which intrinsic homeostatic response is the fetus demonstrating

During labor, especially in cases of prematurity, there are several conditions that can cause NEC: two of these are certainly hypoxia and acidemia (Sharma and Hudak, 2013). Assessment of fetal development using cardiac valve intervals. 162, 3541. Front. The Dutch Hunger Winter and the developmental origins of health and disease. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability. Dev. A., Hahn, C.-S., Painter, K., Haynes, O. M., and Costigan, K. A. These processes can be implemented through cell autonomous or intercellular signaling. Tracking placental development in health and disease. Specific kinds of brain injuries seem also to specifically affect ANS: for instance, DFA revealed that white matter injury, watershed stroke, basal ganglia injury, or global injury can show characteristic HRV signatures (Metzler et al., 2017). Outlook 67, 169189. A decrease in the heart rate b. American College of Obstetricians and Gynecologists. Thus the opinion that most decelerations are purely baroreceptor mediated was not supported by these recent studies.14, 15. As the ANS is controlled by several brain areas (e.g., amygdala, hypothalamus, insula, cingulate cortex, and several brainstem nuclei) that constitute the central autonomic network (CAN), paying attention to their development is fundamental for studying the fetal ANS. Fetal mediators of the relationships between increased pregnancy and labour blood pressure and newborn irritability. J Physiol. Midwifery 29, 13461351. Early Hum. 300, R330R339. Reducing cardioinhibitory activity increases heart rate. Dalton KJ, Dawes GS, Patrick JE. Selye, H. (1950). Both gross motor activity and breathing FMs, particularly during early gestation, represent an important evaluative parameter for fetal neurobehavior and to predict future neurodevelopmental disorders. 18, 175183. 15:721605. doi: 10.3389/fnins.2021.721605. Reconsidering fetal pain. Sleep Med. doi: 10.1111/aogs.13437, Boehm, F. H., Woodruff, L. F., and Growdon, J. H. (1975). Magnesium sulfate as a tocolytic agent. Although the induction of the hormone oxytocin has no cardiac repercussions, it can still influence the development of the vagus nerve and the ANS in the last hours of labor. doi: 10.1016/0378-3782(90)90011-7, Preston, R., Crosby, E. T., Kotarba, D., Dudas, H., and Elliott, R. D. (1993). 89, 13761380. Fetal sleep organization: a biological precursor of self-regulation in childhood and adolescence? Low back pain in pregnancy: investigations, management, and role of neuraxial analgesia and anaesthesia: a systematic review. doi: 10.3122/jabfm.2009.02.080057, Venkataraman, R., Kamaluddeen, M., Amin, H., and Lodha, A. (2017). JAMA. doi: 10.1038/npp.2015.171, McKenna, D. S., Ventolini, G., Neiger, R., and Downing, C. (2006). Table 2. The spleen begins to develop at 5 WGA as a lobulated organ, appears clearly around 8 WGA, and initially functions as a hematopoietic center; then, during fetal development, it gradually loses both this role and its lobules (Moore et al., 2016; Hill, 2021a). (2018). Br J Obstet Gynaecol. Meas. Respiratory System Development - Embryology. 62, 6877. Arch. Different methods could be used to evaluate the quantity and quality of FMs, such as mother perception, acceleration, and variability at cardiotocography (CTG), real-time ultrasound, myography, actocardiography (Zizzo et al., 2020), and the Non-stress Test, which relates FMs to fHR accelerations (Bryant et al., 2020). Secondly, by suppressing melatonin secretion, thus altering the immune system and, potentially, the CAP, with all the negative consequences already mentioned. Fetal movement, in StatPearls (Treasure Island, FL: StatPearls Publishing). Acta Obstet. The exciting take-home message is that much of this development can be gauged non-invasively during pregnancy using readily available bioelectric sensors such as ECG or, less qualitatively well, but still useful, using ultrasound-derived HR estimation, the mainstay of today's CTG and EFM technologies that is in sore need of technological disruption. Antihypertensive drugs in pregnancy. Burgio, E. (2015). Hum. (2016). Am. Keep in mind this doesnt mean youll need an instrumental vaginal or cesarean delivery right away. Metab. Perinatol. Even if further research is needed, maternal vitamin D intake deficit correlates with altered metabolic and contractile development of the heart and the control mechanisms of blood pressure in fetuses (Morris et al., 1995; Gale et al., 2008). Disord. doi: 10.1016/j.jpeds.2003.10.058, Graven, S. N., and Browne, J. V. (2008). doi: 10.2165/00128072-200002060-00002, Kisilevsky, B. S., and Low, J. doi: 10.1136/medethics-2019-105701, Dereymaeker, A., Pillay, K., Vervisch, J., De Vos, M., Van Huffel, S., Jansen, K., et al. Neurobiol. The heart itself contributes to variability. doi: 10.1016/j.smrv.2009.05.001, Chang, Y. P. (2014). Clinicians depend upon the heart rate to infer the condition of another organ, namely the fetal brain. We have shown how alterations in CAN activity and sensorimotor behaviors can give hints about the developing ANS function. Perinatol. Cogn. Annu. Oxytocin specifically enhances valence-dependent parasympathetic responses. J. Gynecol. Physiol. 38, 5666. doi: 10.1016/j.jri.2018.01.004, Pryor, J. R., Maalouf, F. I., Krans, E. E., Schumacher, R. E., Cooper, W. O., and Patrick, S. W. (2017). Historically, research findings oriented to understand the mediators that underlie the basis of fetal programming pointed out the HPA axis disregarding the role of ANS. Pediatr. Obstet. doi: 10.1002/bdra.23045, Lattimore, K. A., Donn, S. M., Kaciroti, N., Kemper, A. R., Neal, C. R., and Vazquez, D. M. (2005). 6:188. doi: 10.3389/fnins.2012.00188, Gamer, M., and Bchel, C. (2012). 86, 672677. Perinatol. Behavioral responses to pain are heightened after clustered care in preterm infants born between 30 and 32 weeks gestational age. Dev. Homeostasis (article) | Human body systems | Khan Academy 1984 Mar 1; 148(5):490-8. About Labor in humans is certainly associated with physiological changes, most of which are regulated by ANS (Sanghavi and Rutherford, 2014; Soma-Pillay et al., 2016). doi: 10.1016/0002-9378(81)90015-6, Lucchini, M., Fifer, W. P., Sahni, R., and Signorini, M. G. (2016). doi: 10.1002/14651858.CD006066.pub3, Allen, L. H. (2001). The placental membrane microbiome is altered among subjects with spontaneous preterm birth with and without chorioamnionitis. 214, 297307. Deep microbial analysis of multiple placentas shows no evidence for a placental microbiome. Becher JC, Stenson BJ, Lyon AJ. A., Gierczak, M., Pattillo, C., Glynn, L. M., et al. Update on the use of antihypertensive drugs in pregnancy. The intrinsic cardiac nervous system and its role in cardiac pacemaking and conduction. Synaptic homeostasis may also play a role in tuning a neuron's response to all types of oscillatory perturbations, as both excitatory and inhibitory synapses are susceptible [6], though in the . Sleep Med. On the other hand, clinical behavior has changed considerably. doi: 10.1016/j.yfrne.2017.10.006, Shiroiwa, Y., Kamiya, Y., Uchibori, S., Inukai, K., Kito, H., Shibata, T., et al. Obstet. Maternal consumption of non-staple food in the first trimester and risk of neural tube defects in offspring. Fetal growth and maternal exposure to particulate matter during pregnancy. 54, 779782. doi: 10.1016/j.molmed.2014.05.002, Borsani, E., Della Vedova, A. M., Rezzani, R., Rodella, L. F., and Cristini, C. (2019). J. Obstet. doi: 10.1007/s40572-015-0053-0, Gutke, A., Betten, C., Degerskr, K., Pousette, S., and Olsn, M. F. (2015). (2017). Occup. Your doctor might ask you to stop pushing efforts, which causes fetal hypoxia to progress rapidly, in the second stage of labor. Infect. Neurorobotics 12:23. doi: 10.3389/fnbot.2018.00023, Fairchild, K. D., Srinivasan, V., Randall Moorman, J., Gaykema, R. P. A., and Goehler, L. E. (2010). 12:20160545. doi: 10.1098/rsbl.2016.0545, Gallup, A. C., and Eldakar, O. T. (2013). J. Obstet. Analg. J. Gynecol. doi: 10.1053/smrv.2002.0243, Montagna, A., and Nosarti, C. (2016). Fetal neurobehavioral development: a tale of two cities. Opioid dependence and pregnancy: minimizing stress on the fetal brain. doi: 10.1016/j.ajog.2016.10.003, McEwen, B. S., Nasca, C., and Gray, J. D. (2016). 115, 3845. All the feedback mechanisms that maintain homeostasis use negative feedback. Sustained neurobehavioral effects of exposure to SSRI antidepressants during development: molecular to clinical evidence. doi: 10.1084/jem.20180794, PubMed Abstract | CrossRef Full Text | Google Scholar, Abrams, R. M., and Gerhardt, K. J. (2020). (2007). (2006). Am. Stimulating the vagus nerve typically produces: a. Neurosci. Off. 20, 5668. Gynecol. Lack of detection of a human placenta microbiome in samples from preterm and term deliveries. 47, 373386. 2016 Sep 1;594(17):4711-25. doi: 10.2147/JIR.S248382, Haraldsdottir, K., Watson, A. M., Goss, K. N., Beshish, A. G., Pegelow, D. F., Palta, M., et al. The preclinical studies analyzed in this review were selected from among those carried out on the ovine species. Clin. Can. Automated analysis means that these digital tracing can be analyzed in a consistent quantitative fashion, not only for the classic patterns defined by the NICHD but for patterns and relationships that are not readily visible to the human eye. Heart rate variability analysis can give paramount hints about the fetus' or newborn's well-being and allow clinicians to predict the occurrence of even deadly complications (Table 1) (Stone et al., 2013; Al-Shargabi et al., 2017; Massaro et al., 2017; Chiera et al., 2020; Frasch, 2020). (2017). 444, S98S109. 40, 445456. The effect of labor on maternal and fetal circulating catecholamines. Am. The rapidity of heart rate change is related to the rapidity of the conditions that trigger the change. N. Y. Acad. Sahin, F. K., Koken, G., Cosar, E., Saylan, F., Fidan, F., Yilmazer, M., et al. From 25 WGA until birth, the vagus nerve myelination, the vagal control by the nucleus ambiguus, and, thus, the PNS rapidly develop, as testified by the appearance of short-term variability in frequency-domain HRV metrics (e.g., HF) and the proportional reduction of long-term variability metrics (e.g., LF), more related to SNS and baroreflex functions (Mulkey and du Plessis, 2018, 2019; Schlatterer et al., 2021). Epidemiology 10, 370375. Maternal heart rate variability during the first stage of labor. Several reports based on observations in human births do not support the reliability of moderate baseline variability to excluded acidemia. Even early prenatal exposure to the virus, indeed, seems to create a chronic hypoxic environment to the fetus, affecting vagus nerve developmental patterns, and imprinting postnatally the ANS cardiac pacemaker activity (Herry et al., 2021). Assoc. Pediatr. Environ. doi: 10.1111/jog.12619. Med. (2014). 8, 3841, Pelzer, E., Gomez-Arango, L. F., Barrett, H. L., and Nitert, M. D. (2017). Further research is required to tie these findings with the recent discovery of the intrinsic fHRV produced by the heart's sino-atrial node (Frasch et al., 2020a). (2018b). Maternal obesity, in particular, both before conception and during pregnancy, is associated with impaired fHRV and poorer ANS development (Christifano et al., 2020). (1999). A decrease in the heart rate The vagus nerve begins maturation 26 to 28 weeks. 42, 335341. Acta Obstet. In particular, we will study what events can interfere with the correct development of these two systems by analyzing the evidence from preclinical and clinical studies in this regard, with the aim of preventing potential complications with long-term consequences. An increase in the heart rate c. An increase in stroke volume d. No change a. 116: Management of intrapartum fetal heart rate tracings. Identified Q&As 100+ Solutions available. A Clin. Paediatr. The persistent exposure to photic stimuli or high noise during pregnancy, for instance, due to the mother's occupation, seems to correlate with reduced fetal growth (Selander et al., 2019), increased incidence of congenital heart diseases (Gong et al., 2017), impaired development of cortical areas (Zhang et al., 1992; Wilson et al., 2008), and potential disruption of the vagus nerve maturation. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Labor is divided into three stages. From 7 to 8 WGA gray and white matter differentiate and, by the end of the 1st trimester, after the embryo has become a fetus, it is possible to recognize all the main brain structures, including the choroid plexus, thalamus, hypothalamus, amygdala, basal ganglia, corpus callosum, brainstem nuclei, cerebellum, and the neural plate of the insula (Moore et al., 2016; Hill, 2021b). doi: 10.1111/j.1552-6909.1996.tb02516.x, De Jonckheere, J., and Storme, L. (2019). (2012). J. Perinatol. 13, 245254. Obstet Gynecol. Figure 1: Schematic outline of heart rate control mechanisms. That is, the machine (computer) learns from the actual data. 181, 816821. Recovery of the FHR was seen as mean arterial pressure rose. doi: 10.1109/ICATE.2016.7754700, Roux, S. G., Garnier, N. B., Abry, P., Gold, N., and Frasch, M. G. (2021). Pattern of brain injury and depressed heart rate variability in newborns with hypoxic ischemic encephalopathy. A Review on the Vagus Nerve and Autonomic Nervous System During Fetal However, theres no clinical evidence suggesting its effectiveness when used alone in women with adequate oxygen levels. Am. Clin. doi: 10.1002/ajim.4700210312, Zhang, X., Sliwowska, J. H., and Weinberg, J. The degree of hypertension and the amount of deceleration were closely related, although some deceleration remained when the transient hypertension was prevented by adrenergic blockade. Can. Regarding the PNS, the vagus nerve has been recognized as a fundamental afferent pathway for sensing the milieu interior in peripheral tissues, thus allowing the organism to respond by activating complex networks involving the whole ANS, endocrine, metabolic, innate, and adaptive immune systems (Frasch et al., 2018b; Bonaz et al., 2021). Heart rate variability code: does it exist and can we hack it? The placental microbiome varies in association with low birth weight in full-term neonates. Am. Around 20 WGA and for the rest of the 2nd trimester, myelination occurs (Borsani et al., 2019). Biol. What is amiss is the understanding and acting upon the fact that each fetus and newborn are not truly new, but, rather, come with weeks and months of experience in utero. 68, 173186. Indeed, fetuses with intrauterine growth restriction (IUGR) frequently present an oxygenation impairment, with a decrease of breathing movements and GMs, and an increasing number of HR decelerations (Bekedam et al., 1991). doi: 10.1289/ehp.99107475, Derbyshire, S. W., and Bockmann, J. C. (2020). Maternal perception of FMs, in conclusion, is one of the factors that could influence in a relevant way the emotional state of the mother. Since the ANS requires 37 weeks in utero to fully develop, preterm newborns can experience difficulties in regulating their internal milieu in the face of environmental factors (Praud et al., 2017). However, the literature shows that the ANS can be assessed through fHRV from 15 to 20 WGA (Hoyer et al., 2012, 2013b, 2015, 2019; Shuffrey et al., 2019). J. Acad. The emergence of fetal behaviour. J. Perinatol. BMJ Open 8:e020031. IX: prolonged pregnancy. (2006). 6:237ra65. Heart rate variability in healthy term newborns is related to delivery mode: a prospective observational study. 39, 769783. 21, 397408. 25, 595604. Antony, K. M., Ma, J., Mitchell, K. B., Racusin, D. A., Versalovic, J., and Aagaard, K. (2015). 30, 23872394. Effect of acute hypoxemia and respiratory acidosis on the fetal heart rate in monkeys. Biol. The hallmark of a negative feedback loop is that it counteracts a change, bringing the value of a parametersuch as temperature or blood sugarback towards it set point. Neuropharmacology 144, 7081. Prenatal cardiac function and postnatal cognitive development: an exploratory study. ), What do Braxton Hicks contractions feel like? Sleep patterns and sleep disturbances across pregnancy. Res. A. Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Moreover, excessive light can impair visual development, thus increasing SNS and HPA axis activation (Weber and Harrison, 2019). doi: 10.1038/nrendo.2012.189, Peaceman, A. M., Meyer, B. which intrinsic homeostatic response is the fetus demonstratingjavascript open new tab but stay on current page . FHR decelerations can be associated with little or no change in peripheral hemoglobin oxygen saturation. Nurs. Off. doi: 10.1172/JCI30555, Tracey, K. J. Gut microbiota and gestational diabetes mellitus: a review of host-gut microbiota interactions and their therapeutic potential. 2007 Jul;197(1):26.e1-6. Some biological systems, however, use positive feedback loops. doi: 10.1159/000488106, Morton, S. U., and Brodsky, D. (2016). The acoustic environment and physiological responses of the fetus. Around the transition between the 1st and 2nd trimester, even the circumventricular organs, in particular, the area postrema, appear: they are organs devoid of the brain-blood barrier that, hence, allow the brain to be directed informed about the biochemical status of the internal milieu (Gokozan et al., 2016). 1032, 6384. The effects of epidural anesthesia on electronic fetal heart rate monitoring. [Drug use during pregnancy, labor and the puerperium and after the drug use in pregnancy study]. Reprod. L&D Resource Library doi: 10.1159/000471764, Selander, J., Rylander, L., Albin, M., Rosenhall, U., Lewn, M., and Gustavsson, P. (2019). Care 26, 534.e9534.e17. Med. First evidence that intrinsic fetal heart rate variability exists and is affected by hypoxic pregnancy. Then, as gestation progresses, the amount of movement, both spontaneous and in response to vibroacoustic stimuli, gradually increases: indeed, mothers begin to feel their babies' movements (Moore et al., 2016; Borsani et al., 2019). Am J Obstet Gynecol. Breastfeed. J. Gynecol. Res. Dev. Front. Maternal plasma levels of oxytocin during physiological childbirth a systematic review with implications for uterine contractions and central actions of oxytocin. The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care. Gynaecol. Behav. J. Neuroinflammation 13:103. doi: 10.1186/s12974-016-0567-x, Freidman, E. A., and Sachtleben, M. R. (1978). What could and should we do to disrupt this status quo and enable individualized insights into the various developmental effects the vagus nerve maturation and pleiotropic physiology provide? doi: 10.1016/j.earlhumdev.2017.07.003, Desrosiers, T. A., Lawson, C. C., Meyer, R. E., Stewart, P. A., Waters, M. A., Correa, A., et al. Infant Child Dev. Category II Application Even with complete pharmacologic blockage of the sympathetic and parasympathetic systems, around 35-40% of fetal lamb heart rate variability persists.19. Physiol. PeriGens EFM Scholarship Program, Basics of Electronic Fetal Monitoring ( EFM ). Even in the sheep experiments using precisely controlled conditions, consistent fetal heart rate decelerations could not be produced equally in all animals despite 2 hours of repetitive maternal vascular occlusions.12 The late decelerations induced by constricting the sheep uterine arteries with and without acidemia are redrawn to scale on the grid used by fetal monitoring paper in Figure 4. Available online at: http://www.ncbi.nlm.nih.gov/books/NBK544290/ (accessed April 8, 2021). All authors reviewed, edited and approved the final version of the paper. Pain 22, 757764. Effect of procedure light on the physiological responses of preterm infants: effects of procedure light on neonates. Curr. The ANS regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development (Hoyer et al., 2017; Mulkey and du Plessis, 2018; Zizzo et al., 2020). Philadelphia, PA: Elsevier. Psychiatry Res. doi: 10.1111/mono.v80.3, DiPietro, J. Summary of the finding of the present review regarding ANS development and HRV. Since the vagus is closely related to the intestinal system, severe intestinal inflammation such as NEC can destroy the cells of the vagal nuclei in the brainstem and inhibit CAP (Fritze et al., 2014). Maternal positioning affects fetal heart rate changes after epidural analgesia for labour. Occupational hazards and pregnancy outcomes. The 1st stage begins when significant and regular contractions start and ends when there is a full cervical dilation of 10 cm. In contrast, we are entering a stretch of Perfect Weather with the convergence of conditions collectively conducive to advancing the science of electronic fetal heart rate interpretation in actual clinical practice. 1996;8(3):471-82. 33, 847850. Maternal psychopathology influences infant heart rate variability: generation R study. Heart rate variability in hypertensive pregnancy disorders: a systematic review. Factors that modulate fetal anaerobic reserve are myocardial glycogen stores, placental exchange capacity and chronic hypoxia. (2019). Circulation 130, 10031008. 7:57. doi: 10.3389/fnint.2013.00057, Gemmel, M., De Lacalle, S., Mort, S. C., Hill, L. A., Charlier, T. D., and Pawluski, J. L. (2019). 120, 14501452. Psychopathol. Brain Mapp. Fetal heart rate is a vital indicator of your baby's health. doi: 10.1038/s41390-021-01460-3, Ray-Griffith, S. L., Wendel, M. P., Stowe, Z. N., and Magann, E. F. (2018). Validation of functional fetal autonomic brain age score fABAS in 5 min short recordings. Review of sleep-EEG in preterm and term neonates. (2018). (2020). Zahr, L. K., and de Traversay, J. doi: 10.1016/0378-3782(79)90002-1, Yee, J. R., Kenkel, W. M., Frijling, J. L., Dodhia, S., Onishi, K. G., Tovar, S., et al. Pathol. Your doctor will then take action to prevent medical complications for your newborn. The nervous system differentiates from the ectoderm approximately around 3 weeks gestational age (WGA), when part of the ectoderm develops into the neural plate. Res. For this reason, before birth neuroendocrine signaling (e.g., catecholamines, cortisol, thyroid hormones, and renin-angiotensin) surges, and SNS outflow from CAN (e.g., hypothalamus, cortical, and brainstem centers) greatly increases. 176, 112118. Heart Assoc. It is instead well known that methylmercury from seafood impairs the higher centers of cardiac autonomic function (Karita et al., 2018), leading to severe ANS abnormalities (Srensen et al., 1999; Grandjean et al., 2004; Murata et al., 2006; Gribble et al., 2015). (2013). As previously mentioned, oxytocin plays an important role in activating the PNS and it has been shown to dampen SNS (Gamer and Bchel, 2012). Women Birth 32, 12. doi: 10.1196/annals.1314.006, Sehmbi, H., D'Souza, R., and Bhatia, A. Res. J. Neurosci. During the 1st trimester, there are no significant differences in HRV track between male and female fetuses (McKenna et al., 2006). A study with autonomic blocking agents in fetal lambs. Med. The musculature of the pelvic floor facilitates rotation and flexion for the fetal head. 31, 189196. Obstet Gynecol. 23, 539549. (2015). (12), Over that last decade mounting evidence based on recent animal experimentation with very sensitive sensors and finer time resolution, has produced more information about hand chemoreceptors and their role in the production of decelerations. FETAL HOMEOSTASIS - ScienceDirect doi: 10.1093/sleep/27.7.1405, Podymow, T., and August, P. (2008). It reaches a stable set point only when its control functions meet the conditions on convexity and relative goals described in the text. 598, 249263. Evidence of a non-vagal (intrinsic myocardial) source of deceleration was demonstrated in experiments with complete vagotomy. A., Parisi, V. M., and Creasy, R. K. (1989). Physiotherapy 104, 338346. REST/NRSF drives homeostatic plasticity of inhibitory synapses in a Autonomic responses of premature newborns to body position and environmental noise in the neonatal intensive care unit. doi: 10.1080/j.1600-0412.2003.820101.x, Jansson, L. M., DiPietro, J. BMC Pregnancy Childbirth 13:111. doi: 10.1186/1471-2393-13-111, Peterson, L. S., Stelzer, I. Autonomic nervous system immaturity due to fetal or postnatal complications (e.g., maternal pathologies, birth difficulties) could then impair the whole brain development and, therefore, behavior, stress response, and mood regulation, with negative consequenceseven serious neurological or psychological pathologiesin infants, adolescent, and adult life (Mulkey et al., 2018; Mulkey and du Plessis, 2019). Any event that perturbs the fetal cardiovascular system will initiate a cascade of compensatory actions to optimize oxygen delivery and restore fetal hemostasis. The placenta harbors a unique microbiome. Inadequate maternal nutrition could also lead to excessive weight gain and gestational diabetes, with negative outcomes for the fetus (AlSaif et al., 2015; Edlow, 2017; Peterson et al., 2020; Tong and Kalish, 2020). Indeed, a prone position improves oxygenation, increases PNS tone, and lowers both salivary cortisol and stress behavior (Gomes et al., 2019). Indeed, the first findings relating HRV alterations to fetal death, thus hinting to a potential predictive role of HRV, date back to the early sixties of the twentieth century (Hon and Lee, 1963). Mapping the immunological homunculus. 3rd ed. Sex differences in neurodevelopmental and neurodegenerative disorders: focus on microglial function and neuroinflammation during development. These pathologies can dysregulate the neuroendocrine axis, altering, in particular, the cortisol production (Wilder, 1998; Sheng et al., 2020) and, thus, affecting sympathovagal balance development. J. Gastrointest. Here low pH and hypoxemia trigger the chemoreceptor response causing peripheral vasoconstriction. Sci. From maternal diet to neurodevelopmental disorders: a story of neuroinflammation. Synaptic and intrinsic homeostasis cooperate to optimize single neuron doi: 10.1089/bfm.2008.0002, Jones, C. M., and Greiss, F. C. (1982). Pathologic fetal acidemia. doi: 10.1542/peds.2016-2828F, Walker, R. W., Clemente, J. C., Peter, I., and Loos, R. J. F. (2017). Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. The association between fetal heart rate patterns and fetal movements in pregnancies between 20 and 30 weeks' gestation. Cyr RM, Usher RH, McLean FH. Early Hum. Langman Medical Embryology. Compared to cesarean section (CS), spontaneous labor without analgesia seems to improve cardiovagal modulation as shown by HF increase and LF decrease, despite several HRV metrics tend to increase in the postnatal days regardless of delivery mode (Kozar et al., 2018).

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