Maturation of the human fetal startle response: evidence for sex-specific maturation of the human fetus.

Despite the evidence for early fetal experience exerting programming influences on later neurological development and health risk, very few prospective studies of human fetal behavior have been reported. In a prospective longitudinal study, fetal nervous system maturation was serially assessed by monitoring fetal heart rate (FHR) responses to vibroacoustic stimulation (VAS) in 191 maternal/fetal dyads. Responses were not detected at 26 weeks gestational age (GA). Sex-specific, age-characteristic changes in the FHR response to VAS were observed by 31 weeks' GA. Males showed larger responses and continued to exhibit maturational changes until 37 weeks' GA, females however, presented with a mature FHR startle response by 31 weeks' GA. The results indicate that there are different rates of maturation in the male and female fetuses that may have implications for sex-specific programming influences.

Low levels of corticotropin-releasing hormone during early pregnancy are associated with precocious maturation of the human fetus.

Elevation in placental corticotropin-releasing hormone (pCRH) during the last trimester of pregnancy has been associated with an increased risk for preterm delivery. Less is known about the consequences for the human fetus exposed to high levels of pCRH early in pregnancy. pCRH levels were measured in 138 pregnant women at least once at 15, 20 and 25 weeks of gestation. At 25 weeks of gestation, fetal heart rate (FHR) responses to a startling vibroacoustic stimulus (VAS) were recorded as an index of maturity. pCRH levels at 15 weeks of gestation, but at no later point, predicted FHR responses to the VAS. Fetuses exposed to the lowest concentrations of pCRH at 15 weeks of gestation exhibited a distinguishable response to the VAS, whereas fetuses exposed to higher levels of pCRH did not respond. The findings suggest that exposure to low levels of pCRH early in gestation may be optimal and associated with a response pattern indicating greater maturity.

Fetal pulse oximetry: correlation between oxygen desaturation, duration, and frequency and neonatal outcomes.

OBJECTIVE: The purpose of this study was to identify the threshold of fetal arterial oxyhemoglobin saturation that predicts neonatal acidosis and adverse outcomes. STUDY DESIGN: Fetal oxygen saturation data from a published randomized controlled trial of fetal pulse oximetry were evaluated in relation to the number and duration of low fetal oxygen saturation episodes and neonatal outcomes. Fetal oxygen saturation episodes (epochs) of at least 10-second duration were categorized into the following groups: (1). <30% and >or=25%, (2). <25% and >or=20%, (3). <20%, and (control) randomly selected control subjects >30%. RESULTS: One hundred seventy-four fetal heart rate tracings were identified. An analysis of mean umbilical artery pH revealed a significant difference between groups 1 and 3 compared with the control subjects. The incidence of adverse neonatal outcome was significantly greater when the number of epochs exceeded 10. An analysis of the duration of fetal oxygen saturation of <30%, as correlated with neonatal compromise, was not significant. CONCLUSION: This study confirms previous findings that fetal oxygen saturation of <30% is associated with declining fetal arterial pH. There appears to be an association between adverse neonatal outcomes and >10 epochs of <30%.