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Poster #19 - Associations Between Fetal and Infant Heart Rate Variability and Socioemotional Development in Toddlers

Thu, March 21, 9:30 to 10:45am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Introduction: Preterm (PT) infants (<34 weeks gestational age at birth) have been reported to be at greater risk for delayed neurodevelopmental, behavioral and educational trajectories (MacKay et al., 2010). Several studies demonstrated the condition of prematurity is a predictor for delayed social competence at 2 years corrected age (Johnson, et al., 2015). While late preterm (LPT) birth (34 0⁄7 – 36 6⁄7 weeks), have shown increased risk for neonatal morbidity and mortality (Vohr, 2013). Measurements of heart rate variability (HRV) demonstrated that PT and LPT infants have compromised autonomic systems at birth (Lucchini, 2018). In this study, we examined the relationship between parameters of fetal and neonatal HRV and 37-month Brief Infant-Toddler Social and Emotional Assessment (BITSEA) scores within our preterm cohort. Linking HRV biomarkers to long-term developmental outcomes may contribute toward risk stratification for PT and LPT infants through non-invasive means.
Population: Participants were assessed and observed as part of Safe Passage Study, a large-scale longitudinal study investigating the impact of prenatal exposure to smoking, alcohol and other environmental factors on birth outcome and development through 3 years of age. The analyzed cohort includes 21 PT and 55 LPT subjects (n=76, 38 male/38 female, mean GA at birth: 34.7 weeks), of which 36 have fetal HRV data and 24 have one-month HRV data.
Methods: Fetal ECG was recorded at 20-24 weeks gestational age. R-to-R intervals (RRis) were identified to compute the square root of the mean of the squared successive differences in RRis (rMSSD). rMSSD is a time-domain estimator mainly quantifying beat-to-beat variability, providing an indirect measure of vagally mediated HRV modulation. One-month rMSSD was extracted from ECG trace recorded during a protocol of three 45° head-up tilts during prone sleep. BITSEA was administered at 37 months.
Results: Controlling for sex, fetal GA, cigarette and alcohol exposure, and maternal Edinburgh depression scores during the second trimester, fetal rMSSD is associated with increased cognitive BITSEA scores (r = .35; p = .031), driven by fine motor BITSEA (r = .425; p = .008) and gross motor BITSEA (r = .357; p = .028). At one month, controlling for sex, adjusted one-month age, cigarette and alcohol exposure and maternal Edinburgh depression scores during the second trimester, the relationship between the median change score of rMSSD in response to a head-up tilt is inversely related to cognitive scores on the BITSEA (r = -.422; p = .032), driven by fine motor (r = -.415; p = .035), as well as receptive language (r = -.609; p = .001).
Discussion: Our results suggest that despite the higher risk associated with prematurity for PT and LPT subjects, more mature beat-to-beat variability (rMSSD) both prenatally and postnatally is associated with improved outcome at 37 months as measured by the BITSEA. Our findings are in accordance with previous research linking specific parameters of increased fetal HRV to greater responsiveness and reactivity. Similarly, postnatal reduction in vagal tone is correlated with increased subject responsiveness to physiological challenge and cognitive tasks (Porges, 2009).

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