RESUMEN

Fetal movement is a crucial indicator of fetal well-being. Characteristics of fetal movement vary across gestation, posing challenges for researchers to determine the most suitable assessment of fetal movement for their study. We summarize the current measurement strategies used to assess fetal movement and conduct a comprehensive review of studies utilizing these methods. We critically evaluate various measurement approaches including subjective maternal perception, ultrasound, Doppler ultrasound, wearable technology, magnetocardiograms, and magnetic resonance imaging, highlighting their strengths and weaknesses. We discuss the challenges of accurately capturing fetal movement, which is influenced by factors such as differences in recording times, gestational ages, sample sizes, environmental conditions, subjective perceptions, and characterization across studies. We also highlight the clinical implications of heterogeneity in fetal movement assessment for monitoring fetal behavior, predicting adverse outcomes, and improving maternal attachment to the fetus. Lastly, we propose potential areas of future research to overcome the current gaps and challenges in measuring and characterizing abnormal fetal movement. Our review contributes to the growing body of literature on fetal movement assessment and provides insights into the methodological considerations and potential applications for research.

Asunto(s)

Movimiento Fetal , Humanos , Movimiento Fetal/fisiología , Femenino , Embarazo , Monitoreo Fetal/métodos , Ultrasonografía Prenatal/métodos , Imagen por Resonancia Magnética/métodos , Magnetocardiografía/métodos , Feto/fisiología , Feto/diagnóstico por imagen

RESUMEN

PURPOSE: Complex fetal behavior involving multiple parts of the body, called general movement (GM), has been considered an essential predictor of neurological functional development because it directly reflects the integrity of the brain and central and peripheral nervous systems. We have developed a novel method for quantitative analysis of fetal behavior using four-dimensional ultrasound (4DUS) and conducted a pilot study for quantitative assessment of fetal GM in the early second trimester. METHODS: All subjects underwent 4DUS to depict the whole fetal body, and maximum velocity (MAXV), median velocity (MV), average velocity (AV), and mode velocity (MOV) were calculated by utilizing optical flow analysis. Receiver operating characteristic (ROC) curve analysis was performed to analyze the optimal speed parameters for detecting GM in the fetus. The Mann-Whitney U test was used to validate MAXV, AV, and MV ability to detect fetal GM. RESULTS: The presence of fetal GMs and the absence of fetal GMs were 226 and 107, respectively, based on optical flow analysis. Mann-Whitney U test revealed a significant difference in the presence or absence of fetal GM in MAXV, MV, AV, and MOV. ROC analysis showed that the area under the curve (AUC) of MAXV was 0.959; the threshold was 0.421, the sensitivity was 86%, and the specificity was 93%. In contrast, the AUC/threshold for AV and MV was 0.700/0.110 (sensitivity 71% and specificity 76%) and 0.521/0.119 (sensitivity 21% and specificity 90%), respectively. Spearman's rank correlation analysis also showed a weak negative correlation between GM and MAXV (r = - 0.235, P < 0.01) and AV (r = - 0.28, P < 0.01). CONCLUSION: In this study, we conducted a quantitative analysis of fetal behavior based on optical flow using 4DUS and demonstrated that it was highly accurate for detecting GMs and for evaluating developmental changes in GMs. The implementation of quantitative analysis of fetal GMs in the early second trimester has been very preliminary, and there is much debate on how it will be clinically applied to perinatal assessment.

Asunto(s)

Movimiento Fetal , Ultrasonografía Prenatal , Femenino , Feto/diagnóstico por imagen , Humanos , Proyectos Piloto , Embarazo , Segundo Trimestre del Embarazo

RESUMEN

Pregnancy is a critical time for the effects of environmental factors on children's development. The effect of added sugar intake on fetal development and pregnancy outcomes remains understudied despite increasing dietary intake in the United States. This study investigated the effect of added sugar on fetal programming by examining the association between maternal added sugar consumption, fetal movement, birth outcomes, and placental DNA methylation. Further, primary human fibroblasts were cultured under normal or high glucose conditions to assess the effect of high glucose exposure on cells' DNA methylation. We found that higher added sugar intake across pregnancy was associated with reduced 3rd-trimester fetal movement (p < .05) and shorter gestation (p < .01). Our sample size was not powered to detect the alteration of individual placental CpG with genome-wide significance. However, a secondary analysis suggested that added sugar consumption was associated with differential methylation of functionally related gene families across pregnancy. Consistent with this, high glucose exposure in primary cultured human fibroblasts altered the methylation of 17% of all CpGs, providing converging evidence for an effect of sugar on DNA methylation. Our results suggest that diets high in added sugar during pregnancy may have implications for offspring health via prenatal programming effects measurable before birth.

Asunto(s)

Metilación de ADN , Placenta , Niño , Epigénesis Genética , Femenino , Desarrollo Fetal , Humanos , Placenta/metabolismo , Embarazo , Azúcares/efectos adversos , Azúcares/metabolismo

RESUMEN

INTRODUCTION: In 2D ultrasound, the lens of the fetal eye can be distinguished as white circles within the hypoechoic eyeball, and eye movements can be visualized from about 15 weeks' gestation. It has been shown that from 31 weeks gestational age the fetal sensory system is capable of directed vision if enough light is available. METHODS: We have developed a light source for delivering visual stimuli to be seen by the fetal eye, using laser dot diodes emitting at 650 nm. The 2D component of 94 fetal ultrasound scans (mean gestational age 240 days), where the light stimulus was presented, was coded to determine whether the eyes moved in response to the stimuli independent of any head movement. RESULTS: The light stimulus significantly provoked head and eye movements, but after the light was withdrawn the head stopped moving, yet the eyes continued to move. CONCLUSION: This provides evidence for visual attention mechanisms that can be controlled through eye movements that are independent of head movements prior to birth.

Asunto(s)

Movimientos Oculares , Movimiento Fetal , Edad Gestacional , Movimientos de la Cabeza , Humanos , Visión Ocular

RESUMEN

Objective To assess fetal behavioral changes in response to vibroacoustic stimulation (VAS) in normal singleton pregnancies using four-dimensional (4D) ultrasound. Methods Ten types of fetal movements and facial expressions in 68 healthy pregnant women between 24 and 40 weeks were studied using 4D ultrasound for 3 min before and after 3-s VAS. The frequencies of mouthing, yawning, tongue expulsion, back arch, jerky arm movement, startle movement, smiling, scowling, hand-to-face movement, and blinking were evaluated. The fetuses were subdivided into four gestational age groups (24-27, 28-31, 32-35, and ≥36 weeks). Comparison of the frequencies of the fetal behaviors before and after the stimulation in each gestational age group was conducted to detect the response to stimulation with advancing gestation. Results There were no significant differences in the frequency of each fetal behavior before and after VAS at 24-27, 28-31, and 32-35 weeks of gestation. However, the frequencies of blinking and startle movements were significantly higher after VAS in the 36-40 gestational age group (P < 0.05). Conclusion The age of 36 weeks of gestation might represent an advanced stage of brain and central nervous system development and maturation as the response to stimuli is prominent at this age compared with earlier gestation.

Asunto(s)

Movimiento Fetal , Ultrasonografía Prenatal , Femenino , Edad Gestacional , Humanos , Embarazo

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This study examined the developmental trajectories of general and breathing movements in fetal twins. Fetal movement patterns were assessed from real-time ultrasound recordings performed at 12-15, 20-23, and 28-32 weeks of gestation in 42 twin pairs. Results indicated that both general movements and breathing movements followed a curvilinear, inverted U-shaped curve. Developmental trajectories were unrelated within pairs of twins and were not associated with gestational age at birth and birth weight. However, sex differences were found for general movements with males displaying more time making general movements at 21 weeks and a steeper decline in time spent making general movements during the second half of pregnancy than females. These age-related changes in fetal movements may reflect CNS development. These findings also suggest that twins' behavioral development is largely independent of co-twin development, gestational age at birth, and birth weight, but not of fetal sex.

Asunto(s)

Desarrollo Fetal/fisiología , Movimiento Fetal/fisiología , Embarazo Gemelar , Mecánica Respiratoria/fisiología , Femenino , Edad Gestacional , Humanos , Masculino , Embarazo , Respiración , Gemelos , Ultrasonografía Prenatal

RESUMEN

AIM: To assess the effect of psychotropic drugs on fetal behavior using four-dimensional (4D) ultrasound in the third trimester of pregnancy. METHODS: Fetal behavior was assessed using Kurjak's antenatal neurodevelopmental test (KANET) using 4D ultrasound between 28 and 36 weeks of gestation. Thirty healthy (control group) and 10 psychotropic-drug-administered pregnant (case group) women were studied. The total value of the KANET score and values of each parameter (eight parameters) were compared between the two groups. RESULTS: The total KANET score was normal (except for one fetus in the case group: total score of 9) in both groups, and there was no significant difference in the total KANET score. When individual KANET parameters were compared, no significant differences were noted in any of the eight parameters. CONCLUSION: Our results showed that there is no difference in fetal behavior between fetuses of normal pregnant women and those of psychotropic-drug-administered pregnant women in the third trimester of pregnancy. These results suggest that psychotropic drugs may not affect fetal behavioral development in utero. However, the data and their interpretation in the present study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size are needed to assess the effect of psychotropic drugs on fetal neurobehavior during pregnancy.

Asunto(s)

Desarrollo Fetal/efectos de los fármacos , Movimiento Fetal/efectos de los fármacos , Psicotrópicos , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Japón , Evaluación de Resultado en la Atención de Salud , Embarazo , Tercer Trimestre del Embarazo , Embarazo de Alto Riesgo , Atención Prenatal/métodos , Psicotrópicos/administración & dosificación , Psicotrópicos/efectos adversos , Psicotrópicos/clasificación , Proyectos de Investigación , Ultrasonografía Prenatal/métodos

RESUMEN

Previous research has revealed that fetuses detect and respond to extrauterine stimuli such as maternal movement and speech, but little attention has been cast on how fetuses may directly influence and respond to each other in the womb. This study investigated whether motor activity of E20 rat fetuses influenced the behavior of siblings in utero. Three experiments showed that; (a) contiguous siblings expressed a higher frequency of synchronized movement than noncontiguous siblings; (b) fetuses that lay between two siblings immobilized with curare showed less movement relative to fetuses between saline or uninjected controls; and (c) fetuses between two siblings behaviorally activated by the opioid agonist U50,488 also showed less activity and specific behavioral changes compared to controls. Our findings suggest that rat fetuses are directly impacted by sibling motor activity, and thus that a rudimentary form of communication between siblings may influence the development of fetuses in utero.

Asunto(s)

Comunicación Animal , Movimiento Fetal/fisiología , Relaciones entre Hermanos , Hermanos , 3,4-Dicloro-N-metil-N-(2-(1-pirrolidinil)-ciclohexil)-bencenacetamida, (trans)-Isómero/farmacología , Analgésicos no Narcóticos/farmacología , Animales , Femenino , Embarazo , Ratas , Ratas Sprague-Dawley

RESUMEN

Fetal neurology is evolving as an area of great interest in prenatal diagnosis and fetal medicine. The identification and diagnosis of brain damage prenatally has been a great challenge in obstetrics for many years. Investigations of fetal behavior in comparison with morphological studies led to the conclusion that fetal behavioral patterns directly reflect developmental and maturational processes of the fetal central nervous system (CNS). Four-dimensional (4D) ultrasound has greatly improved the assessment of the quality of the fetal spontaneous movements, and enabled a better evaluation of fetal behavior. The assessment of normal neurobehavioral development by 4D ultrasound provided the opportunity to investigate functional characteristics of the fetus that could predict neurological developmental dysfunction. Some studies have already been carried out to evaluate this new methodology in the observation of fetal behavior during different stages of gestation, in an attempt to better understand the relationships between the maturation of the CNS of the fetus and its implications on its behavior pattern. We present a review of literature on fetal behavior by 4D ultrasound.

Asunto(s)

Desarrollo Fetal , Movimiento Fetal , Ultrasonografía Prenatal/métodos , Sistema Nervioso Central/embriología , Femenino , Feto , Humanos , Imagenología Tridimensional/métodos , Trastornos del Neurodesarrollo/diagnóstico , Embarazo , Diagnóstico Prenatal/métodos

RESUMEN

OBJECTIVE: To evaluate the frequencies of fetal facial expressions in the third trimester of pregnancy, when fetal brain maturation and development are progressing in normal healthy fetuses. METHODS: Four-dimensional (4 D) ultrasound was used to examine the facial expressions of 111 healthy fetuses between 30 and 40 weeks of gestation. The frequencies of seven facial expressions (mouthing, yawning, smiling, tongue expulsion, scowling, sucking, and blinking) during 15-minute recordings were assessed. The fetuses were further divided into three gestational age groups (25 fetuses at 30-31 weeks, 43 at 32-35 weeks, and 43 at ≥36 weeks). Comparison of facial expressions among the three gestational age groups was performed to determine their changes with advancing gestation. RESULTS: Mouthing was the most frequent facial expression at 30-40 weeks of gestation, followed by blinking. Both facial expressions were significantly more frequent than the other expressions (p < .05). The frequency of yawning decreased with the gestational age after 30 weeks of gestation (p = .031). Other facial expressions did not change between 30 and 40 weeks. The frequency of yawning at 30-31 weeks was significantly higher than that at 36-40 weeks (p < .05). There were no significant differences in the other facial expressions among the three gestational age groups. CONCLUSIONS: Our results suggest that 4D ultrasound assessment of fetal facial expressions may be a useful modality for evaluating fetal brain maturation and development. The decreasing frequency of fetal yawning after 30 weeks of gestation may explain the emergence of distinct states of arousal.

Asunto(s)

Expresión Facial , Imagenología Tridimensional , Ultrasonografía Prenatal , Adulto , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Tercer Trimestre del Embarazo

RESUMEN

BACKGROUND: This study aims to investigate average gestational week in which mothers feel their baby's movements for the first time, and the maternal-fetal factors affecting this time. METHODS: A total of 423 pregnant women between 11 and 25 weeks of gestation were included in this prospective study. The patient cohort was divided into three subgroups according to the gestational week in which fetal movements were felt for the first time by the pregnant women. The women who felt the first movement before 25th percentile value constituted Group 1; between 25th and 75th percentile value constituted Group 2; and beyond 75th percentile value constituted Group 3. These three groups were then compared in terms of maternal age, parity, body mass index (BMI), tea and coffee consumption during pregnancy, smoking, educational status, accordance of mother to regular pregnancy follow-ups, placental site, and gender of the baby. RESULTS: These three groups were statistically and significantly different regarding the above mentioned determinants except for mothers' tea and coffee consumption, smoking, and gender of the baby (p < 0.05). CONCLUSION: This study revealed factors that affect maternal perception of first fetal movements in both a positive and negative manner. Although it is hard to define an exact time for each individual, an approximate time according to our data can be given to a mother, which considers an affecting factor on the basis of average gestational week.

Asunto(s)

Movimiento Fetal , Percepción , Adolescente , Adulto , Femenino , Edad Gestacional , Humanos , Edad Materna , Embarazo , Estudios Prospectivos , Adulto Joven

RESUMEN

Objective To evaluate fetal behavioral differences between singleton and twin fetuses before 20 weeks of gestation using four-dimensional (4D) ultrasound. Methods 4D ultrasound was used to examine fetal movements in 58 singleton and 48 twin normal fetuses at 12-19 weeks. The frequencies of eight fetal movements were assessed through 15-min recordings. The fetuses were divided into two gestational age groups (12-13 and 14-19 weeks) to evaluate the changes with advancing gestation in twin versus singleton fetuses. Results Arm and general movements were the most frequent movements in singleton fetuses, whereas only general movement was significantly more frequent than the other seven fetal movements in twin fetuses at 12-13 weeks. At 14-19 weeks, frequencies of arm and leg movements were significantly higher than those of the other six movements in singleton fetuses, while only arm movement was significantly more frequent than the other fetal movements in twin fetuses. Comparisons of fetal movements between singleton and twin fetuses revealed that only arm movement showed a significant difference at 12-13 weeks, while the frequencies of all movements in singleton fetuses were significantly higher than those in twin fetuses at 14-19 weeks. Conclusion Our results suggest that the limitation of available space and crowding of twin fetuses with advancing gestation may have a marked impact on twin fetal movements compared with singleton fetuses, even in the first half of pregnancy. Further studies are needed to assess whether decreased fetal movements in twin pregnancy can affect fetal and neonatal development and maturation before and after birth.

Asunto(s)

Movimiento Fetal , Embarazo Gemelar/fisiología , Femenino , Humanos , Embarazo , Ultrasonografía Prenatal

RESUMEN

OBJECTIVE: The objective of this study is to determine whether ambient light serves as a fetal stimulus to decrease the amount of time needed to complete a biophysical profile. STUDY DESIGN: This is a randomized controlled trial of singleton gestations undergoing a biophysical profile. Patients were randomized to either ambient light or a darkened room. The primary outcome was the time needed to complete the biophysical profile. Secondary outcomes included total and individual component biophysical profile scores and scores less than 8. A subgroup analysis of different maternal body mass indices was also performed. RESULTS: 357 biophysical profile studies were analyzed. 182 studies were performed with ambient light and 175 were performed in a darkened room. There was no difference in the median time needed to complete the biophysical profile based on exposure to ambient light (6.1min in darkened room versus 6.6min with ambient light; P=0.73). No difference was found in total or individual component biophysical profile scores. Subgroup analysis by maternal body mass index did not demonstrate shorter study times with ambient light exposure in women who were normal weight, overweight or obese. CONCLUSION: Ambient light exposure did not decrease the time needed to complete the biophysical profile. There was no evidence that ambient light altered fetal behavior observed during the biophysical profile.

Asunto(s)

Monitoreo Fetal/métodos , Feto/fisiología , Luz , Atención Prenatal , Adulto , Femenino , Humanos , Embarazo , Adulto Joven

RESUMEN

In the third trimester of pregnancy, the human fetus has the capacity to process perceptual information [1-3]. With advances in 4D ultrasound technology, detailed assessment of fetal behavior [4] is now possible. Furthermore, modeling of intrauterine conditions has indicated a substantially greater luminance within the uterus than previously thought [5]. Consequently, light conveying perceptual content could be projected through the uterine wall and perceived by the fetus, dependent on how light interfaces with maternal tissue. We do know that human infants at birth show a preference to engage with a top-heavy, face-like stimulus when contrasted with all other forms of stimuli [6, 7]. However, the viability of performing such an experiment based on visual stimuli projected through the uterine wall with fetal participants is not currently known. We examined fetal head turns to visually presented upright and inverted face-like stimuli. Here we show that the fetus in the third trimester of pregnancy is more likely to engage with upright configural stimuli when contrasted to inverted visual stimuli, in a manner similar to results with newborn participants. The current study suggests that postnatal experience is not required for this preference. In addition, we describe a new method whereby it is possible to deliver specific visual stimuli to the fetus. This new technique provides an important new pathway for the assessment of prenatal visual perceptual capacities.

Asunto(s)

Feto/fisiología , Tercer Trimestre del Embarazo/fisiología , Percepción Visual , Femenino , Humanos , Masculino , Estimulación Luminosa , Embarazo

RESUMEN

BACKGROUND: In 2012, yoga was practiced by 20 million Americans, of whom 82% were women. A recent literature review on prenatal yoga noted a reduction in some pregnancy complications (ie, preterm birth, lumbar pain, and growth restriction) in those who practiced yoga; to date, there is no evidence on fetal response after yoga. OBJECTIVES: We aimed to characterize the acute changes in maternal and fetal response to prenatal yoga exercises using common standardized tests to assess the well-being of the maternal-fetal unit. STUDY DESIGN: We conducted a single, blinded, randomized controlled trial. Uncomplicated pregnancies between 28 0/7 and 36 6/7 weeks with a nonanomalous singleton fetus of women who did not smoke, use narcotics, or have prior experience with yoga were included. A computer-generated simple randomization sequence with a 1:1 allocation ratio was used to randomize participants into the yoga or control group. Women in the yoga group participated in a 1-time, 1 hour yoga class with a certified instructor who taught a predetermined yoga sequence. In the control group, each participant attended a 1-time, 1 hour PowerPoint presentation by an obstetrician on American Congress of Obstetricians and Gynecologists recommendations for exercise, nutrition, and obesity in pregnancy. All participants underwent pre- and postintervention testing, which consisted of umbilical and uterine artery Doppler ultrasound, nonstress testing, a biophysical profile, maternal blood pressure, and maternal heart rate. A board-certified maternal-fetal medicine specialist, at a different tertiary center, interpreted all nonstress tests and biophysical profile data and was blinded to group assignment and pre- or postintervention testing. The primary outcome was a change in umbilical artery Doppler systolic to diastolic ratio. Sample size calculations indicated 19 women per group would be sufficient to detect this difference in Doppler indices (alpha, 0.05; power, 80%). Data were analyzed using a repeated-measures analysis of variance, a χ(2), and a Fisher exact test. A value of P < .05 was considered significant. RESULTS: Of the 52 women randomized, 46 (88%) completed the study. There was no clinically significant change in umbilical artery systolic to diastolic ratio (P = .34), pulsatility index (P = .53), or resistance index (P = .66) between the 2 groups before and after the intervention. Fetal and maternal heart rate, maternal blood pressure, and uterine artery Dopplers remained unchanged over time. When umbilical artery indices were individually compared with gestational age references, there was no difference between those who improved or worsened between the groups. CONCLUSION: There was no significant change in fetal blood flow acutely after performing yoga for the first time in pregnancy. Yoga can be recommended for low-risk women to begin during pregnancy.

Asunto(s)

Feto/fisiología , Arterias Umbilicales/fisiología , Arteria Uterina/fisiología , Yoga , Adulto , Presión Sanguínea , Femenino , Frecuencia Cardíaca Fetal , Humanos , Movimiento , Embarazo , Atención Prenatal , Flujo Pulsátil , Método Simple Ciego , Ultrasonografía Doppler , Arterias Umbilicales/diagnóstico por imagen , Arteria Uterina/diagnóstico por imagen , Resistencia Vascular , Adulto Joven

RESUMEN

OBJECTIVE: To determine whether maternal anxiety affects fetal movement patterns in the third trimester of pregnancy. METHODS: The inclusion criteria were a state of good health and a singleton pregnancy between 36 and 40 weeks. Thirty healthy pregnant women were included. The Beck Anxiety Inventory (BA) questionnaire with 21 self-reported items validated for the Brazilian population was applied. The women were asked to record the number of minutes taken to perceive 10 fetal movements once a day for one week. Anxiety symptoms were rated as moderate or severe according to the BAI total score. RESULTS: The mean BAI score was 20.8 (SD = 10.2) and the mean time to count 10 fetal movements was 24.3 min (SD = 6.6 min). The BAI items significantly associated with moderate or severe maternal anxiety were numbness or tingling, fear of the worst happening, terrified, feeling of choking, fear of losing control and fear of dying. There was a statistically significant negative correlation between the total BAI score and the mean time of 10 perceived fetal movements (p < 0.0001; rho = -0.70; 95% CI for rho -0.84 to -0.45). CONCLUSIONS: Maternal anxiety seems to affect fetal movement patterns in late pregnancy and is associated with the mother's increased perception of fetal activity.

Asunto(s)

Ansiedad , Movimiento Fetal , Adulto , Femenino , Humanos , Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Adulto Joven

RESUMEN

INTRODUCTION: The aim of this research is to contribute to knowledge of the normal spontaneous motor behavior of the human fetus during the second trimester of pregnancy. This study focuses on five patterns of spontaneous fetal movement: startle (S), axo-rhizomelic rhythmia (ARR), axial stretching (AS), general movement (GM), and diaphragmatic contraction (DC). METHODS: A cohort of 13 subjects was followed up using 2D obstetrical ultrasound images at 12, 16, 20, and 24 weeks of gestation. As inclusion criteria, neonatal neurological examination and general movements after eutocic delivery at term were normal in all of the subjects, and their neuromotor and cognitive development until the end of pre-school age were also normal. RESULTS: All these five motor patterns are present at the beginning of the 2(nd) gestational trimester, but their quantitative and qualitative traits are diverse according to gestational ages. The phasic, isolated or rhythmically repeated movements, S and ARR, are prominent at 12 and 16 weeks of gestation, and then their presence gradually diminishes. By contrast, tonic and complex AS and GM movements increase their presence and quality at 20 and 24 weeks. RAR constitute a particular periodic motor pattern not described in previous literature. Moreover, the incidence of DC is progressive throughout the trimester, in clusters of 2-6 arrhythmic and irregular beats. Fetal heart rate increases during fetal motor active periods. CONCLUSIONS: All five normal behavioral patterns observed in the ultrasounds reflect the progressive tuning of motor generators in human nervous system during mid-pregnancy.

Asunto(s)

Movimiento Fetal , Ultrasonografía Prenatal , Adulto , Femenino , Humanos , Estudios Longitudinales , Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , Adulto Joven

RESUMEN

Differences in fetal neurodevelopment can have important implications on future perceptual and learning capabilities. The aim of this study was to assess autonomic nervous system and complexity dynamics in fetal heart rate (FHR) tracings from 27 singleton fetuses in cephalic or breech presentations, matched for gestational age (37(+3) -40(+4) weeks), weight, gender and outcome. Breeches exhibited significantly higher mean FHR and LF/(MF + HF) ratio, as well as lower entropy, denoting increased sympatho-vagal balance and decreased complexity, consistent with the occurrence of more active fetal behavioral states. These findings suggest that there are neurodevelopment differences between fetuses in cephalic and breech presentation.

Asunto(s)

Presentación de Nalgas/psicología , Desarrollo Fetal/fisiología , Frecuencia Cardíaca Fetal/fisiología , Adulto , Entropía , Femenino , Edad Gestacional , Humanos , Masculino , Embarazo , Adulto Joven

RESUMEN

OBJECTIVE: In this paper we evaluate the evidence for sex differences in fetal programming within the context of the proposed viability-vulnerability tradeoff. METHODS: We briefly review the literature on the factors contributing to primary and secondary sex ratios. Sex differences in fetal programming are assessed by summarizing previously published sex difference findings from our group (6 studies) and also new analyses of previously published findings in which sex differences were not reported (6 studies). RESULTS: The review and reanalysis of studies from our group are consistent with the overwhelming evidence of increasing risk for viability among males exposed to environmental adversity early in life. New evidence reported here support the argument that females, despite their adaptive agility, also are influenced by exposure to early adversity. Two primary conclusions are (i) female fetal exposure to psychobiological stress selectively influences fear/anxiety, and (ii) the effects of female fetal exposure to stress persist into preadolescence. These persisting effects are reflected in increased levels of anxiety, impaired executive function and neurological markers associated with these behaviors. CONCLUSIONS: A tacit assumption is that females, with their adaptive flexibility early in gestation, escape the consequences of early life exposure to adversity. We argue that the consequences of male exposure to early adversity threaten their viability, effectively culling the weak and the frail and creating a surviving cohort of the fittest. Females adjust to early adversity with a variety of strategies, but their escape from the risk of early mortality and morbidity has a price of increased vulnerability expressed later in development.

Asunto(s)

Adaptación Psicológica , Ansiedad , Encéfalo/anomalías , Desarrollo Infantil , Función Ejecutiva , Desarrollo Fetal , Viabilidad Fetal , Mujeres Embarazadas , Efectos Tardíos de la Exposición Prenatal , Caracteres Sexuales , Estrés Psicológico/psicología , Ansiedad/metabolismo , Ansiedad/psicología , Biomarcadores/sangre , Niño , Hormona Liberadora de Corticotropina/sangre , Hormona Liberadora de Corticotropina/metabolismo , Miedo , Femenino , Edad Gestacional , Humanos , Hidrocortisona/sangre , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisario/metabolismo , Masculino , Leche Humana/metabolismo , Tamaño de los Órganos , Sistema Hipófiso-Suprarrenal/metabolismo , Placenta/metabolismo , Valor Predictivo de las Pruebas , Embarazo , Mujeres Embarazadas/psicología , Efectos Tardíos de la Exposición Prenatal/metabolismo , Efectos Tardíos de la Exposición Prenatal/psicología , Estudios Prospectivos , Desempeño Psicomotor

RESUMEN

Durante as últimas décadas, o desenvolvimento da ultrassonografia em tempo real tem possibilitado a visibilização direta do feto no útero, bem como a avaliação de sua atividade. Com o advento da ultrassonografia tridimensional (3D) no final dos anos 1980, iniciou-se uma nova era no diagnóstico por imagem em Obstetrícia, ampliando-se sobremaneira a possibilidade do estudo fetal. Recentemente, uma técnica que permitiu que a imagem 3D fosse transformada em um modo em tempo real foi introduzida e tem sido chamada de ultrassonografia em quarta dimensão (4D), a qual permite o monitoramento contínuo da face fetal e de outras áreas da superfície do feto, como, por exemplo, suas extremidades. Alguns estudos já se ocuparam em avaliar esta nova metodologia na observação do comportamento fetal durante diferentes estágios da gestação, na tentativa de melhor entender as relações entre a maturação do sistema nervoso central do feto e suas implicações em seu padrão de comportamento. No presente artigo, os autores realizam uma revisão sobre o uso atual da ultrassonografia 4D na avaliação do comportamento fetal, discorrendo sobre as perspectivas da técnica em espelhar, por meio da observação de padrões de movimentos e expressões faciais, o desenvolvimento neurológico do feto, destacando as potenciais aplicabilidades dessa tecnologia como nova área de pesquisa em medicina fetal.

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In the last decades, the development of real-time ultrasonography has allowed the direct view of the fetus in the uterus, as well as assessing its activity. The advent of threedimensional ultrasonography (3D) at the end of the 80s initiated a new era in diagnostic imaging for Obstetrics, dramatically increasing the possibility of studying the fetus. Recently, a new technique allowing the 3D image to be transformed into real-time was introduced: the four-dimensional (4D) ultrasonography. It allows the continuous monitoring of fetal face and other surface areas, such as the extremities. Some studies have already assessed this new methodology for fetal behavior observation during different stages of pregnancy, trying to understand better the relationship between fetal central nervous system maturation and the implications for its behavior. In this article, the authors review the current use of 4D ultrasonography in the assessment of fetal behavior, and discuss the possibilities of the technique to show the neurological development of the fetus, by means of watching movement and facial expressions. They also highlight the potential applicability of this new method in this new research area of fetal medicine.

Asunto(s)

Femenino , Humanos , Embarazo , Movimiento Fetal/fisiología , Ultrasonografía Prenatal/métodos , Sistema Nervioso Central/embriología , Expresión Facial