Heart Rate Variability and Pregnancy Complications: Systematic Review

Overview

Journal Interact J Med Res

Publisher JMIR Publications

Specialty Biomedical Engineering

Date 2023 Jun 5

PMID 37276013

Authors

Zahra Sharifi-Heris

Amir M Rahmani

Anna Axelin

Mahkameh Rasouli

Miriam Bender

Affiliations

Soon will be listed here.

Abstract

Background: The autonomic nervous system (ANS) is known as a critical regulatory system for pregnancy-induced adaptations. If it fails to function, life-threatening pregnancy complications could occur. Hence, understanding and monitoring the underlying mechanism of action for these complications are necessary.

Objective: We aimed to systematically review the literature concerned with the associations between heart rate variability (HRV), as an ANS biomarker, and pregnancy complications.

Methods: We performed a comprehensive search in the PubMed, Medline Completion, CINAHL Completion, Web of Science Core Collection Classic, Cochrane Library, and SCOPUS databases in February 2022 with no time span limitation. We included studies concerned with the association between any pregnancy complications and HRV, with or without a control group. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used for the review of the studies, and Covidence software was used for the study selection process. For data synthesis, we used the guideline by Popay et al.

Results: Finally, 12 studies with 6656 participants were included. Despite the methodological divergency that hindered a comprehensive comparison, our findings suggest that ANS is linked with some common pregnancy complications including fetal growth. However, existing studies do not support an association between ANS and gestational diabetes mellitus. Studies that linked pulmonary and central nervous system disorders with ANS function did not provide enough evidence to draw conclusions.

Conclusions: This review highlights the importance of understanding and monitoring the underlying mechanism of ANS in pregnancy-induced adaptations and the need for further research with robust methodology in this area.

Citing Articles

Pathways to maternal health inequities: Structural racism, sleep, and physiological stress.

Christian L, Brown R, Carroll J, Thayer J, Lewis T, Gillespie S Brain Behav Immun. 2024; 123:502-509.

PMID: 39362504 PMC: 11624070. DOI: 10.1016/j.bbi.2024.09.037.

Autonomic Dysfunction and Cardiac Performance in Pregnant Women with Hypertensive Disorders: A Comparative Study Using Heart Rate Variability and Global Longitudinal Strain.

Bogdan C, Apostol A, Ivan V, Sandu O, Petre I, Petre I Life (Basel). 2024; 14(8).

PMID: 39202781 PMC: 11355154. DOI: 10.3390/life14081039.

Preterm birth risk stratification through longitudinal heart rate and HRV monitoring in daily life.

Feli M, Azimi I, Sarhaddi F, Sharifi-Heris Z, Niela-Vilen H, Liljeberg P Sci Rep. 2024; 14(1):19896.

PMID: 39191907 PMC: 11349982. DOI: 10.1038/s41598-024-70773-0.

Multifractal analysis of heart rate variability in pregnancy during sleep.

Mendez M, Bianchi A, Recker F, Strizek B, Murguia J, Reali P Front Cardiovasc Med. 2024; 11:1404055.

PMID: 39165260 PMC: 11333245. DOI: 10.3389/fcvm.2024.1404055.

Feasibility of continuous smart health monitoring in pregnant population: A mixed-method approach.

Sharifi-Heris Z, Fortier M, Rahmani A, Sharifiheris H, Bender M PLOS Digit Health. 2024; 3(6):e0000517.

PMID: 38837965 PMC: 11152270. DOI: 10.1371/journal.pdig.0000517.

References

Ecklund-Flores L, Myers M, Monk C, Perez A, Odendaal H, Fifer W . Maternal depression during pregnancy is associated with increased birth weight in term infants. Dev Psychobiol. 2017; 59(3):314-323. PMC: 5470319. DOI: 10.1002/dev.21496. View

Sullivan S, Umans J, Ratner R . Hypertension complicating diabetic pregnancies: pathophysiology, management, and controversies. J Clin Hypertens (Greenwich). 2011; 13(4):275-84. PMC: 8673181. DOI: 10.1111/j.1751-7176.2011.00440.x. View

Zollkau J, Dolker E, Schmidt A, Schneider U, Hoyer D . Dependencies between maternal and fetal autonomic tone. J Perinat Med. 2019; 47(3):323-330. DOI: 10.1515/jpm-2018-0221. View

Cerritelli F, Frasch M, Antonelli M, Viglione C, Vecchi S, Chiera M . A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows. Front Neurosci. 2021; 15:721605. PMC: 8488382. DOI: 10.3389/fnins.2021.721605. View

Duong H, Tadesse G, Nhat P, Van Hao N, Prince J, Duong T . Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Tetanus. Am J Trop Med Hyg. 2019; 102(2):403-407. PMC: 7008337. DOI: 10.4269/ajtmh.19-0720. View

Faber R, Stepan H, Baumert M, Voss A, Walther T . Changes of blood pressure and heart rate variability precede a grand mal seizure in a pregnant woman. J Perinat Med. 2004; 32(6):538-40. DOI: 10.1515/JPM.2004.124. View

Heiskanen N, Saarelainen H, Karkkainen H, Valtonen P, Lyyra-Laitinen T, Laitinen T . Gestational diabetic patients with adequate management have normal cardiovascular autonomic regulation during the third trimester of pregnancy and 3 months after delivery. J Diabetes Complications. 2009; 24(4):234-41. DOI: 10.1016/j.jdiacomp.2008.12.006. View

Xiong X, Fraser W . Impact of pregnancy-induced hypertension on birthweight by gestational age. Paediatr Perinat Epidemiol. 2004; 18(3):186-91. DOI: 10.1111/j.1365-3016.2004.00553.x. View

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4:1. PMC: 4320440. DOI: 10.1186/2046-4053-4-1. View

10.

Sharifiheris Z, Rahmani A, Onwuka J, Bender M . The Utilization of Heart Rate Variability for Autonomic Nervous System Assessment in Healthy Pregnant Women: Systematic Review. JMIR Bioinform Biotechnol. 2024; 3(1):e36791. PMC: 11135217. DOI: 10.2196/36791. View

11.

McCurdy C, Bishop J, Williams S, Grayson B, Smith M, Friedman J . Maternal high-fat diet triggers lipotoxicity in the fetal livers of nonhuman primates. J Clin Invest. 2009; 119(2):323-35. PMC: 2631287. DOI: 10.1172/JCI32661. View

12.

Sato N, Fudono A, Imai C, Takimoto H, Tarui I, Aoyama T . Placenta mediates the effect of maternal hypertension polygenic score on offspring birth weight: a study of birth cohort with fetal growth velocity data. BMC Med. 2021; 19(1):260. PMC: 8567693. DOI: 10.1186/s12916-021-02131-0. View

13.

Amador-Licona N, Guizar-Mendoza J, Juarez M, Linares-Segovia B . Heart sympathetic activity and pulmonary function in obese pregnant women. Acta Obstet Gynecol Scand. 2009; 88(3):314-9. DOI: 10.1080/00016340802702201. View

14.

Ishida J, Matsuoka T, Saito-Fujita T, Inaba S, Kunita S, Sugiyama F . Pregnancy-associated homeostasis and dysregulation: lessons from genetically modified animal models. J Biochem. 2011; 150(1):5-14. DOI: 10.1093/jb/mvr069. View

15.

Balajewicz-Nowak M, Furgala A, Pitynski K, Thor P, Huras H, Rytlewski K . The dynamics of autonomic nervous system activity and hemodynamic changes in pregnant women. Neuro Endocrinol Lett. 2016; 37(1):70-7. View

16.

Wang L, Leng J, Liu H, Zhang S, Wang J, Li W . Association between hypertensive disorders of pregnancy and the risk of postpartum hypertension: a cohort study in women with gestational diabetes. J Hum Hypertens. 2017; 31(11):725-730. PMC: 5628121. DOI: 10.1038/jhh.2017.46. View

17.

Tkachenko O, Shchekochikhin D, Schrier R . Hormones and hemodynamics in pregnancy. Int J Endocrinol Metab. 2014; 12(2):e14098. PMC: 4005978. DOI: 10.5812/ijem.14098. View

18.

Poyhonen-Alho M, Viitasalo M, Nicholls M, Lindstrom B, Vaananen H, Kaaja R . Imbalance of the autonomic nervous system at night in women with gestational diabetes. Diabet Med. 2010; 27(9):988-94. DOI: 10.1111/j.1464-5491.2010.03062.x. View

19.

Zygmunt A, Stanczyk J . Methods of evaluation of autonomic nervous system function. Arch Med Sci. 2012; 6(1):11-8. PMC: 3278937. DOI: 10.5114/aoms.2010.13500. View

20.

Kc K, Shakya S, Zhang H . Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015; 66 Suppl 2:14-20. DOI: 10.1159/000371628. View