Alterations in Maternal–Fetal Heart Rate Coupling Strength and Directions in Abnormal Fetuses

Because fetal gas exchange occurs via the maternal placenta, there has been growing interests in understanding the patterns and directions of maternal-fetal cardiac coupling. We recently reported the evidence of short-term maternal–fetal cardiac couplings in normal fetuses by using Normalized Short Time Partial Directed Coherence (NSTPDC) technique. Our results have shown weakening of coupling from fetal heart rate to maternal heart rate as the fetal development progresses while the influence from maternal to fetal heart rate coupling behaves oppositely. The aim of this study was to test if maternal-fetal coupling patterns change in various types of abnormal cases of pregnancies. We applied NSTPDC on simultaneously recorded fetal and maternal beat-by-beat heart rates collected from fetal and maternal ECG signals of 66 normal and 19 abnormal pregnancies. NSTPDC fetal-to-maternal coupling analyses revealed significant differences between the normal and abnormal cases (normal: normalized factor (NF)=-0.32±0.71, fetus-to-mother coupling area (A_fBBI→mBBI) =0.43±0.12, mother-to-fetus coupling area (A_mBBI→fBBI)=0.50±0.12; abnormal: NF=-1.66±0.77, A_fBBI→mBBI=0.08±0.12, A_mBBI→fBBI=0.66±0.24; p<0.01). In conclusion, maternal-fetal cardiac coupling strength and direction and their associations with regulatory mechanisms (patterns) of developing autonomic nervous system function could be novel clinical markers of healthy prenatal development and its deviation. However, further research is required on larger samples of abnormal cases.