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Lobmaier SM, Müller A, Zelgert C, Shen C, Su PC, Schmidt G, Haller B, Berg G, Fabre B, Weyrich J, Wu HT, Frasch MG, Antonelli MC. Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG. Arch Gynecol Obstet 2019; 301:405-414. [PMID: 31781889 DOI: 10.1007/s00404-019-05390-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR. METHODS Prospective case-control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2-3 months, was measured at birth. RESULTS 538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother-child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (- 0.49-0.18), p < 0.001]. CONCLUSION Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied. TRIAL REGISTRATION Clinical trial registration: NCT03389178.
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Affiliation(s)
- Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - A Müller
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - C Zelgert
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Shen
- Department of Mathematics, Duke University, Durham, NC, 27705, USA
| | - P C Su
- Department of Mathematics, Duke University, Durham, NC, 27705, USA
| | - G Schmidt
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - B Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Buenos Aires, Argentina
| | - G Berg
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Facultad de Farmacia Y Bioquímica, Buenos Aires, Argentina
| | - B Fabre
- Facultad de Farmacia Y Bioquímica. Instituto de Fisiopatología Y Bioquímica Clínica (INFIBIOC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J Weyrich
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - H T Wu
- Department of Mathematics, Duke University, Durham, NC, 27705, USA.,Department of Statistical Science, Duke University, Durham, NC, 27705, USA.,Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - M G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - M C Antonelli
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Instituto de Biología Celular Y Neurociencia "Prof. E. De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Weyrich J, Brach L, Gantner L, Heinrich R, Karge A, Niepoth K, Schneider A, Krämer A, Ettl J. Rhabdomyolyse unter Therapie mit Palbociclib, Letrozol und Simvastatin – ein Fallbericht. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Weyrich
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - L Brach
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - L Gantner
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - R Heinrich
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - A Karge
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - K Niepoth
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - A Schneider
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - A Krämer
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
| | - J Ettl
- Klinikum rechts der Isar, Frauenklinik, München, Deutschland
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Schneider A, Krämer A, Weyrich J, Brambs C, Ettl J. Palbociclib nach Chemotherapie in fortgeschrittener Linie: Profitiert die Patientin davon? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Schneider
- Frauenklinik der Technischen Universität München, München, Deutschland
| | - A Krämer
- Frauenklinik der Technischen Universität München, München, Deutschland
| | - J Weyrich
- Frauenklinik der Technischen Universität München, München, Deutschland
| | - C Brambs
- Frauenklinik der Technischen Universität München, München, Deutschland
| | - J Ettl
- Frauenklinik der Technischen Universität München, München, Deutschland
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Brach L, Gantner L, Weyrich J, Schneider K, Thürmel K, Kuschel B, Lobmaier S, Heinrich R. Fallbericht, sFLT/Plgf-Quotient als Lebensretter. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Weyrich J, Bogdanski R, Ortiz JU, Kuschel B, Schneider KTM, Lobmaier SM. Interdisciplinary Peripartum Management of Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation - a Case Report and Literature Review. Geburtshilfe Frauenheilkd 2016; 76:273-276. [PMID: 27065489 PMCID: PMC4824632 DOI: 10.1055/s-0041-110132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/02/2015] [Accepted: 11/22/2015] [Indexed: 01/20/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of acute severe cardiac and respiratory failure. One of the indications is acute respiratory distress syndrome (ARDS) for which, in some severe cases, ECMO represents the only possibility to save lives. We report on the successful long-term use of ECMO in a postpartum patient with recurrent pulmonary decompensation after peripartum uterine rupture with extensive blood loss.
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Affiliation(s)
- J. Weyrich
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - R. Bogdanski
- Klinik für Anaesthesiologie der Technischen Universität München
| | - J. U. Ortiz
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - B. Kuschel
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - K. T. M. Schneider
- Frauenklinik und Poliklinik der Technischen Universität München, München
| | - S. M. Lobmaier
- Frauenklinik und Poliklinik der Technischen Universität München, München
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