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.

Maternal cardiac deceleration capacity : a novel insight into maternal autonomic function in pregnancies complicated by hypertensive disorders and intrauterine growth restriction / D. Casati, T. Stampalija, E. Ferrazzi, A.M. Alberti, I. Scebba, A. Paganelli, D. Di Martino, M.L. Muggiasca, A. Bauer. - In: EUROPEAN JOURNAL OF OBSTETRICS, GYNECOLOGY, AND REPRODUCTIVE BIOLOGY. - ISSN 0301-2115. - 206(2016), pp. 6-11. [10.1016/j.ejogrb.2016.08.007]

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

T. Stampalija;E. Ferrazzi;D. Di Martino;
2016

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.
Cardiac deceleration capacity; Hypertensive disorders of pregnancy; Intrauterine growth restriction; Maternal autonomic function; Adult; Autonomic Nervous System; Case-Control Studies; Deceleration; Electrocardiography; Female; Fetal Growth Retardation; Heart; Heart Rate; Humans; Hypertension, Pregnancy-Induced; Placenta; Placental Insufficiency; Pregnancy; Prospective Studies; Ultrasonography, Prenatal; Umbilical Arteries; Reproductive Medicine; Obstetrics and Gynecology
Settore MED/40 - Ginecologia e Ostetricia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/623818
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