Measurement of baroreceptor-mediated effects on heart rate variability in fetal sheep

A Fluorescent Probe for the Detection of γ‐Glutamyl Transpeptidase Activity and its Application in Garlic

A fluorescent probe (probe 1) was developed for detection the activity of γ‐glutamyl transpeptidase (GGT). Probe 1 could recognize GGT by the enzymatic hydrolysis of peptide bond by GGT. There has a linear relationship between the fluorescence intensity of probe 1 at 416 nm and the activity of GGT, and the detection limit of GGT activity was 0.0796 U/mL. And the color of the probe solution gradually changed from light blue to bright yellow with the increase of GGT activity under 365 nm ultraviolet light. Importantly, the activity of GGT was linearly related to the photo of the probe solution with B/(R+G) value. Probe 1 could detect GGT activity by smartphone without professional equipment. Furthermore, the probe has been successfully applied to detect of GGT activity in garlic.

Impact of in vitro embryo culture and transfer on blood pressure regulation in the adolescent lamb

Nutrition during the periconceptional period influences postnatal cardiovascular health. We determined whether in vitro embryo culture and transfer, which are manipulations of the nutritional environment during the periconceptional period, dysregulate postnatal blood pressure and blood pressure regulatory mechanisms. Embryos were either transferred to an intermediate recipient ewe (ET) or cultured in vitro in the absence (IVC) or presence of human serum (IVCHS) and a methyl donor (IVCHS+M) for 6 days. Basal blood pressure was recorded at 19-20 weeks after birth. Mean arterial pressure (MAP) and heart rate (HR) were measured before and after varying doses of phenylephrine (PE). mRNA expression of signaling molecules involved in blood pressure regulation was measured in the renal artery. Basal MAP did not differ between groups. Baroreflex sensitivity, set point, and upper plateau were also maintained in all groups after PE stimulation. Adrenergic receptors alpha-1A (αAR1A), alpha-1B (αAR1B), and angiotensin II receptor type 1 (AT1R) mRNA expression were not different from controls in the renal artery. These results suggest there is no programmed effect of ET or IVC on basal blood pressure or the baroreflex control mechanisms in adolescence, but future studies are required to determine the impact of ET and IVC on these mechanisms later in the life course when developmental programming effects may be unmasked by age.

Altered autonomic control of heart rate variability in the chronically hypoxic fetus

KEY POINTS

Fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, and a decrease in FHRV is associated with fetal compromise. However, the mechanisms by which FHRV is reduced in the chronically hypoxic fetus have yet to be established. The sympathetic and parasympathetic influences on heart rate mature at different rates throughout fetal life, and can be assessed by time domain and power spectral analysis of FHRV. In this study of chronically instrumented fetal sheep in late gestation, we analysed FHRV daily over a 16 day period towards term, and compared changes between fetuses of control and chronically hypoxic pregnancy. We show that FHRV in sheep is reduced by chronic hypoxia, predominantly due to dysregulation of the sympathetic control of the fetal heart rate. This presents a potential mechanism by which a reduction in indices of FHRV predicts fetuses at increased risk of neonatal morbidity and mortality in humans. Reduction in overall FHRV may therefore provide a biomarker that autonomic dysregulation of fetal heart rate control has taken place in a fetus where uteroplacental dysfunction is suspected.

ABSTRACT

Although fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, the mechanisms by which it is reduced in the chronically hypoxic fetus have yet to be established. In particular, the physiological mechanism underlying the reduction of short term variation (STV) in fetal compromise remains unclear. In this study, we present a longitudinal study of the development of autonomic control of FHRV, assessed by indirect indices, time domain and power spectral analysis, in normoxic and chronically hypoxic, chronically catheterised, singleton fetal sheep over the last third of gestation. We used isobaric chambers able to maintain pregnant sheep for prolonged periods in hypoxic conditions (stable fetal femoral arterial P O 2 10-12 mmHg), and a customised wireless data acquisition system to record beat-to-beat variation in the fetal heart rate. We determined in vivo longitudinal changes in overall FHRV and the sympathetic and parasympathetic contribution to FHRV in hypoxic (n = 6) and normoxic (n = 6) ovine fetuses with advancing gestational age. Normoxic fetuses show gestational age-related increases in overall indices of FHRV, and in the sympathetic nervous system contribution to FHRV (P < 0.001). Conversely, gestational age-related increases in overall FHRV were impaired by exposure to chronic hypoxia, and there was evidence of suppression of the sympathetic nervous system control of FHRV after 72 h of exposure to hypoxia (P < 0.001). This demonstrates that exposure to late gestation isolated chronic fetal hypoxia has the potential to alter the development of the autonomic nervous system control of FHRV in sheep. This presents a potential mechanism by which a reduction in indices of FHRV in human fetuses affected by uteroplacental dysfunction can predict fetuses at increased risk.

Endogenous angiotensins and catecholamines do not reduce skin blood flow or prevent hypotension in preterm piglets

Endocrine control of cardiovascular function is probably immature in the preterm infant; thus, it may contribute to the relative ineffectiveness of current adrenergic treatments for preterm cardiovascular compromise. This study aimed to determine the cardiovascular and hormonal responses to stress in the preterm piglet. Piglets were delivered by cesarean section either preterm (97 of 115 days) or at term (113 days). An additional group of preterm piglets received maternal glucocorticoids as used clinically. Piglets were sedated and underwent hypoxia (4% FiO₂ for 20 min) to stimulate a cardiovascular response. Arterial blood pressure, skin blood flow, heart rate and plasma levels of epinephrine, norepinephrine, angiotensin II (Ang II), angiotensin‐(1–7) (Ang‐(1‐7)), and cortisol were measured. Term piglets responded to hypoxia with vasoconstriction; preterm piglets had a lesser response. Preterm piglets had lower blood pressures throughout, with a delayed blood pressure response to the hypoxic stress compared with term piglets. This immature response occurred despite similar high levels of circulating catecholamines, and higher levels of Ang II compared with term animals. Prenatal exposure to glucocorticoids increased the ratio of Ang‐(1‐7):Ang II. Preterm piglets, in contrast to term piglets, had no increase in cortisol levels in response to hypoxia. Preterm piglets have immature physiological responses to a hypoxic stress but no deficit of circulating catecholamines. Reduced vasoconstriction in preterm piglets could result from vasodilator actions of Ang II. In glucocorticoid exposed preterm piglets, further inhibition of vasoconstriction may occur because of an increased conversion of Ang II to Ang‐(1‐7).

This study aimed to determine if immature hormonal control of the cardiovascular system contributes to preterm cardiovascular compromise. Physiological and hormonal responses of preterm piglets to hypoxia are immature compared with term piglets. This is not due to a lack of endogenous catecholamines or angiotensin II, but may be due to the differences in cardiovascular actions of the renin–angiotensin system.

Validation of spontaneous assessment of baroreceptor reflex sensitivity and its relation to heart rate variability in the ovine fetus pre- and near-term

Assessment of baroreceptor reflex sensitivity (BRS) in the ovine fetus provides insight into autonomic cardiovascular regulation. Currently, assessment of BRS relies on vasoactive drugs, but this approach is limited by feasibility issues and by the nonphysiologic nature of the stimulus. Thus we aimed to validate the method of spontaneous BRS assessment against the reference method of using vasoactive drugs in preterm (0.76 gestation, n = 16) and near-term (0.86 gestation, n = 16) chronically instrumented ovine fetuses. The BRS measures derived from the spontaneous and reference methods correlated at both gestational ages (R = 0.67 ± 0.03). The sequence method of spontaneous BRS measures also correlated both to the root mean square of standard deviations (RMSSD), which is a measure of fetal heart rate variability reflecting vagal modulation (R = 0.69 ± 0.03), and to fetal body weight (R = 0.65 ± 0.03), which is a surrogate for growth trajectory of each fetus. The methodology presented may aid in developing new models to study BRS and cardiovascular control in ovine fetus in the last trimester of pregnancy.

Nonlinear properties of vagal and sympathetic modulations of heart rate variability in ovine fetus near term

Fetal heart rate (FHR) monitoring is commonly used although clinical studies questioned its diagnostic value. Sophisticated FHR variability (fHRV) measures such as fHRV complexity may improve the sensitivity and specificity of FHR monitoring. A more detailed understanding of the physiology underlying fHRV complexity is essential to harness its use for monitoring fetal health. To examine the specific effects of vagal and sympathetic modulations on fHRV complexity, we blocked vagal activity with atropine and sympathetic activity with propranolol in near-term fetal sheep ( n = 7, 0.85 gestation). Under these conditions, we analyzed the linear and nonlinear parts of fHRV complexity from autonomic information flow. Overall fHRV complexity decreased with both drugs compared with nonrapid eye movement sleep baseline ( P < 0.05). With atropine, this was because of a decrease of the linear part of fHRV complexity on the long-term time scale ( P < 0.05), suggesting that vagal modulation of fHRV is adequately described by linear fHRV measures. With propranolol, the nonlinear part of fHRV complexity decreased on the short-term time scale ( P < 0.05), suggesting that sympathetic influences on fHRV can be detected by the nonlinear part of fHRV complexity. Thus the complex interplay of vagal and sympathetic modulations of fHRV is reflected differently and specifically in the linear and nonlinear properties of fHRV complexity, and on different time scales. Analysis of linear and nonlinear properties of fHRV may improve sensitivity and specificity of FHR monitoring.

Is baroreflex control of sympathetic activity and heart rate active in the preterm fetal sheep?

The arterial baroreflex is a fundamental reflex that buffers rapid changes in arterial blood pressure (BP) via regulation of the heart rate and sympathetic nerve activity to the vasculature. In adults a sigmoidal relationship between BP and both heart rate and sympathetic nerve activity is well documented. Its role in blood pressure control before birth is unclear. Preterm babies have a high incidence of low BP, especially in the first few days of life, which could be related, in part, to immaturity of the baroreflex. In the present study, we investigated the baroreflex control of fetal heart rate and renal sympathetic nerve activity (RSNA) in preterm fetal sheep in utero (102 ± 1 days of gestation; term 140 days). Phenylephrine was associated with a significant increase in BP from 38 ± 2 to 58 ± 3 mmHg and a decrease in heart rate (HR) from 177 ± 4 to 116 ± 8 beats per minute (bpm). Sodium nitroprusside was associated with a significant fall in BP from 38 ± 2 to 26 ± 1 mmHg and an increase in HR from 182 ± 4 to 274 ± 8 bpm. However, the time between the 50% changes in BP and HR was significantly greater after hypotension than hypertension (31 ± 8 s vs. 14 ± 5 s, P < 0.05). No significant changes in RSNA occurred with either stimulus. This suggests that there are different maturational tempos for the components of the central autonomic response to altered blood pressure.

Heart rate variability analysis allows early asphyxia detection in ovine fetus

Fetal heart rate (FHR) monitoring is commonly used to predict asphyxia but clinical and experimental studies have questioned its diagnostic value. We examined the usefulness of fetal heart rate variability (fHRV) measures in detecting early asphyxia using chronically instrumented fetal sheep under normoxic (n = 6) and asphyxic conditions (3 umbilical cord occlusions, n = 6). The occlusions consistently led to pH decreases from 7.35 +/- 0.01 to 7.09 +/- 0.03 ( P < .05). FHR showed biphasic deceleration during each occlusion, associated with increasing arterial blood pressure ( P < .05). RMSSD, an index of vagal modulation of fHRV, increased consistently during repeated occlusion induced FHR decelerations ( P < .05). Under normoxic conditions, RMSSD did not change during FHR decelerations and decreased during FHR accelerations ( P < .05). Our results suggest that an increase of RMSSD in association with FHR decelerations reflects initial vagal activation during fetal asphyxia. RMSSD may accurately identify asphyxic fetuses early. Clinical validation is needed.

Fetal body weight and the development of the control of the cardiovascular system in fetal sheep

Reduced birth weight predisposes to cardiovascular diseases in later life. We examined in fetal sheep at 0.76 (n = 18) and 0.87 (n = 17) gestation whether spontaneously occurring variations in fetal weight affect maturation of autonomic control of cardiovascular function. Fetal weights at both gestational ages were grouped statistically in low (LW) and normal weights (NW) (P < 0.01). LW fetuses were within the normal weight span showing minor growth dysproportionality at 0.76 gestation favouring heart and brain, with a primary growth of carcass between 0.76 and 0.87 gestation (P < 0.05). While twins largely contributed to LW fetuses, weight differences between singletons and twins were absent at 0.76 and modest at 0.87 gestation, underscoring the fact that twins belong to normality in fetal sheep not constituting a major malnutritive condition. Mean fetal blood pressure (FBP) of all fetuses was negatively correlated to fetal weight at 0.76 but not 0.87 gestation (P < 0.05). At this age, FBP and baroreceptor reflex sensitivity were increased in LW fetuses (P < 0.05), suggesting increased sympathetic activity and immaturity of circulatory control. Development of vagal modulation of fetal heart rate depended on fetal weight (P < 0.01). These functional associations were largely independent of twin pregnancies. We conclude, low fetal weight within the normal weight span is accompanied by a different trajectory of development of sympathetic blood pressure and vagal heart rate control. This may contribute to the development of elevated blood pressure in later life. Examination of the underlying mechanisms and consequences may contribute to the understanding of programming of cardiovascular diseases.

Different etiologies of intrauterine growth restriction and different consistencies in the occurrence of abnormal local nonstationarity of fetal heart rate

Fetuses with intrauterine growth restriction (IUGR) can be programmed in utero to develop hypertension in adult life. The etiology of IUGR in human fetuses is not uniform. The present study demonstrated that different etiologies of growth restriction, idiopathic cause, and pregnancy-induced hypertension, produce different consistencies in the occurrence of an abnormal local very-short-term nonstationarity of heart rate during intrauterine period. Whether the consistent abnormality that was found in the growth-restricted fetuses associated with pregnancy-induced hypertension is linked to the different risk of later hypertension requires future studies.

Development of baroreflex function and hind limb vascular reactivity in the horse fetus

This study investigated, in vivo, the mechanisms underlying the development of cardiovascular function in the horse fetus, with particular relevance to baroreflex function and hind limb vascular arterial reactivity to constrictor agonists. Under general anaesthesia, vascular catheters were inserted and a Transonic flow probe was implanted around one of the metatarsal arteries of 13 horse fetuses, either at 0.6 of gestation (n= 6) or at 0.9 of gestation (n= 7, term approximately 335 days). At least 5 days after surgery, pressor, vasoconstrictor and cardiac chronotropic responses to exogenous bolus doses of phenylephrine, angiotensin II and arginine vasopressin were recorded. Fetal cardiac baroreflex slopes were obtained using the peak pressor and heart rate responses to increasing doses of phenylephrine. Fetal treatment with phenylephrine, angiotensin II and vasopressin produced significant changes in arterial blood pressure, hind limb vascular resistance and heart rate. Pressor and vasopressor responses to all agonists were greater at 0.9 than at 0.6 of gestation; however, fetal cardiac baroreflex sensitivity decreased with advancing gestational age. Correlation analysis revealed that fetal plasma cortisol rather than gestational age was a greater determinant of pressor and vasopressor reactivity. In contrast, gestational age rather than cortisol better determined heart rate and baroreflex responsiveness in the equine fetus. The data show that development of cardiovascular function in the equine fetus occurs via cortisol-dependent and -independent pathways.

Influence of sympathetic tone on heart rate during vagal stimulation and nitroprusside induced hypotension in ovine fetus

OBJECTIVE

To characterize effects of sympathetic tone on fetal heart rate (FHR) reflex responses and FHR variability in late gestation.

DESIGN/METHODS

Changes in FHR and autonomic tones were studied (i) after electrical vagal stimulation and (ii) during nitroprusside-induced hypotension, in seven late gestation ovine fetus in control condition (ctrl), after dobutamine (beta1-activation) and atenolol (beta1-blockade). Results are expressed as mean +/- SEM.

RESULTS

(i) Minimal FHR after vagal stimulation was not influenced by atenolol or dobutamine but dobutamine accelerated FHR normalization. (ii) During nitroprusside induced hypotension atenolol inhibited the initial increases in FHR and FHR variability (measured by SD and LFnu) but not the bradycardia occurring below a mean arterial pressure of 38 +/- 2 mmHg. Dobutamine did not abolish the depressor reflex. During hypotension the positive chronotropic effect of sympathetic tone increased from 15 +/- 2 to 42 +/- 7 bpm then decreased at a rate of -7.6 +/- 1.5 bpm mmHg(-1), vagal negative chronotropic influence steadily increased at a rate of 1.9 +/- 0.4 bpm mmHg(-1). Changes in FHR variability were not correlated with vagal or sympathetic chronotropic effects.

CONCLUSIONS

beta1-stimulation does not affect sinus-node response to vagal stimulation but improves the speed of FHR normalization. FHR response to hypotension depends on an initial increase in both sympathetic and parasympathetic chronotropic effects that is associated with a sympathetic dependent increase in FHR variability and is followed by a withdrawal of sympathetic tone.

Approximate entropy of fetal heart rate variability as a predictor of fetal distress in women at term pregnancy

BACKGROUND

The aim of this study is to investigate the relationship between approximate entropy (ApEn) of fetal heart rate (FHR) with umbilical blood gas parameters and the power spectrum of FHR variability in Chinese and to test whether ApEn of FHR variability could be used as a predictor of fetal distress in women at term pregnancy.

METHODS

Sixty-seven pregnant women with singleton, term fetus were recruited for the recording of FHR variability and the data were used for the estimate of ApEn. Blood gases after birth were measured through umbilical artery.

RESULTS

In all 67 neonates, there was some amount of interinfant variability in the ApEn values with a mean of 1.139 +/- 0.169. The ApEn values were significantly (P < 0.05) correlated with pO(2), SO(2), pCO(2), pH, HCO(3), or base excess (BE). The 15 fetuses with low ApEn (ApEn <1.0) had higher risk of metabolic acidosis (BE less than -12 mmol/l) than those with high ApEn (ApEn > or =1) (likelihood ratio = 12.301, P < 0.001). The powers of FHR variability in all frequency ranges (0-0.256 Hz) were lower in the low-ApEn group than those in the high-ApEn group.

CONCLUSIONS

The ApEn of FHR variability significantly decreased during fetal asphyxia, including hypoxia, hypercapnia, and both respiratory and metabolic acidosis; low ApEn was linked to decreased power spectrum density in all frequency domains. The ApEn values may be used as a predictor of fetal distress in women at term pregnancy.

Development of baroreflex and endocrine responses to hypotensive stress in newborn foals and lambs

OBJECTIVE

The aims of this study were to compare and contrast the development of the cardiac baroreflex and endocrine responses to acute hypotensive stress in healthy newborn pony foals and lambs during the first two weeks of postnatal life.

METHODS

Under general anaesthesia, seven Welsh pony foals and six Welsh Mountain lambs were catheterised with hind limb artery and vein catheters. Following post-surgical recovery, at 1 week and 2 weeks of age, blood pressures of the animals were raised and lowered acutely by intravenous infusion of phenylephrine and sodium nitroprusside, respectively. During hypotension, blood samples were taken for measurement of plasma hormones associated with activation of the stress axis.

RESULTS

Basal arterial blood pressure increased significantly (P<0.05) between week 1 and week 2 in the absence of any significant change in basal heart rate in foals and with a significant reduction in basal heart rate in lambs. In foals, the slope of the heart rate-blood pressure relationship decreased in response to acute hypertension, and it increased in response to acute hypotension, from week 1 to week 2 (all P<0.05). In contrast, in lambs, the slope of the heart rate-blood pressure relationship decreased with both acute hypertension and acute hypotension from week 1 to week 2 (all P<0.05). In foals, there were significant increases in plasma concentrations of noradrenaline, neuropeptide Y (NPY), vasopressin, adrenocorticotrophic hormone (ACTH) and cortisol in response to hypotension (P<0.05). In lambs, there were also significant increases in plasma concentrations of ACTH and cortisol during hypotension. Plasma concentrations of noradrenaline, NPY and vasopressin were not measured during hypotension in lambs. In foals, although the magnitude of the ACTH response to hypotension was smaller at week 2 than week 1, the increment in plasma cortisol was similar in the two age groups. In contrast, in lambs, the profile of both the ACTH and cortisol responses was similar at week 1 and week 2.

CONCLUSION

These data suggest that the increase in basal arterial blood pressure in the foal and the lamb during the first 2 weeks of postnatal life is accompanied by differential maturational changes in the vagal and sympathetic components of the cardiac baroreflex between the two species. These developmental cardiac baroreflex changes occur together with increased adrenocortical responsiveness to acute hypotensive stress, which appears comparatively more mature in lambs than in foals.

Cardiovascular and endocrine effects of a single course of maternal dexamethasone treatment in preterm fetal sheep

OBJECTIVE

To determine the effects of a single course of maternally administered dexamethasone on preterm fetal sheep in utero.

DESIGN

Prospective randomised controlled trial.

SETTING

University laboratory.

SAMPLE

Pregnant sheep at 0.7 of gestation.

METHODS

Pregnant ewes at 103 days of pregnancy (term = 147 days) were given two intramuscular injections of vehicle (n= 7) or 12 mg of dexamethasone (DEX; n= 8) 24 hours apart. Fetuses were continuously monitored for five days.

MAIN OUTCOME MEASURES

Fetal mean arterial blood pressure, carotid and femoral arterial blood flow and vascular resistance, heart rate, heart rate variability, fetal plasma cortisol and ACTH and fetal body movements.

RESULTS

DEX injections led to an acute increase in mean arterial blood pressure with a rise in carotid and femoral vascular resistance, a fall in femoral arterial blood flow, and a brief fall in fetal heart rate followed by significant tachycardia. From 24 hours after the injections, mean arterial blood pressure and vascular resistance returned to control values, however, a mild tachycardia [200 (3) vs 184 (4) bpm, P < 0.05] and loss of the circadian pattern of fetal heart rate variability persisted until the end of recording. Plasma ACTH and cortisol were markedly suppressed by DEX (P < 0.05), with values returning to control levels 32 and 72 hours after the first injection, respectively. There was no effect on basal fetal heart rate variability, body movements, carotid arterial blood flow, or the circadian pattern of fetal heart rate.

CONCLUSION

In contrast to previous experiments utilising direct fetal infusion of steroids, maternal administration of DEX was associated with only transient hypertension.

Redistribution of power spectrum of heart rate variability during acute umbilical artery embolism and hypoxemia in late-gestation fetal sheep

OBJECTS

Fetal heart rate variability (HRV) is subject to a number of factors, including fetal distress. The aim of this study was to investigate the power spectral distribution of fetal heart rate variability during acute hypoxemia following umbilical artery embolism and to test the hypothesis that the relative proportion of frequency domains in total power of HRV, reflects the changes in HRV during hypoxemia more closely than the absolute values.

METHODS

Acute hypoxemia was induced in seven catheterized late-gestation fetal sheep by repeated injections of microspheres to cause umbilical artery embolism. The very-low, low-, middle- and high-frequency domains (0-0.025, 0.025-0.125, 0.125-0.20, and 0.20-0.50 cycles/beat, respectively) were determined by power spectral analysis.

RESULTS

Umbilical artery embolism induced marked fetal hypoxemia, hypercapnia and acidosis, accompanied by an increase in heart rate and a decrease in arterial blood pressure. These changes were associated with the increase in power over the entire frequency range and in the relative power in the low-frequency range (P<0.01), and with decrease in the relative power in the high-frequency range (P<0.05). Correlations were found between the relative power in the low- and high-frequency ranges and PO2 and between the relative power in these ranges and mean arterial blood pressure (P<0.05), but not PCO2 or pH.

CONCLUSIONS

The present study indicates that acute hypoxemia induced by umbilical artery embolism leads to the redistribution of power spectral density of fetal HRV and that the relative proportion of individual frequency domains may reflect the changes in HRV during acute hypoxemia more closely than the absolute power values.

Effects of fetal behavioral states on renal sympathetic nerve activity and arterial pressure of unanesthetized fetal sheep

Fetal behavior, renal sympathetic nerve activity (RSNA), mean arterial pressure (MAP), and heart rate (HR) were studied 1-3 days after surgery in seven fetal sheep (aged 127-136 days). Five behavioral states were defined from chart recordings of electrocortical (electrocorticographic; ECoG) activity and eye, limb, and breathing movements. Most records were of high-voltage ECoG (HV) or low-voltage (LV) ECoG with breathing (LVB); 6.7 +/- 1.7% were LV ECoG with no breathing (LV0). RSNA was lower in LV0 (P < 0.001) and greater in LVB than in HV (P < 0.05). MAP was lower in both LV states than in HV and when the fetuses went from LV to HV (P < 0.001 to P < 0.03). HR was highest in HV (P < 0.001). In HV and LVB and when the fetus went from LV to HV, MAP and HR were inversely related (P = 0.012-0.003). In LVB and from LV to HV there were direct relationships between MAP and RSNA (P = 0.0014, P = 0.08), and when the fetus went from LV to HV there was also an inverse relationship between HR and RSNA (P = 0.02). Thus fetal RSNA, MAP, and HR are affected by behavioral state as is fetal cardiovascular control. The increase in RSNA during fetal breathing showed that there was an altered level of fetal RSNA associated with fetal breathing activity.