Lynn J. Groome

Maternal Anxiety During Pregnancy: Effect on Fetal Behavior at 38 to 40 Weeks of Gestation

The purpose of this study was to determine if there is a relationship between fetal behavior and maternal anxiety during pregnancy. The study population consisted of 18 uncomplicated human pregnancies at 38 to 40 weeks gestation. Maternal anxiety was assessed one time using Spielbergers State-Trait Anxiety Inventory. After an overnight fast, each mother was given a standard meal on arrival to the fetal testing unit. Each fetus was examined for 4 hours using heart rate monitoring and real-time sonography. Fetal behavioral states were assigned based on heart rate pattern and the presence or absence of eye and gross body movements. We found that, compared with fetuses of mothers with low trait anxiety scores, fetuses of mothers with relatively high trait anxiety scores spent significantly more time in quiet sleep and exhibited less gross body movement when in active sleep. The results of this pilot study raise the possibility that maternal anxiety during pregnancy may have a significant effect on fetal behavior.

Pneumonia as a Complication of Pregnancy

Objective: To identify risk factors for the development of antepartum pneumonia and to describe maternal and perinatal outcome in pregnant women with pneumonia.Methods: The study group consisted of 59 women with antepartum pneumonia. Pneumonia was defined by the presence of lower respiratory tract symptoms, radiographic findings, no other source of infection, and at least two of the following: oral temperature ≥38°C, white blood cell count ≥15,000/ml, auscultatory findings, and/or positive sputum cultures. For comparison, a control group (n = 118) of pregnant women was formed by selecting the first mother who delivered immediately before and after an index study subject.Results: Mothers in the study group were significantly more likely than women in the control group to have either a history of asthma (P = 0.022) or an admission hematocrit ≥30% (P < 0.001). Women with pneumonia were also more likely to receive a tocolytic agent (P < 0.001) and/or beta-methasone to enhance fetal lung maturity (P < 0.001). ...

Spectral analysis of heart rate variability during quiet sleep in normal human fetuses between 36 and 40 weeks of gestation.

Respiratory sinus arrhythmia (RSA) is a clinical manifestation of the parasympathetic nervous system which can be identified in the high-frequency region of the heart rate variability (HRV) power spectrum. The purpose of this study was to determine the relative contribution of RSA to overall HRV for human fetuses in quiet sleep. The study population consisted of 13 normal human fetuses between 36 and 40 weeks of gestation for whom data were collected during spontaneous breathing and normally occurring apneic periods. Fetal breathing was monitored continuously using real-time sonography. The fetal electrocardiogram was captured transabdominally in 3-min blocks at a rate of 833 Hz and fetal R-waves were extracted from the raw signal using adaptive signal processing techniques. Fetal behavioral state was determined at the beginning and end of each 3-min data collection period. The fetal R-wave interbeat intervals (IBIs) were converted to equally-spaced, time-based data, and linear detrending of the time series was accomplished by subtracting the mean heart period from each weighted IBI. Total power (TP, 0.0-2.5 Hz) was divided into RSA (0.4-1.0 Hz), high-frequency (HF, 0.2-2.5 Hz), low-frequency (LF, 0.04-0.2 Hz), and very-low-frequency (VLF, 0.0-0.04 Hz) regions, and the power densities were summed to determine the absolute power for each frequency component. A total of 81 3-min blocks (mean per subject 6.3, range 2-14) were available for analysis. Eleven (85%) of 13 fetuses demonstrated a HF peak during fetal breathing, and RSA accounted for approximately 20% of the TP.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous motor activity in the perinatal infant before and after birth: Stability in individual differences

This study was undertaken to determine if a relationship existed between the duration of spontaneous general movements before and after birth. Twenty-two infants were examined three times as fetuses between 38 and 40 weeks gestational age and three times as neonates between 2 and 4 weeks postnatal age. Motor activity level during active sleep periods was quantified by direct sonographic visualization for fetuses and by videotaped images of trunk movement for neonates. We found that both fetuses and neonates exhibited stable individual differences in motor activity level. In addition, infants who moved at a certain rate as fetuses generally moved at the same relative rate as neonates up to 4-weeks postnatal age. Our findings suggested that individual differences in motor activity level in the 1st month following birth probably arise during fetal life.

Behavioral state affects heart rate response to low-intensity sound in human fetuses

The cardiac orienting reflex is elicited by a low-intensity sound, it consists of a sustained heart rate (HR) deceleration, and it is a specific physiological correlate of cognitive processing. In this study we examined the relationship between behavioral state and the cardiac orienting reflex in 75 human fetuses between 36 and 40 weeks gestation. Each fetus was stimulated with a 30-s speech sound at an average intensity of 83 dB SPL in quiet sleep (QS) and active sleep (AS). The fetal cardiac electrical signal was captured transabdominally at a rate of 1024 Hz and fetal R-waves were extracted using adaptive signal processing. Fetal behavioral states were assigned based on HR pattern and the presence or absence of eye and general body movements. We found that a significant HR deceleration occurred, in both QS and AS, following stimulus onset. However, HR decelerations occurred more often in QS than AS; and for fetuses exhibiting a HR deceleration, the magnitude of the deceleration was greater in AS compared to QS. In addition, in AS female fetuses exhibited a larger, more sustained HR deceleratory response than male fetuses, but the seconds x gender interaction in QS was not significant. Based on these results, we concluded that behavioral state is an important determinant of the HR deceleratory response in human fetuses.

High vagal tone is associated with more efficient regulation of homeostasis in low‐risk human fetuses

Homeostasis is maintained primarily by the parasympathetic nervous system and is thought to provide a physiological substrate for the development of complex behaviors. This investigation was undertaken to test the hypothesis that infants with high parasympathetic tone are more efficient regulators of homeostasis than infants with low parasympathetic tone. Respiratory sinus arrhythmia (RSA) was used as a measure of parasympathetic tone, and the efficiency of homeostatic control was quantified, for each infant, by the slope (SRSA) and correlation coefficient (RRSA) of the regression line relating fluctuations in heart period and fluctuations in RSA. To test our hypothesis, we examined the relationship between RSA and both SRSA and RRSA in 34 low-risk human fetuses between 36 and 40 weeks gestation. We found that fetuses who were parasympathetic-dominated had larger SRSA and RRSA values, and hence were more efficient regulators of homeostasis, than fetuses who were sympathetic-dominated. The results of our analyses are important because they establish, very early in development, a physiological basis for the relationship between vagal tone and the development of complex behaviors.

Increased Neutrophil Numbers Account for Leukocytosis in Women with Preeclampsia

We evaluated the leukocyte differentials in women with normal pregnancies and in pregnancies complicated by preeclampsia (PE). A retrospective study was performed in 240 women who were delivered at Louisiana State University Health Sciences Center-Shreveport, Louisiana, from January 1, 2002, to July 31, 2003. A total of 80 patients were studied in each group: normal pregnancy, mild PE, or severe PE. Leukocyte total and neutrophil, lymphocyte, monocyte, eosinophil, basophil, hemoglobin, and platelet counts were analyzed by analysis of variance and pairwise comparison. Data are presented as mean +/- standard deviation. A P value <0.05 was set as statistically different. The total leukocyte count was significantly increased in women with severe PE compared with women with mild PE and normal pregnant controls: 10.66 +/- 3.70 ( P < 0.0001) versus 9.47 +/- 2.59 and 8.55 +/- 1.93 (1 x 10 (3)/microL), respectively. The increased total leukocyte count was mainly due to the increase in neutrophil numbers: 8.05 +/- 4.01 (severe; P < 0.0001) versus 6.69 +/- 2.23 (mild) and 5.90 +/- 1.79 (controls), respectively. The total neutrophil count was further increased 48 hours after delivery in the group with severe PE. No statistical differences for monocyte and lymphocyte counts were observed between normal and PE groups. Increased neutrophil numbers account for the leukocytosis in women with PE.

Temporal pattern and spectral complexity as stimulus parameters for eliciting a cardiacorienting reflex inhuman fetuses

The purpose of this study was to determine whether temporal pattern and/or spectral complexity were important stimulus parameters for eliciting a cardiac orienting reflex (OR) in low-risk human fetuses. Each of 28 term fetuses was exposed to four sounds formed from the four different combinations of temporal pattern (pulsed, continuous) and spectral complexity (sine wave, IsJ). The fetal cardiac electrical signal was captured transabdominally at a rate of 1024 Hz, and fetal R-waves were extracted by using adaptive signal-processing techniques. We found that pulsed sounds elicited a significantly greater decrease in heart rate (HR) than did continuous sounds. However, the HR response was relatively unaffected by spectral complexity. For the pure tone and the phoneme used in this study, our results indicate that temporal characteristics were more effective at eliciting a cardiac OR in human fetuses than was spectral complexity.

Elevated Maternal Soluble Gp130 and IL-6 Levels and Reduced Gp130 and SOCS-3 Expressions in Women Complicated With Preeclampsia

Increased inflammatory response plays a significant role in the vascular pathophysiology in preeclampsia. However, the mechanism for increased inflammatory response in preeclampsia is largely unknown. Interleukin (IL)-6 levels are elevated in women with preeclampsia. IL-6 and its receptors, IL-6R and glycoprotein (gp)130, play a critical role in mediating antiinflammatory response via induction of SOCS-3 (suppressor of cytokine signaling-3). However, IL-6 receptor levels and expressions have not been studied in preeclampsia. In this study, we measured IL-6 and its 2 soluble receptors, soluble IL-6R and soluble gp130, in maternal plasma from normal and preeclamptic pregnant women and found that not only IL-6 but also soluble gp130 levels were significantly higher in preeclamptic women than in normotensive pregnant controls. We further examined IL-6R, gp130, and SOCS-3 expressions in maternal vessels and leukocytes and found that gp130 and SOCS-3 expressions were downregulated in both vessel endothelium and leukocytes from preeclampsia. Different patterns for IL-6R and gp130 expressions were found. IL-6R expression was also downregulated in leukocytes from preeclampsia. Our results suggest that increased plasma soluble gp130/soluble IL-6R/IL-6 ratio and reduced membrane transsignaling gp130 expression could contribute to decreased SOCS-3 expression and subsequent reduction in SOCS-3 antiinflammatory activity in women with preeclampsia. Thus, reduced gp130 and SOCS-3 expressions may offer, at least in part, a plausible explanation of reduced antiinflammatory protection in the maternal vascular system in preeclampsia.

The heart rate deceleratory response in low-risk human fetuses: effect of stimulus intensity on response topography.

The purpose of this study was to determine the effect of stimulus intensity on heart rate response in 18 low-risk human fetuses between 37 and 40 weeks gestation. Each fetus was stimulated in quiet sleep with a 30-s voice sound at intensities of 80 dB and 90 dB. The fetal cardiac electrical signal was captured transabdominally at a rate of 1024 Hz and fetal R-waves were extracted using adaptive signal-processing techniques. We found that fetuses generally exhibited a 5- to 10-s decrease in heart rate following stimulus onset at an intensity of 80 dB. The response pattern changed from deceleratory to acceleratory when stimulus intensity was increased to 90 dB. Our findings suggest that a heart rate deceleration at low-stimulus intensity may be a component of the orienting reflex in the human fetus.