Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate Variability

Prenatal assessment of fetal development is primarily carried out by measuring fetal heart rate (HR) and HR variability (HRV). HRV has been used as an index for the autonomic nervous system (ANS) activity. Hence, fetal ANS (fANS) development has been assessed in previous literature by evaluating fet...

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Main Authors: Namareq Widatalla, Mohanad Alkhodari, Kunihiro Koide, Chihiro Yoshida, Yoshiyuki Kasahara, Masatoshi Saito, Yoshitaka Kimura, Ahsan Khandoker
Format: Article
Language:English
Published: IEEE 2025-01-01
Series:IEEE Access
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Online Access:https://ieeexplore.ieee.org/document/11005568/
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author Namareq Widatalla
Mohanad Alkhodari
Kunihiro Koide
Chihiro Yoshida
Yoshiyuki Kasahara
Masatoshi Saito
Yoshitaka Kimura
Ahsan Khandoker
author_facet Namareq Widatalla
Mohanad Alkhodari
Kunihiro Koide
Chihiro Yoshida
Yoshiyuki Kasahara
Masatoshi Saito
Yoshitaka Kimura
Ahsan Khandoker
author_sort Namareq Widatalla
collection DOAJ
description Prenatal assessment of fetal development is primarily carried out by measuring fetal heart rate (HR) and HR variability (HRV). HRV has been used as an index for the autonomic nervous system (ANS) activity. Hence, fetal ANS (fANS) development has been assessed in previous literature by evaluating fetal HRV (fHRV) at different gestational ages (GAs). Previously, it was demonstrated that fHRV was affected by factors such as fetal behavioral states and maternal conditions. Therefore, reliable evaluation of fANS development based on fHRV depends on the appropriate assessment of fHRV. In this study, we develop an HRV parameter based on maternal and fetal HRV to assess fHRV. The parameter was calculated by using 5-minute segments of non-invasive maternal and fetal electrocardiogram (ECG) records (158 subjects (GA: 19 - 40 weeks)). The parameter was developed by first counting the number of R peaks per 2 seconds (nRpp2s) and then calculating the standard deviation (SD) of nRpp2s (snRpp2s). After that, the HRV parameter was obtained by calculating the difference between maternal and fetal snRpp2s (dmf). The dmf was used to divide data into three patterns to evaluate the association of fHRV with GA and maternal HRV (mHRV) per pattern. The results showed discrepancies in the degree of association of fHRV with GA, implying that fHRV is not always an indicator of fANS development. These differences are expected due to maternal-related influences, as maternal HRV (mHRV) shows a pattern-specific association with fetal HRV (fHRV), that is, the two are correlated in some patterns but not in others. In addition, a comparison analysis of fHRV among the three patterns revealed that the discrepancies concerning fHRV could also be related to fetal behavioral states. The findings of this study provide a novel approach to assessing fHRV and fetal development relative to mHRV.
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spelling doaj-art-c2cea746fb454839a6177f8df0ebf97c2025-08-20T03:54:07ZengIEEEIEEE Access2169-35362025-01-0113879418794910.1109/ACCESS.2025.357032611005568Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate VariabilityNamareq Widatalla0https://orcid.org/0000-0001-9848-8531Mohanad Alkhodari1https://orcid.org/0000-0002-5248-6327Kunihiro Koide2Chihiro Yoshida3Yoshiyuki Kasahara4Masatoshi Saito5Yoshitaka Kimura6Ahsan Khandoker7https://orcid.org/0000-0002-0636-1646Tohoku University, Sendai, JapanDepartment of Biomedical and Biotechnolgy Engineering, Khalifa University, Abu Dhabi, United Arab EmiratesDepartment of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, JapanTohoku University, Sendai, JapanTohoku University, Sendai, JapanTohoku University, Sendai, JapanDepartment of Biomedical and Biotechnolgy Engineering, Khalifa University, Abu Dhabi, United Arab EmiratesPrenatal assessment of fetal development is primarily carried out by measuring fetal heart rate (HR) and HR variability (HRV). HRV has been used as an index for the autonomic nervous system (ANS) activity. Hence, fetal ANS (fANS) development has been assessed in previous literature by evaluating fetal HRV (fHRV) at different gestational ages (GAs). Previously, it was demonstrated that fHRV was affected by factors such as fetal behavioral states and maternal conditions. Therefore, reliable evaluation of fANS development based on fHRV depends on the appropriate assessment of fHRV. In this study, we develop an HRV parameter based on maternal and fetal HRV to assess fHRV. The parameter was calculated by using 5-minute segments of non-invasive maternal and fetal electrocardiogram (ECG) records (158 subjects (GA: 19 - 40 weeks)). The parameter was developed by first counting the number of R peaks per 2 seconds (nRpp2s) and then calculating the standard deviation (SD) of nRpp2s (snRpp2s). After that, the HRV parameter was obtained by calculating the difference between maternal and fetal snRpp2s (dmf). The dmf was used to divide data into three patterns to evaluate the association of fHRV with GA and maternal HRV (mHRV) per pattern. The results showed discrepancies in the degree of association of fHRV with GA, implying that fHRV is not always an indicator of fANS development. These differences are expected due to maternal-related influences, as maternal HRV (mHRV) shows a pattern-specific association with fetal HRV (fHRV), that is, the two are correlated in some patterns but not in others. In addition, a comparison analysis of fHRV among the three patterns revealed that the discrepancies concerning fHRV could also be related to fetal behavioral states. The findings of this study provide a novel approach to assessing fHRV and fetal development relative to mHRV.https://ieeexplore.ieee.org/document/11005568/Heart rate variabilityelectrocardiogramfetal autonomic nervous systemfetal developmentfetal behavioral states
spellingShingle Namareq Widatalla
Mohanad Alkhodari
Kunihiro Koide
Chihiro Yoshida
Yoshiyuki Kasahara
Masatoshi Saito
Yoshitaka Kimura
Ahsan Khandoker
Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate Variability
IEEE Access
Heart rate variability
electrocardiogram
fetal autonomic nervous system
fetal development
fetal behavioral states
title Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate Variability
title_full Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate Variability
title_fullStr Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate Variability
title_full_unstemmed Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate Variability
title_short Pattern-Based Assessment of the Association of Fetal Heart Variability With Fetal Development and Maternal Heart Rate Variability
title_sort pattern based assessment of the association of fetal heart variability with fetal development and maternal heart rate variability
topic Heart rate variability
electrocardiogram
fetal autonomic nervous system
fetal development
fetal behavioral states
url https://ieeexplore.ieee.org/document/11005568/
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