Maternal cardiac deceleration capacity: a novel insight into maternal autonomic function in pregnancies complicated by hypertensive disorders and intrauterine growth restriction.
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.
Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy. Electronic address: daniela.casati@unimi.it.
D
D
Casati
Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
T
T
Stampalija
Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
E
E
Ferrazzi
Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
A M
AM
Alberti
Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
I
I
Scebba
Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
A
A
Paganelli
Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
D
D
Di Martino
Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
M L
ML
Muggiasca
Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
A
A
Bauer
D000328:Adult; D001341:Autonomic Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D003654:Deceleration; D004562:Electrocardiography; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010920:Placenta / Q000000981:diagnostic imaging / Q000503:physiopathology; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology
Cardiac deceleration capacity; Hypertensive disorders of pregnancy; Intrauterine growth restriction; Maternal autonomic function