The effects of lockdown during the COVID-19 pandemic on fetal movement profiles.

PURPOSE: The current study investigated the direct impact of the COVID-19 lockdown on fetal movements, addressing a critical research gap. While previous research has predominantly examined the effects of lockdown on maternal health and postnatal outcomes, little attention has been paid to the direct consequences on fetal well-being as indicated by their movement profile. METHODS: We conducted analysis of movement profiles in 20 healthy fetuses during the COVID-19 pandemic lockdown (third national UK lockdown period between January and March 2021) and compared them with 20 healthy fetuses from pre-covid pregnancies, all at 32 weeks gestation. We controlled for maternal stress, depression, and anxiety. RESULTS: Pregnant mothers during pre-covid compared with those during the COVID-19 lockdown reported similar levels of stress (p = 0.47), depression (p = 0.15), and anxiety (p = 0.07). Their fetuses, however, differed in their movement profiles with mouth movement frequencies significantly higher during COVID-19 lockdown (COVID-19 lockdown: mean of 5.909) compared to pre-Covid pregnancies (mean of 3.308; p = 0.029). Furthermore, controlling for maternal anxiety a regression analysis indicated that frequency of fetal mouth movements (p = 0.017), upper face movements (p = 0.008), and touch movements (p = 0.031) were all significantly higher in fetuses observed during lockdown compared to fetuses before the Covid period. CONCLUSION: Fetuses show an effect of lockdown independent of maternal anxiety, stress, or depression. These findings contribute to our understanding of fetal development during extraordinary circumstances, raising questions about the potential effects of having to stay indoors during lockdowns.

Effects of maternal mental health on fetal visual preference for face-like compared to non-face like light stimulation.

The question of whether humans react differentially to face-like versus non face-like light stimulation in the prenatal period has been much discussed, but to date has remained unresolved. In this feasibility study we have come closer to understanding fetal vision. In contrast to other studies examining fetal reactions to prenatal light stimulation, we controlled maternal factors known to affect fetal neurodevelopment; including maternal mental health and attachment. We found that, for fetuses at 33 weeks gestation, maternal mental health (anxiety and depression), and fetal growth factors (femur length) all had a significant effect on fetal reactivity to face-like compared to a non-face-like control light stimulus. This calls into question some previously published results. We discuss implications of these findings in terms of the development of fetal visual perception.

Prenatal effects of maternal nutritional stress and mental health on the fetal movement profile.

PURPOSE: Prenatal sub-optimal nutrition and exposure to maternal stress, anxiety and depression in pregnancy have been linked to increased postnatal morbidity and mortality. Fetal growth is most vulnerable to maternal dietary deficiencies, such as those evident in hyperemesis gravidarum (HG), early in pregnancy. The purpose of this pilot study was to examine the effects of HG on fetal movement profiles as a measure of fetal healthy development in the 3rd trimester of pregnancy, and to assess whether nutritional stress on the mother can be evaluated using isotopic analysis of hair. METHOD: We analyzed fetal movement profiles using 4D ultrasound scans at 32- and 36-weeks' gestation. Fetuses of women (N = 6) diagnosed with HG, having lost more than 10% of their body weight in the first trimester of pregnancy were compared to a healthy group (N = 6), controlling for stress, depression and anxiety. We tested carbon and nitrogen isotope ratios in maternal hair as a measure of both diet and nutritional changes due to catabolism of body proteins and fats. RESULTS: HG and catabolism were significantly correlated (p = 0.02). Furthermore, at 32-weeks' gestation movement profiles of fetuses of mothers with HG differed significantly from the movement profiles of fetuses of healthy mothers. Fetuses of mothers suffering from HG showed a significantly increased ratio of fine-grained movements at 32 weeks (p = 0.008); however, there were no significant differences detectable at 36-weeks' gestation. CONCLUSION: The effect of HG on fetal development as expressed by variations in fetal movement profiles in this pilot study suggest that prenatal effects of HG can be measured using movement profiles. Isotope analysis of hair can supplement this with information on nutritional imbalances early in pregnancy.

Effects of maternal anxiety and depression on fetal neuro-development.

BACKGROUND: Fetal development is affected by maternal mental health with research indicating that maternal anxiety and depression are co-morbid; nevertheless differential effects on the fetus have been found. This study examines, prenatally, effects of maternal stress, anxiety and depression on fetal eye-blink reactions to experimental sound and light stimulation. METHODS: Two groups of singleton fetuses (mean 32-weeks gestation) were examined using 4D ultrasound: a control group (N = 14, 7 female) with no stimulation and an experimental group (N = 21, 13 female) exposed to experimental sound, light and cross-modal stimulation. For both groups ultrasound scans were performed and fetal eye-blink was assessed. Mothers completed the Hospital-Anxiety-and-Depression Scale and the Perceived-Stress Scale. Analysis was carried out using Poisson mixed effects modelling. RESULTS: Fetal eye-blink rate during experimental stimulation was significantly and differentially associated with maternal mental health with a 20% increase of fetal eye-blink rate for each unit increase in anxiety score (p = 0.02) and a decrease of 21% of eye blink rate for each unit of increase in depression score (p = 0.02). Sound stimulation but not light stimulation significantly affected blink-rate with fetuses habituating to the stimuli (p < 0.001). LIMITATIONS: Limitations are the relatively small number of fetuses and that a follow up after birth is essential to establish potential long-term effects. CONCLUSIONS: Of clinical importance is the finding that although fetuses are affected by maternal mental health in general here we demonstrate, using eye-blink-rate during stimulation as measure of neuro-development, that fetuses are differentially affected by maternal anxiety and depression with anxiety increasing and depression decreasing fetal reactivity significantly.

The development of anticipation in the fetus: a longitudinal account of human fetal mouth movements in reaction to and anticipation of touch.

Research suggests that fetuses open or close their mouth in relation to directed movements but it is unclear whether mouth opening anticipates the touch or is a reaction to touch, as there has been no analysis so far of (1) the facial area of touch and (2) the sequential ordering of touch and mouth movements. If there is prenatal development of the anticipation of touch we would expect the frequency of fetal mouth opening immediately preceding the arriving hand at the mouth area to increase with fetal age. Fifteen healthy fetuses, eight girls and seven boys, underwent four additional 4-D scans at 24, 28, 32, and 36 weeks gestation. Changes in the frequency of touch for different facial regions indicated a significant decline in touch of the upper and side parts of the face and a significant increase in touching lower and perioral regions of the face with increasing gestational age. Results supporting the hypothesis showed a significant increase in the proportion of anticipatory mouth movements before touch increasing by around 8% with each week of gestational age. Additionally there was a decrease in the proportion of reactive mouth movements decreasing by around 3% for each week of gestational age.

Development of prenatal lateralization: evidence from fetal mouth movements.

BACKGROUND: Human lateralized behaviors relate to the asymmetric development of the brain. Research of the prenatal origins of laterality is equivocal with some studies suggesting that fetuses exhibit lateralized behavior and other not finding such laterality. Given that by around 22weeks of gestation the left cerebral hemisphere compared to the right is significantly larger in both male and female fetuses we expected that the right side of the fetal face would show more movement with increased gestation. This longitudinal study investigated whether fetuses from 24 to 36weeks of gestation showed increasing lateralized behaviors during mouth opening and whether lateralized mouth movements are related to fetal age, gender and maternal self-reported prenatal stress. PARTICIPANTS: Following ethical approval, fifteen healthy fetuses (8 girls) of primagravid mothers were scanned four times from 24 to 36-gestation. Two types of mouth opening movements - upper lip raiser and mouth stretch - were coded in 60 scans for 10min. RESULTS: We modeled the proportion of right mouth opening for each fetal scan using a generalized linear mixed model, which takes account of the repeated measures design. There was a significant increase in the proportion of lateralized mouth openings over the period increasing by 11% for each week of gestational age (LRT change in deviance=10.92, 1df; p<0.001). No gender differences were found nor was there any effect of maternally reported stress on fetal lateralized mouth movements. There was also evidence of left lateralization preference in mouth movement, although no evidence of changes in lateralization bias over time. This longitudinal study provides important new insights into the development of lateralized mouth movements from 24 to 36 weeks of gestation.

Turn-taking in early vocal interaction: a comparison of premature and term infants' vocal interaction with their mothers.

AIMS: The present study was designed to test the hypothesis that mothers of premature infants compared with mothers of term infants differ in the structure which they impose on the vocal exchanges with their infants. METHODS: Thirteen mothers and their premature and term babies, were observed at discharge and 2 months later in three situations: free play, changing nappy, and feeding. Maternal child-directed speech was coded as well as the timing of their utterances in respect to the infants' vocalizations. The mean relative frequency of infant vocalizations following maternal child-directed speech was computed. RESULTS: It was found that mothers of premature babies in comparison with mothers of term babies, followed significantly more often their infants' vocalizations with an utterance directed at the child. In contrast, term infants compared with preterm infants followed significantly more often their mother's utterances with a vocalization. CONCLUSION: Mothers of premature and of term babies differ in their timing of child-directed speech. This might have implications for the language development of premature and term infants.

Maternal pitch height in ordinary and play situations.

Ten children at mean ages of 0; 11.3 and 0;15.3 and their monolingual German-speaking mothers were audio- and videotaped in their homes while having a meal with a spoon (ordinary situation) and while feeding a doll with a spoon (play situation). Sentences spoken by the mothers that were comparable in length and sentence type across situations were analysed acoustically. In both data-collection sessions, it was found that the mothers spoke with the same mean amplitude in the two situations but they used higher mean fundamental frequency when speaking during the play situation than during the ordinary situation. In the first data-collection session, when the infants did not yet use meaningful words or engage in pretend play, the mothers also used a wider pitch range in the play situation than in the ordinary situation. It is concluded that mothers use both pitch height and pitch range to introduce the preverbal infant to the difference between non-play and play situations, and they continue to use variations in pitch height to mark the same distinction after the children have become active participants in pretend play activities. Implications of the results are discussed in terms of possible longitudinal patterns associated with mothers' use of intonational key and register.

Active patients: the integration of modern and traditional obstetric practices in Nepal.

This paper describes the integration of modern and traditional obstetric practices in a provincial hospital in the Maithili-speaking area of southern Nepal. The doctors and nurses consciously distance themselves from the traditional practices of their obstetrical patients, whom they view as 'ignorant'; but because hospital resources are insufficient to impose the normative form of modern medical organization, patients and their relatives assert a more active role in providing hospital-based care. In consequence, mothers are delivered according to both modern, clinical as well as local cultural practices. Recent WHO policy has cast modern medicine as the agent in the integration of traditional healing within national health systems. This essay shows that in poor countries the powers of agency may not be exclusively in the hands of the medical profession. Patients, and others in their social networks, have become agents, constraining and negotiating the terms on which modern medicine is to be integrated within their traditional obstetric practices.

The quality of a mother's milk and the health of her child: beliefs and practices of the women of Mithila.

Among Maithil women there is an understanding of the relation between a mother's milk and the health of her child. Their understanding is supported by the Ayurvedic tradition. Characteristic is the way in which breast-feeding condenses so many meanings--nutritional, medical and moral--into one act. The mother not only nurses her child but also forms his character, fulfills her own personhood and perpetuates her husband's family.

The role of massage in south Asia: child health and development.

Massage, together with breast-feeding, are the two fundamental nurturing practices of women in south Asia. In Mithila women are expected to massage their infants daily. If they do not, they lay themselves open to censure. Implicit in massage is the idea that a child's health is preserved by fostering its strength and invulnerability. Massage 'works' by instilling fearlessness, hardening bone structure, enhancing movement and limb coordination, and increasing weight. These practices, in turn, are premised on the idea that between birth and weaning the infant is highly impressionable such that its identity can be shaped by the women who nurture it.

The development of concepts of simultaneity in children's understanding of emotions.

The development of children's understanding of simultaneously occurring emotions was investigated. A developmental progression was found in their giving examples of ambivalent situations (e.g. characterised by both happiness and anger); and in their descriptions of situations. The youngest children (mean age = 5.8) gave as examples of ambivalence two unrelated events associated with different emotions. At the next stage children (mean age = 7.0) were able to connect sequentially two events. At a third stage (mean age = 10.1) the children were able to conceive of situations in which two emotions of opposite valence occurred simultaneously.

Cognitive maturity and the experience of fear and pain in hospital.

Children between 4 years 6 months and 13 years 5 months of age who had been admitted to the St Charles Hospital, London for tonsillectomies were interviewed prior to their operation. It was found that cognitive maturity is an important factor in determining how children understand their hospital experience and the way in which they conceive of strategies for coping with fear and pain. Furthermore, it is suggested that because the younger children lack the cognitive maturity to develop autonomous strategies, they might be less able than older children to accept medical intervention, even under the most favourable conditions of hospitalization.