Highlights
- •Raw fetal electrocardiogram data were recorded noninvasively at different gestations.
- •Fetal heart rate patterns were derived from the stored raw data.
- •Accelerations of the fetal heart rate were used as a proxy for fetal movements.
- •Duration of accelerations was significantly longer in women who used marijuana or methamphetamine.
- •Number of accelerations was significantly fewer in complicated pregnancies.
- •Duration of accelerations was significantly longer in women who concomitantly uses alcohol and tobacco, as early as 20–24 weeks’ gestation.
Abstract
Objective
To determine the value of quantifying accelerations of the fetal heart rate (FHR),
as collected non-invasively during pregnancy, as a proxy for fetal movements.
Study Design
The study consists of a prospective collection of research material with retrospective
analyses of the collected fetal electrocardiograms (ECGs), done in a homogeneous population
in a low socioeconomic residential area of Cape Town, South Africa, as part of the
Safe Passage Study. Recruitment and follow-up were done from August 2007 to August
2016. Maternal and fetal ECGs were collected non-invasively at various gestational
ages, for approximately 30–60 min at a time in 4418 pregnant women. After processing
of the signal, the number and duration of accelerations and the area under the acceleration
curve of the FHR were calculated and compared with the pulsatility index (PI) of the
uterine, umbilical, and middle cerebral arteries, common medical conditions, tobacco,
alcohol, marijuana, and methamphetamine use and z-scores of the birthweight (BWZS).
Results
Of the total, 2777, 691, and 3879 women were at gestational ages of 20–24, 28–32 and
34–38 weeks respectively. At 20–24 weeks duration of accelerations was significantly
longer in women who used marijuana (p = 0.014) or methamphetamine (p < 0.001) when
compared to nonusers. At 28–32 weeks the duration of accelerations was significantly
shorter in hypertensive women (p = 0.003) and significantly longer in women who used
methamphetamine (p = 0.015). At 34–38 weeks the number of accelerations were significantly
less in women who had hypertension ((p = 0.01) or stillbirths (p = 0.028) and the
duration significantly shorter in hypertensive women (p = 0.007) and significantly
longer in women who used marjuana (p = 0.003) or methamphetamine (p = 0.028). The
acceleration area was significantly smaller (p = 0.02) in women who has stillbirths.
Duration of accelerations was significantly longer in users of nicotine and alcohol
when compared with that of abstainers. Birthweight z-score correlated significantly
with number of accelerations (p < 0.01) and the acceleration area (<0.01). There was
a significant negative correlation between the number of accelerations (p < 0.01)
and acceleration area (p < 0.01) and the PI of the uterine artery at 34–38 weeks.
Conclusions
Calculation of the acceleration parameters of the FHR during pregnancy may provide
useful information for evaluating fetal development.
Keywords
Abbreviations:
BWZS (birthweight z-score), fECG (fetal electrocardiogram), FGR (fetal growth restriction), FHR (fetal heart rate), GA (gestational age), MCA (middle cerebral artery), mECG (maternal electrocardiogram), PI (pulsatility index), SPS (Safe Passage Study)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 08, 2022
Accepted:
October 3,
2022
Received in revised form:
September 20,
2022
Received:
June 16,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
