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      Fetal autonomic brain age scores, segmented heart rate variability analysis, and traditional short term variability

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          Abstract

          Disturbances of fetal autonomic brain development can be evaluated from fetal heart rate patterns (HRP) reflecting the activity of the autonomic nervous system. Although HRP analysis from cardiotocographic (CTG) recordings is established for fetal surveillance, temporal resolution is low. Fetal magnetocardiography (MCG), however, provides stable continuous recordings at a higher temporal resolution combined with a more precise heart rate variability (HRV) analysis. A direct comparison of CTG and MCG based HRV analysis is pending. The aims of the present study are: (i) to compare the fetal maturation age predicting value of the MCG based fetal Autonomic Brain Age Score (fABAS) approach with that of CTG based Dawes-Redman methodology; and (ii) to elaborate fABAS methodology by segmentation according to fetal behavioral states and HRP. We investigated MCG recordings from 418 normal fetuses, aged between 21 and 40 weeks of gestation. In linear regression models we obtained an age predicting value of CTG compatible short term variability (STV) of R 2 = 0.200 (coefficient of determination) in contrast to MCG/fABAS related multivariate models with R 2 = 0.648 in 30 min recordings, R 2 = 0.610 in active sleep segments of 10 min, and R 2 = 0.626 in quiet sleep segments of 10 min. Additionally segmented analysis under particular exclusion of accelerations (AC) and decelerations (DC) in quiet sleep resulted in a novel multivariate model with R 2 = 0.706. According to our results, fMCG based fABAS may provide a promising tool for the estimation of fetal autonomic brain age. Beside other traditional and novel HRV indices as possible indicators of developmental disturbances, the establishment of a fABAS score normogram may represent a specific reference. The present results are intended to contribute to further exploration and validation using independent data sets and multicenter research structures.

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          In utero programming of chronic disease.

          1. Many human fetuses have to adapt to a limited supply of nutrients. In doing so they permanently change their structure and metabolism. 2. These 'programmed' changes may be the origins of a number of diseases in later life, including coronary heart disease and the related disorders stroke, diabetes and hypertension. 3. This review examines the evidence linking these diseases to fetal undernutrition and provides an overview of previous studies in this area.
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            Fetal programming of coronary heart disease.

            D. Barker (2002)
            People who develop coronary heart disease grow differently from other people both in utero and during childhood. Slow growth during fetal life and infancy is followed by accelerated weight gain in childhood. Two disorders that predispose to coronary heart disease, type 2 diabetes and hypertension, are preceded by similar paths of growth. Mechanisms underlying this are thought to include the development of insulin resistance in utero, reduced numbers of nephrons associated with small body size at birth and altered programming of the micro-architecture and function of the liver. Slow fetal growth might also heighten the body's stress responses and increase vulnerability to poor living conditions in later life. Coronary heart disease appears to be a developmental disorder that originates through two widespread biological phenomena, developmental plasticity and compensatory growth.
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              Are there behavioural states in the human fetus?

              The aim of this study was to search for the existence of behavioural states in the human fetus and to describe their developmental course. In a longitudinal study, 14 low-risk fetuses were studied at 2-week intervals from 32 weeks of gestation onward. Fetal body movements as well as fetal eye movements, visualized by means of real-time ultrasonic imaging, and fetal heart rate patterns, recorded by means of a cardiotocograph, were used as state variables. At 38 and 40 weeks, four distinct behavioural states, named states 1F through 4F and corresponding respectively to states 1 through 4 of the neonate, could be identified. That these constellations of parameters represented true behavioural states was demonstrated by the stability of association of parameters for prolonged periods and by the simultaneity of change of parameters at state transitions. There is evidence for episodes of wakefulness in the fetus. Before 36 weeks, cycles were present in each of the state variables and combinations of parameters typical of particular states were observed. However, the relatively short durations of these combinations and the lack of simultaneity of change in the three state variables support the conclusion that these periods of coincidence occurred by chance and did not represent organized behavioural states.
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                Author and article information

                Contributors
                Journal
                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                1662-5161
                25 November 2014
                2014
                : 8
                : 948
                Affiliations
                [1] 1Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
                [2] 2Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology Ilmenau, Germany
                [3] 3Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
                Author notes

                Edited by: Silvia Comani, Università degli Studi “G. d’Annunzio”, Italy

                Reviewed by: Dirk Cysarz, Witten/Herdecke University, Germany; Kathleen M. Gustafson, University of Kansas Medical Center, USA

                *Correspondence: Dirk Hoyer, Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Erlanger Allee 101, D-07747 Jena, Germany e-mail: Dirk.Hoyer@ 123456med.uni-jena.de

                This article was submitted to the journal Frontiers in Human Neuroscience.

                Article
                10.3389/fnhum.2014.00948
                4243554
                25505399
                feab2d88-32bf-4ec7-b2be-a085a3c5e578
                Copyright © 2014 Hoyer, Kowalski, Schmidt, Tetschke, Nowack, Rudolph, Wallwitz, Kynass, Bode, Tegtmeyer, Kumm, Moraru, Götz, Haueisen, Witte, Schleußner and Schneider.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution and reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 September 2014
                : 07 November 2014
                Page count
                Figures: 4, Tables: 4, Equations: 0, References: 19, Pages: 8, Words: 5337
                Categories
                Neuroscience
                Original Research Article

                Neurosciences
                prenatal diagnosis,fetal autonomic brain age,magnetocardiography,cardiotocography

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