Comparison of fetal and maternal heart rate measures using electrocardiographic and cardiotocographic methods.

PURPOSE: To determine the reliability at term of: (1) two methods of measuring fetal heart rate (HR), electrocardiographic (ECG, the 'gold standard') and cardiotocographic (CTG) and (2) two ECG methods of measuring maternal HR variability over relatively brief periods of time (s-min). METHODS: During 20 min of rest (N=39) and during 2 min of auditory stimulation (mother's recorded voice, n=19), fetal HR data were collected using an ECG (Monica AN24) and a Hewlett-Packard Model 1351A CTG. Simultaneously, maternal HR data (n=37) were collected using the same ECG device (Monica AN24) and a second stand-alone cardiac monitor (Spacelab 514T cardiac monitor with a QRS detector). RESULTS: During 20 min of maternal rest, correlations of individual fetal CTG with ECG measures of HR at each second were moderate to high (r=.57-.97) for 77% of fetuses. Correlations of HR averaged over fetuses and over each of the 20 min were high (r=.93-.97); fetal HR averaged over 20 min varied between devices from 0.0 to 0.8 bpm. During 2 min of maternal voice presentation, correlations of fetal HR over each second were moderate to high (r=.54-.99) for 95% of fetuses and high (all rs=.99) when averaged across fetuses in 30s or 2 min epochs. Average fetal HR between devices over the 2 min voice varied from 0.0 to 0.6 bpm. Correlations and/or % agreement between the two ECG methods of measuring maternal HR were high. Average maternal HR over 10 min showed 81% of pairs with a difference of ≤ 1 bpm; correlations for HR variability measures varied from r=.89 to .97. CONCLUSIONS: Good reliability was demonstrated between individual spontaneous and auditory induced fetal CTG and ECG with high correlations when HR data were averaged over fetuses or in 30-120 s epochs. High reliability of maternal HR measures was obtained using two ECG devices.

Fetuses respond to father's voice but prefer mother's voice after birth.

Fetal and newborn responding to audio-recordings of their father's versus mother's reading a story were examined. At home, fathers read a different story to the fetus each day for 7 days. Subsequently, in the laboratory, continuous fetal heart rate was recorded during a 9 min protocol, including three, 3 min periods: baseline no-sound, voice (mother or father), postvoice no-sound. Following a 20 min delay, the opposite voice was delivered. Newborn head-turning was observed on 20 s trials: three no-sound, three voice (mother or father), three opposite voice, three no-sound trials with the same segment of each parent's recording. Fetuses showed a heart rate increase to both voices which was sustained over the voice period. Consistent with prior reports, newborns showed a preference for their mother's but not their father's voice. The characteristics of voice stimuli that capture fetal attention and elicit a response are yet to be identified.

Atypical fetal response to the mother's voice in diabetic compared with overweight pregnancies.

OBJECTIVE: To characterize fetal spontaneous heart rate changes and movements and auditory-elicited heart rate changes in fetuses in diabetic pregnancies compared with those in uneventful, overweight pregnancies. METHODS: Spontaneous heart rate and movements and maternal voice-elicited heart rate changes were observed in 46 mother-fetal pairs (n = 14 gestational diabetic and n = 32 overweight prepregnancy) at 36 (±1) weeks gestational age. Fetal heart rate changes, body movements, and breathing movements were observed for 20 minutes while the mother was at rest. Subsequently, each fetus was presented with a 2-minute audio recording of the mother's voice using the following 6-minute procedure: 2 minutes no-voice baseline, 2 minutes voice presentation, and 2 minutes no-voice postvoice period; heart rate was recorded continuously. RESULTS: There were no differences in spontaneous heart rate changes, body movements, or breathing movements between the 2 groups. Fetuses in the overweight group showed an increase in the heart rate during the playing of their mother's voice, whereas fetuses in the diabetic group showed no response. CONCLUSIONS: Fetuses in overweight pregnancies responded to the mother's voice with an increase in the heart rate as has been reported previously in uneventful pregnancies. The lack of response to the mother's voice in fetuses in diabetic pregnancies may represent immature neural or auditory system development, an increased sensorineural threshold, and thyroid or iron deficiency.

Atypical fetal voice processing in preeclamptic pregnancy.

OBJECTIVE: To compare fetal heart rate (HR) response to the mother's voice in pregnancies complicated by preeclampsia with those of fetuses in uneventful, normotensive pregnancies. METHOD: Fifty fetuses (n = 22, preeclampsia; n = 28, uneventful, normotensive pregnancies) between 32 and 40 weeks gestational age were recruited. Each fetus was presented with a 2-min no-sound baseline period followed by a 2-min voice period during which an audio recording of his/her mother reading a story was played through a loud speaker over the maternal abdomen at an average of 95 dBA followed by a 2-min no-voice offset period. HR was recorded continuously. RESULTS: Fetuses in the preeclamptic group showed no response to the mother's voice when it was played. In comparison, fetuses in the uneventful, normotensive group responded to the mother's voice with a HR increase. CONCLUSION: Fetuses in pregnancies complicated by preeclampsia show atypical auditory processing of the mother's voice. Such atypical responding may reflect a delay in auditory system maturation, functional elevation of sensorineural threshold, or decreased thyroid hormone.

Onset and maturation of fetal heart rate response to the mother's voice over late gestation.

BACKGROUND: Term fetuses discriminate their mother's voice from a female stranger's, suggesting recognition/learning of some property of her voice. Identification of the onset and maturation of the response would increase our understanding of the influence of environmental sounds on the development of sensory abilities and identify the period when speech and language might influence auditory processing. AIM: To characterize the onset and maturation of fetal heart rate response to the mother's voice. METHODS: 143 fetuses from 29 to 40 weeks gestational age (GA) received a standardized protocol: no-sound pre-voice baseline (2 min), audio recording of their mother reading a story (2 min), no-sound post-voice (2 min). The voice was delivered 10 cm above the maternal abdomen at an average of 95 dB A; heart rate was recorded continuously. RESULTS: For data analyses, fetuses were categorized into four age groups: 29­31, 32­34, 35­37, and > 37 weeks GA. Onset of response to the mother's voice occurred at 32­34 weeks GA. From 32 to 37 weeks GA, there was an initial heart rate decrease followed by an increase. At term, there was a response shift to an initial heart rate increase. The percentage of fetuses responding increased over gestation from 46% at 32­34 weeks GA to 83% at term. CONCLUSION: A relatively long latency and sustained duration of the heart rate response suggest auditory processing, the formation of neural networks, above the level of the brainstem.

The effects of exercise conditioning in normal and overweight pregnant women on blood pressure and heart rate variability.

Pre-pregnancy obesity is a risk factor for preeclampsia, gestational diabetes, and hypertension. Regular exercise during pregnancy has been shown to decrease the risk of these obstetrical complications. The purpose of this prospective study was to measure the effects of an exercise program in normal-weight and overweight/obese pregnant women on blood pressure (BP) and cardiac autonomic function, determined by heart rate variability (HRV) and baroreflex sensitivity (BRS). Twenty-two sedentary pregnant women, recruited at 20 weeks gestational age (GA), were grouped as normal weight or overweight/obese. They were systematically assigned to an exercise (walking) group or control (nonwalking) group after the first participants were randomly assigned. Women in the walking groups participated in a 16-week, low-intensity walking program. BP, HRV, and BRS were measured at rest and during exercise at the beginning (20 weeks GA) and end (36 weeks GA) of the walking program. Results indicated that women in the control groups (especially overweight women) showed changes in BP, HRV, and BRS over pregnancy that were not seen in the walking group. Overweight women in the control group increased resting systolic BP by 10 mmHg and diastolic BP by 7 mmHg. HRV declined in the control group but not in the walking group. A reduction in BRS and R-R interval at rest was found in all groups except the walking normal-weight group. The results suggest that an exercise program could attenuate the increase in BP and the loss of parasympathetic tone associated with pregnancy, especially in overweight women.

Maternal heart rate variability and fetal behavior in hypertensive and normotensive pregnancies.

The relation between maternal heart rate variability (HRV) and fetal behavior was examined in hypertensive and normotensive pregnant women. A total of 40 mother-fetal pairs (n = 20 normotensive mothers; n = 20 hypertensive mothers) at 33-41 weeks' gestation were observed using a standardized procedure lasting approximately 50 min. It included the following measurements: maternal beat-by-beat arterial blood pressure and HRV; spontaneous fetal heart rate (HR), body and breathing movements; and an estimate of amniotic fluid volume. The women in the hypertensive group had higher average body mass index (BMI) (33.7 vs. 28.8 kg/m2) than the normotensive group. In the normotensive group, there was no association between maternal HRV and fetal gestational age, HR, body or breathing movements. In the hypertensive group, maternal HRV measures of low-frequency, high-frequency, and total power were associated with fetal gestational age; also, there was an association between maternal autonomic modulation of HR and fetal spontaneous HR. These findings suggest that the maternal autonomic system influences fetal cardiac function in pregnancies complicated by hypertension.

Estimated cardiac vagal tone predicts fetal responses to mother's and stranger's voices.

Heart rate responses of 84 near-term fetuses to recorded female voices were examined in 166 trials of auditory stimulation. Each fetus was presented with a 2-min recording of their mother's voice and a 2-min recording of a female stranger's voice, in counterbalanced order, with a 10-min rest period between trials. High frequency heart rate variability during a 2-min baseline period was used to estimate cardiac vagal tone for each trial. Differential heart rate responses to familiar and unfamiliar voice recordings were observed during a 2-min poststimulus period, only when estimated cardiac vagal tone was high. This finding suggests that vagal tone plays a moderating role in the cardiac responses of term fetuses to familiar and unfamiliar stimuli.

Auditory processing deficits in growth restricted fetuses affect later language development.

An increased risk for language deficits in infants born growth restricted has been reported in follow-up studies for more than 20 years, suggesting a relation between fetal auditory system development and later language learning. Work with animal models indicate that there are at least two ways in which growth restriction could affect the development of auditory perception in human fetuses: a delay in myelination or conduction and an increase in sensorineural threshold. Systematic study of auditory function in growth restricted human fetuses has not been reported. However, results of studies employing low-risk fetuses delivering as healthy full-term infants demonstrate that, by late gestation, the fetus can hear, sound properties modulate behavior, and sensory information is available from both inside (e.g., maternal vascular) and outside (e.g., noise, voices, music) of the maternal body. These data provide substantive evidence that the auditory system is functioning and that environmental sounds are available for shaping neural networks and laying the foundation for language acquisition before birth. We hypothesize that fetal growth restriction affects auditory system development, resulting in atypical auditory information processing in growth restricted fetuses compared to healthy, appropriately-grown-for-gestational-age fetuses. Speech perception that lays the foundation for later language competence will differ in growth restricted compared to normally grown fetuses and be associated with later language abilities.

Comparison of fetal behavior in low- and high-risk pregnancies.

Meta-analyses were conducted on archival data of human fetal behavior to identify differential behavior among high-risk fetuses in pregnancies complicated by threatened preterm delivery, maternal hypertension or diabetes compared with low-risk fetuses in uneventful pregnancies, delivering as healthy, full-term infants. Data for a total of 493 fetuses (260 high risk, 233 low risk) from 23 weeks' gestation to term who participated in a study using a standardized protocol including observations of spontaneous and auditory-induced behavior were retrieved from our laboratory database. There were no differences in spontaneous behaviors when scored using clinical criteria for the nonstress test and biophysical profile; however, there were differences in the magnitude of the behaviors measured in the tests. Developmental differences were observed between those threatening to deliver early and the fetuses of hypertensive and diabetic mothers. The latter two groups differed little from one another but differed from low-risk fetuses in their response to auditory stimulation. We concluded that differences in behavior among high-risk groups suggest that atypical fetal behaviors may represent adaptation to condition specific insult rather than a generalized response to insult per se. The finding that high-risk fetuses showed atypical responses to auditory stimuli indicates a need to examine the relation between fetal auditory function and later language acquisition.

Gender differences in functional capacity following myocardial infarction: an exploratory study.

This study examined functional capacity and hemodynamic responses to exercise in men and women during early recovery after myocardial infarction (MI). Participants were tested at hospital discharge and six weeks following discharge. At each testing time, they completed the Beck Depression Inventory and a symptom-limited graded exercise test (SL-GXT). Functional capacity, expressed in metabolic equivalents (METs), was estimated from performance on the SL-GXT. Hemodynamic response measures included heart rate (HR), systolic blood pressure (SBP). and rate-pressure product (RPP). Both men and women demonstrated significant increases in functional capacity from discharge to six weeks later although the levels were lower for women (M = 2.8 METs) than men (M = 7.3 METs). This indicates a need for gender-sensitive counselling for unsupervised exercise rehabilitation during early recovery following MI.

Effects of experience on fetal voice recognition.

The ability of human fetuses to recognize their own mother's voice was examined. Sixty term fetuses were assigned to one of two conditions during which they were exposed to a tape recording of their mother or a female stranger reading a passage. Voice stimuli were delivered through a loudspeaker held approximately 10 cm above the maternal abdomen and played at an average of 95 dB SPL. Each condition consisted of three 2-min periods: no stimulus, voice (mother or stranger), and no stimulus. Fetal heart rate increased in response to the mother's voice and decreased in response to the stranger's; both responses were sustained for 4 min. The finding of differential behavior in response to a familiar versus a novel voice provides evidence that experience influences fetal voice processing. It supports an epigenetic model of speech perception, presuming an interaction between genetic expression of neural development and species-specific experience.