Maternal cardiac deceleration capacity: a novel insight into maternal autonomic function in pregnancies complicated by hypertensive disorders and intrauterine growth restriction. (November 2016)

• Record Type: Journal Article
• Authors: Casati, D.; Stampalija, T.; Ferrazzi, E.; Alberti, A.M.; Scebba, I.; Paganelli, A.; Di Martino, D.; Muggiasca, M.L.; Bauer, A.
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 206(2016:Nov.)
• Page Start: 6
• Page End: 11
• Publication Date: 2016-11
• Subjects: Hypertensive disorders of pregnancy -- Intrauterine growth restriction -- Cardiac deceleration capacity -- Maternal autonomic function; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2016.08.007
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To explore maternal cardiac deceleration capacity (DC), a marker of autonomic function derived from electrocardiographic (ECG) signals, in pregnancies complicated by intrauterine growth restriction (IUGR) and hypertensive disorders of pregnancy (HDP) associated to IUGR (HDP-IUGR) or to appropriate for gestational age fetal growth (HDP-AGAf). Methods: Prospective single center case-control study conducted at Buzzi Children's Hospital, Milan. Maternal ECGs were analyzed by Phase Rectified Signal Averaging (PRSA) method to obtain cardiac DC in women with: HDP-IUGR, HDP-AGAf, severe-IUGR, mild-IUGR and uncomplicated pregnancies. IUGR was defined as abdominal circumference <5th centile; severe-IUGR was associated with umbilical artery Doppler pulsatility index >2 standard deviations. Non-parametric tests were adopted. Results: 269 women were recruited. Women with HDP-IUGR ( n = 35) showed significantly higher cardiac DC compared both to controls ( n = 141) ( p = 0.003) and women with HDP-AGAf ( n = 18) ( p = 0.01). Women with severe-IUGR ( n = 14) showed significantly higher DC than controls ( p = 0.01). Women with mild-IUGR ( n = 61) as well as women with HDP-AGAf showed no differences in DC compared to controls (both p = 0.3). Conclusions: Women with pregnancy complicated by severe placental failure, such as HDP-IUGR and severe IUGR, show significant autonomic alterations, as indicated by elevated cardiac DC. On the contrary, pregnancy complications such as HDP-AGAf and mild IUGR show no impact on maternal autonomic balance. We present a new approach to explore maternal autonomic cardiovascular regulation that might reflect the severity of placental vascular insufficiency.