title: Autonomic regulation in fetuses with congenital heart disease.
abstract: BACKGROUND
  Exposure to antenatal stressors affects autonomic regulation in fetuses. Whether the presence of congenital heart disease (CHD) alters the developmental trajectory of autonomic regulation is not known.
  This prospective observational cohort study aimed to further characterize autonomic regulation in fetuses with CHD; specifically hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF).
  
  
  METHODS
  From 11/2010 to 11/2012, 92 fetuses were enrolled: 41 controls and 51 with CHD consisting of 19 with HLHS, 12 with TGA, and 20 with TOF. Maternal abdominal fetal electrocardiogram (ECG) recordings were obtained at 3 gestational ages: 19-27 weeks (F1), 28-33 weeks (F2), and 34-38 weeks (F3).
  
  
  METHODS
  Fetal ECG was analyzed for mean heart rate along with 3 measures of autonomic variability of the fetal heart rate: interquartile range, standard deviation, and root mean square of the standard deviation of the heart rate (RMSSD), a measure of parasympathetic activity.
  
  
  RESULTS
  During F1 and F2 periods, HLHS fetuses demonstrated significantly lower mean HR than controls (p<0.05). Heart rate variability at F3, as measured by standard deviation, interquartile range, and RMSSD was lower in HLHS than controls (p<0.05). Other CHD subgroups showed a similar, though non-significant trend towards lower variability.
  
  
  CONCLUSIONS
  Autonomic regulation in CHD fetuses differs from controls, with HLHS fetuses most markedly affected.
authors: Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors: Saira
authors: S
authors: Siddiqui
authors: Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
authors: Abigail
authors: A
authors: Wilpers
authors: Department of Developmental Psychobiology, NY State Psychiatric Institute, New York, NY, USA.
authors: Michael
authors: M
authors: Myers
authors: Department of Developmental Psychobiology, NY State Psychiatric Institute, New York, NY, USA.
authors: J David
authors: JD
authors: Nugent
authors: Department of Developmental Psychobiology, NY State Psychiatric Institute, New York, NY, USA.
authors: William P
authors: WP
authors: Fifer
authors: Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA. Electronic address: iib6@columbia.edu.
authors: Ismée A
authors: IA
authors: Williams
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology*; D016022:Case-Control Studies; D004194:Disease; D005260:Female; D005318:Fetal Heart / Q000294:innervation / Q000503:physiopathology*; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D011247:Pregnancy
keywords: autonomic regulation; congenital heart disease; neurodevelopment