Monitoring fetal maturation-objectives, techniques and indices of autonomic function

• Type of Material: Article
• Authors: Dirk Hoyer, Jena University; Jan Zebrowski, Warsaw University of Technology; Dirk Cysarz, Witten Herdecke University; Hernani Goncalves, University of Porto; Adelina Pytlik, Jena University; Celia Amorim-Costa, University of Porto; Joao Bernardes, University of Porto; Diogo Ayres-de-Campos, University of Porto; Otto W. Witte, Jena University; Ekkehard Schleussner, Jena University; Lisa Stroux, University of Oxford; Christopher Redman, University of Oxford; Antoniya Georgieva, University of Oxford; Stephen Payne, University of Oxford; Gari D. Clifford, Emory University; Maria G. Signorini, Politecnico di Milano; Giovanni Magenes, University of Pavia; Fernando Andreotti, Tech University Dresden; Hagen Malberg, Tech University Dresden; Sebastian Zaunseder, Tech University Dresden; Igor Lakhno, Kharkiv VN Karazin National University; Uwe Schneider, Jena University
• Language: English
• Date: 2017-05-01
• Publisher: IOP Publishing: Hybrid Open Access
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Institute of Physics and Engineering in Medicine.
• Final Published Version (URL): http://dx.doi.org/10.1088/1361-6579/aa5fca
• Title of Journal or Parent Work: Physiological Measurement
• ISSN: 0967-3334
• Volume: 38
• Issue: 5
• Start Page: R61
• End Page: R88
• Grant/Funding Information: HG was supported by a post-doctoral grant (SFRH/BPD/69671/2010) from Fundação para a Ciência e a Tecnologia (FCT), Portugal.; DH and US are supported by German Research Foundation: ‘Development of a clinic suitable marker of fetal autonomic maturation’ (DFG: Ho 1634/15–12, Schn 775/7–1).; AG was supported by the Action Medical Research and the Henry Smith Charity. GC acknowledges the support of the National Institutes of Health, the Fogarty International Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant number 1R21HD084114-01 (‘Mobile Health Intervention to Improve Perinatal Continuum of Care in Guatemala’).; LS acknowledges the support of the RCUK Digital Economy Programme, grant number EP/G036861/1 (Oxford Centre for Doctoral Training in Healthcare Innovation).; The building of the Jena Fetal Monitoring Data Base was furthermore supported by ‘Biomagnetic investigations of fetal autonomic and central nervous maturation and its disturbances due to intrauterine growth restriction and glucocorticoide administration (DFG: Ho 1634/12–2, Schn 775/2–3)’ and ‘Prenatal diagnosis-Indices of fetal developmental disturbances enabled by advanced signal identification techniques’ (Marie Curie Intra-European Fellowship, Proposal No 237290).
• Keywords: COMPUTERIZED ANALYSIS; fetal development; nonlinear signal analysis; RECURRENCE PLOTS; NONLINEAR PARAMETERS; prenatal diagnosis; Physiology; CTG; Biophysics; Engineering, Biomedical; NORMAL-PREGNANCY; BEHAVIORAL STATES; Technology; HEART-RATE-VARIABILITY; INTRAUTERINE GROWTH RESTRICTION; SYMBOLIC DYNAMICS; autonomic nervous system; MCG; Life Sciences & Biomedicine; ECG EXTRACTION; ECG; RATE PATTERNS; Engineering; heart rate variability; Science & Technology; functional autonomic brain age score; fABAS
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Human Development; Biology, Neuroscience

Abstract

Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.