A Hierarchy of Cell Intrinsic and Target-Derived Homeostatic Signaling Available online at: http://www.ncbi.nlm.nih.gov/books/NBK470566/ (accessed February 22, 2021). Whereas, in the previous section we described the fetal development in relation to ANS maturation, showing potential short-term and long-term alteration in case something should negatively affect pregnancy or labor, this section will now detail what factors can alter ANS development and in which ways. ArXiv200108264 Q-Bio. (2020). 20, 106118. 56, 3539. [Low back pain during pregnancy. Birt. Rev. 38, 5666. 99, 712. The effect of lumbar epidural anesthesia on fetal heart rate baseline variability. 111, 201231. Table 1. Hebbian and homeostatic synaptic plasticity - Wiley Online Library Rev. Should one of them be damaged, the other one alone could not regulate the body's homeostasis efficiently anymore. Am. ACOG Practice Bulletin No. J. Perinat. Auton. 22, 337358. Autonomic responses to sighs in healthy infants and in victims of sudden infant death. Therefore, it would be worth it to improve fetal cardiac monitoring technology in order to detect ECG and fHRV even in the first weeks of pregnancy. 188, 524531. Hypotheses 67, 614. Smith J, Wells L, Dodd K. The continuing fall in incidence of hypoxic-ischaemic encephalopathy in term infants. doi: 10.1016/j.psyneuen.2005.04.014, Thome, J., Densmore, M., Frewen, P. A., McKinnon, M. C., Thberge, J., Nicholson, A. doi: 10.1016/j.ntt.2010.09.003, Jarczok, M. N., Aguilar-Raab, C., Koenig, J., Kaess, M., Borniger, J. C., Nelson, R. J., et al. Therapeutic potential of vagus nerve stimulation for inflammatory bowel diseases. doi: 10.1109/CIC.2000.898490, Ho, J. J., Subramaniam, P., and Davis, P. G. (2020). Acta Obstet. We show that deletion of insulin-like growth factor-1 receptor (IGF-1R) limits firing rate homeostasis in response . J. Perinatol. J. Obstet. doi: 10.1016/j.sleep.2014.12.006, Mirmiran, M., Maas, Y. G. H., and Ariagno, R. L. (2003). Therefore, dysregulation of sympathetic control . NeoReviews 15, e537e545. Its dominance results in what effect to the FHR baseline? Gynecol. Am. doi: 10.1007/BF03009602, Prince, A. L., Ma, J., Kannan, P. S., Alvarez, M., Gisslen, T., Harris, R. A., et al. Can we learn to assess this individual experience? 4, 167170. Res. doi: 10.1016/B978-0-12-809468-6.00031-0, Prechtl, H. F. (1990). Placental microbiome and its role in preterm birth. Obstet. As a result, several motor and neuroendocrine responses are induced: for instance, gastrointestinal and anabolic hormones such as cholecystokinin, insulin, and insulin-like growth factor-1 are released. 89, 13761380. Environ. Vagal NC cells then give rise to the parasympathetic, sympathetic, and sensory ganglia (Hutchins et al., 2018; Simkin et al., 2019; Fedele and Brand, 2020). This paper will also focus on which factorsi.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposuremay affect the development of the vagus. Neurosci. It is also in common use during the peripartum period to administer the mother antibiotic prophylaxis. Gynecol. doi: 10.1093/jn/131.2.581S, Almadhoob, A., and Ohlsson, A. doi: 10.1097/00063198-200311000-00005, Sanghavi, M., and Rutherford, J. D. (2014). Cholinergic anti-inflammatory pathway also plays a very important role in preventing and ameliorating NEC cases (Garzoni et al., 2013). 2:CD006066. Fetal compensation or decompensation is a function of all of these factors. Neurologic injury in acidemic term infants. However, the literature shows that the ANS can be assessed through fHRV from 15 to 20 WGA (Hoyer et al., 2012, 2013b, 2015, 2019; Shuffrey et al., 2019). The medulla oblongata also contains the vasomotor center that regulates peripheral blood vessel dilation and constriction to help maintain normal blood pressure and distribute blood to vital organs. Res. Nurs. Gynecol. Delayed cord clamping in healthy term infants: more harm or good? Human fetal lungs harbor a microbiome signature. Res. As the ANS is controlled by several brain areas (e.g., amygdala, hypothalamus, insula, cingulate cortex, and several brainstem nuclei) that constitute the central autonomic network (CAN), paying attention to their development is fundamental for studying the fetal ANS. Sleep and prematurity: sleep outcomes in preterm children and influencing factors. Argent. A short review of adipokines, smooth muscle and uterine contractility. 1252, 1724. (1995). Physiol. Regarding the vagus nerve, at this stage, the dorsal motor nucleus is the predominantly active effector center (Porges, 2011). doi: 10.1111/1471-0528.12371, Lee, K. A., and Gay, C. L. (2004). doi: 10.3390/nu7032001, Stphan-Blanchard, E., Chardon, K., Lk, A., Delanaud, S., Bach, V., and Telliez, F. (2013). J. Clin. Mapping the immunological homunculus. Assessment of fetal development using cardiac valve intervals. Pasupathy D, Wood AM, Pell JP, Fleming M, Smith GC. Immunol. doi: 10.4274/tjod.galenos.2019.59932. Gynecol. Gynecol. J. Obstet. Physiol. 301, 405414. Gynecol. Prenatal opioid exposure: neurodevelopmental consequences and future research priorities. Other work by Bennet et al has also challenged common teaching about the relationship between hypertension and decelerations. Furthermore, some studies have already shown the feasibility of correlating external factors related to maternal lifestyle or internal factors such as FM to fHRV changes as early as 2028 WGA (DiPietro et al., 2007; Hoyer et al., 2019; Shuffrey et al., 2019). A., Thorp, J. Then, as gestation progresses, the amount of movement, both spontaneous and in response to vibroacoustic stimuli, gradually increases: indeed, mothers begin to feel their babies' movements (Moore et al., 2016; Borsani et al., 2019). (2014). This increases the flow of deoxygenated blood to your heart and body, including your uterus and placenta. In the next weeks, the nervous system rapidly grows: the five secondary brain vesicles, along with the four ventricles and the meninges form, while the glioblasts (the glial cells precursors) start to differentiate and migrate throughout the developing nervous system. Gynecol. (2017). doi: 10.1289/ehp.99107475, Derbyshire, S. W., and Bockmann, J. C. (2020). (2015). Both the baroreflex and the chemoreflex have parasympathetic efferents in the vagus nerve. (2020). 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). doi: 10.1176/appi.ajp.2007.06071172, Tan, C. M. J., and Lewandowski, A. J. 41, 323. (2019). Gynecol. Field DR, Parer JT, Auslender R, Baker BW, Ross BK, Leicht CH. 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. Psychol. Early Hum. J. Physiol. doi: 10.1016/j.earlhumdev.2018.07.003, Mller, F., and O'Rahilly, R. (1989). (2019). (2021a). Figure 3: Two proposed pathways with late decelerations, adapted from Freeman et al. (2013). It is noteworthy that earmuffs show ambiguous results, that is, they can both help oxygenation and sleep and provoke stress (Zahr and de Traversay, 1995; Aita et al., 2013; Almadhoob and Ohlsson, 2020). Classic teaching on the mechanisms of variable decelerations is outlined in Figure 2. Drugs to Support Fetal Growth Synthetic glucocorticoids (sGCs) are the therapy of choice to support fetal maturation for the risk of preterm delivery. The nadir of the deceleration was very close to the end of the compression period in both groups. 140, 702706. Its dominance results in what effect to the FHR baseline? doi: 10.1038/s41390-021-01460-3, Ray-Griffith, S. L., Wendel, M. P., Stowe, Z. N., and Magann, E. F. (2018). Despite the fact that there are contrasting results about the sensitivity of fetal activity reported by the mother (Sorokin et al., 1982; Schmidt et al., 1984), it appears that there is an association between the increase of force and frequency of perceived movements and a reduced risk of stillbirth and negative outcomes (Heazell et al., 2018). Reducing cardioinhibitory activity increases heart rate. Oxytocin increases autonomic cardiac control: moderation by loneliness. 63, 281287. The persistent exposure to photic stimuli or high noise during pregnancy, for instance, due to the mother's occupation, seems to correlate with reduced fetal growth (Selander et al., 2019), increased incidence of congenital heart diseases (Gong et al., 2017), impaired development of cortical areas (Zhang et al., 1992; Wilson et al., 2008), and potential disruption of the vagus nerve maturation. BJOG Int. An important factor that is present in several cases of labor is epidural analgesia (Bautista and George, 2020). A., Tsai, A. S., Ghaemi, M. S., Han, X., Ando, K., et al. Is less noise, light and parental/caregiver stress in the neonatal intensive care unit better for neonates? Two powerful and fundamentally different forms of plasticity involved in this process are Hebbian mechanisms, which alter synaptic connectivity in a synapse-specific manner, and homeostatic mechanisms that maintain stable function by globally adjusting overall synaptic weights and neuronal excitability. In this model hypertension followed by baroreceptor response were proposed as the key steps stimulating the cardioinhibitory center and causing slowing of the heart rate mediated via the vagus. Psychol. Microbiome of the placenta in pre-eclampsia supports the role of bacteria in the multifactorial cause of pre-eclampsia. (2018). Tracking placental development in health and disease. 14:561186. doi: 10.3389/fnins.2020.561186, Christian, P., and Stewart, C. P. (2010). Usually, any process that causes the following conditions is capable of inducing late decelerations: Two of the most common late deceleration causes include an overactive uterus and hypotension due to epidural analgesia. Changing patterns of birth asphyxia and trauma over 20 years. If born prematurely, newborns lose the low-frequency maternal sounds that are essential for the correct maturation of their hearing system, with negative consequences on brain maturation and speech development (McMahon et al., 2012). 32, 16851695. which intrinsic homeostatic response is the fetus demonstrating This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Anatomy and Physiology. Curr. 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). Fetal Neonatal Med. One of many unusual FHR patterns observed during labor, late decelerations could be considered dangerous. In animal studies, Martin demonstrated that in sheep the initial fetal heart rate response to sudden hypoxemia was a slowing of the heart rate with increased variability.12 Others observed similar changes in sheep and in monkeys.31-33 Field et al found initial decreases in heart rate variability with iliac occlusion in sheep, but variability returned to normal by 36 minutes despite worsening metabolic acidosis.34 These observations of normal variability in the face of acidemia led researchers to postulate that some aspect of variability control could be different in animals compared to humans. However, when late decels occur in more than 50 percent of the contractions of your uterus, then fetal hypoxia is a plausible explanation. 14:887. doi: 10.3389/fnins.2020.00887, Chang, J. J., Pien, G. W., Duntley, S. P., and Macones, G. A. 212, 653.e1653.e16. Defects Res. Even if the light-dark cycle does not seem to significantly affect the fetal circadian rhythm, there are age-dependent fHRV patterns after transabdominal fetal stimulation with halogen light, similarly to the VAS (Peleg and Goldman, 1980), which seem increasingly definite in the later stages of pregnancy, when the fetal optic pathways and ANS control on the cardiac activity reach maturity (Thanaboonyawat et al., 2006). Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review. The effect of augmentation of labour with syntocinon on the fetal CTG using objective computerised analysis: a nested case-control study. Publ. J Dev Physiol. Maternal inflammation disrupts fetal neurodevelopment via increased placental output of serotonin to the fetal brain. Scand. In particular, the subplate (a central hub for cortical connectivity) becomes visible and begins to receive connection from the thalamus, basal forebrain, and brainstem. Full-time exposure to occupational noise during pregnancy was associated with reduced birth weight in a nationwide cohort study of Swedish women. Area postrema undergoes dynamic postnatal changes in mice and humans: dynamic postnatal changes of area postrema. . In fact, the brain, through the CAN, controls the sympathetic and parasympathetic preganglionic motoneurons and regulates the activity of the vagus nerve (Benarroch, 1993). (2009). It also responds to baroreceptors, chemoreceptors and catecholamines. 2008 Aug;32(4):239-42. doi: 10.1111/j.1749-6632.1998.tb09547.x, Wilson, J. D., Adams, A. J., Murphy, P., Eswaran, H., and Preissl, H. (2008). J. Physiol. The Heart's rhythm n blues: sex differences in circadian variation patterns of vagal activity vary by depressive symptoms in predominantly healthy employees. Am J Obstet Gynecol. (2013). Ann. Sameshima H, Ikenoue T, Ikeda T, Kamitomo M, Ibara S. Unselected low-risk pregnancies and the effect of continuous intrapartum fetal heart rate monitoring on umbilical blood gases and cerebral palsy. B., de Waard, M., et al. doi: 10.1523/JNEUROSCI.09-05-01764.1989, Tsuda, K., Iwata, S., Mukai, T., Shibasaki, J., Takeuchi, A., Ioroi, T., et al. (2015). Orig. Int. 1, 1724. Although CS delivery is far faster than a vaginal birth modality, the fetus is still subjected to significant stress that can create changes in the development of some systems, including the ANS (Tribe et al., 2018). The effects of prenatal alcohol exposure (PAE) on fetuses are collectively known as fetal alcohol spectrum disorders (FASD). doi: 10.1038/s41390-019-0309-8, Noben, L., Verdurmen, K. M. J., Warmerdam, G. J. J., Vullings, R., Oei, S. G., and van Laar, J. O. E. H. (2019). Ikenoue T, Martin CB Jr, Murata Y, Ettinger BB, Lu PS. Sci. 25, 236247. Newborns can also be subject to EMFs, from the incubator or the care unit environment. (2021). Indeed, at 32 WGA the cerebral cortex resembles the adult one and, in the next week, synchronicity between the hemispheres develops, as well as complex connections among several brain areas and networks (Moore et al., 2016; Borsani et al., 2019).

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