulation of the mother's abdomen (at the height of the fetal head), foot massage, hand massage, or control condition (no stimulation). Consistent with previous research conducted during midgestation, the fetuses of mothers who received two trials of 3-sec, 60-Hz vibratory stimulation did not show changes in movement. In contrast, the fetuses of mothers who received a 3-min foot massage showed greater movement than the control fetuses. However, stimulating the mother's hand (another highly innervated area) did not increase fetal activity. By late gestation (M age=35.4 weeks), vibratory stimulation resulted in increased fetal activity. These findings replicate previous research indicating that vibratory stimulation to the mother's abdomen does not elicit fetal activity until later in gestation. Furthermore, our findings indicate that stimulating the mothers' feet, but not the hands, can evoke fetal activity in midgestation.