An investigation of fetal behavioural states during maternal sleep in healthy late gestation pregnancy: an observational study.

KEY POINTS: Fetal behavioural state in healthy late gestation pregnancy is significantly affected by maternal position overnight. Maternal left lateral position is the one most frequently adopted at sleep onset. The maternal position at sleep onset is maintained the longest overnight. Fetal state 1F is more common in maternal supine positions overnight. Fetal state 4F is less common in maternal supine sleep positions. Fetal state and maternal sleep position are independently associated with fetal heart rate variability. Maternal sleep position significantly affects fetal heart rate and heart rate variability and affects circadian fetal heart rate patterns. ABSTRACT: Fetal behavioural states (FBS) are measures of fetal wellbeing. Maternal position affects FBS with supine position being associated with an increased likelihood of fetal quiescence consistent with the human fetus adapting to a lower oxygen consuming state. Several studies have now confirmed the association between sleep position and risk of late intrauterine death. We designed this study to observe the effects of maternal sleep positions overnight in healthy late gestation pregnancy. Twenty-nine healthy women had continuous fetal ECG recordings overnight. Two blinded observers assigned fetal states in 5 min blocks. Measures of fetal heart rate variability (FHRV) were calculated from ECG beat to beat data. Maternal position was determined from infrared video recording. Compared to state 2F (active sleep), 4F (active awake-high activity) occurred almost exclusively when the mother was in a left or right lateral position. State 1F (quiet sleep) was more common when the mother was supine [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.11-1.52] and less common on the maternal right side with the left being the referent position (OR 0.81, 95% CI, 0.70-0.93). State 4F was more common between 21.00 and 01.00 h than between 01.00 and 07.00 h (OR 2.83, 95% CI 2.32-3.47). In each fetal state, maternal position had significant effects on fetal heart rate and measures of FHRV. In healthy late gestation pregnancy, maternal sleep position affects FBS and heart rate variability. These effects are probably fetal adaptations to positions which may produce a mild hypoxic stress.

Effect of maternal position on fetal behavioural state and heart rate variability in healthy late gestation pregnancy.

KEY POINTS: Fetal behavioural state in healthy late gestation pregnancy is affected by maternal position. Fetal state 1F is more likely to occur in maternal supine or right lateral positions. Fetal state 4F is less likely to occur when the woman lies supine or semi-recumbent. Fetal state change is more likely when the woman is supine or semi-recumbent. Fetal heart rate variability is affected by maternal position with variability reduced in supine and semi-recumbent positions. ABSTRACT: Fetal behavioural states (FBS) are measures of fetal wellbeing. In acute hypoxaemia, the human fetus adapts to a lower oxygen consuming state with changes in the cardiotocograph and reduced fetal activity. Recent studies of late gestation stillbirth described the importance of sleep position in the risk of intrauterine death. We designed this study to assess the effects of different maternal positions on FBS in healthy late gestation pregnancies under controlled conditions. Twenty-nine healthy women had continuous fetal ECG recordings under standardized conditions in four randomly allocated positions, left lateral, right lateral, supine and semi-recumbent. Two blinded observers, assigned fetal states in 5 min blocks. Measures of fetal heart rate variability were calculated from ECG beat to beat data. Compared to state 2F, state 4F was less likely to occur when women were semi-recumbent [odds ratio (OR) = 0.11, 95% confidence interval (95% CI) 0.02, 0.55], and supine (OR = 0.27, 95% CI 0.07, 1.10). State 1F was more likely on the right (OR = 2.36, 95% CI 1.11, 5.04) or supine (OR = 4.99, 95% CI 2.41, 10.43) compared to the left. State change was more likely when the mother was semi-recumbent (OR = 2.17, 95% CI 1.19, 3.95) or supine (OR = 2.67, 95% CI 1.46, 4.85). There was a significant association of maternal position to mean fetal heart rate. The measures of heart rate variability (SDNN and RMSSD) were reduced in both semi-recumbent and supine positions. In healthy late gestation pregnancy, maternal position affects FBS and heart rate variability. These effects are likely fetal adaptations to positions which may produce a mild hypoxic stress.

A description of sleep behaviour in healthy late pregnancy, and the accuracy of self-reports.

BACKGROUND: The importance of maternal sleep and its contribution to maternal and fetal health during pregnancy is increasingly being recognised. However, the ability to accurately recall sleep practices during pregnancy has been questioned. The aim of this study is to test the accuracy of recall of normal sleep practices in late pregnancy. METHODS: Thirty healthy women between 35 and 38 weeks of gestation underwent level III respiratory polysomnography (PSG) with infrared digital video recordings in their own homes. Data regarding sleep positions, number of times getting out of bed during the night and respiratory measures were collected. A sleep questionnaire was administered the morning after the recorded sleep. Continuous data were assessed using Spearman's Rho and Bland-Altman. Cohen's Kappa was used to assess recall in the categorical variables. RESULTS: Two-thirds of participants went to sleep on their left side. There was good agreement in sleep onset position between video and questionnaire data (Kappa 0.52), however the there was poor agreement on position on wakening (Kappa 0.24). The number of times getting out of bed during the night was accurately recalled (Kappa 0.65). Twenty five out of 30 participants snored as recorded by PSG. Questionnaire data was inaccurate for this measure. Bland-Altman plots demonstrated acceptable agreement between video and questionnaire data for estimated sleep duration, but not the time taken to fall asleep (sleep latency). One participant had mild obstructive sleep apnoea and another probable high upper airways resistance. CONCLUSIONS: Sleep onset position, sleep duration and the number of times getting out of bed during the night were accurately recalled, but sleep latency and sleep position on waking were not. This study identifies the sleep variables that can be accurately obtained by questionnaire and those that cannot.

Validation of thoracic impedance cardiography by echocardiography in healthy late pregnancy.

BACKGROUND: Assessment of stroke volume (SV) is often necessary in clinical and research settings. The clinically established method for SV assessment in pregnancy is echocardiography, but given its limitations, it is not always an appropriate measurement tool. Thoracic impedance cardiography (ICG) allows continuous, non-invasive SV assessment. However, SV determination relies on assumptions regarding the thoracic shape that may mean the algorithm is not valid in pregnancy. The available data regarding the validity of ICG against an established reference standard using modern SV algorithms are both limited and conflicting. We aimed to test the validity of ICG in a clinically realistic setting in late pregnancy using echocardiography. METHODS: Twenty-nine women in late pregnancy underwent standard echocardiography assessments with simultaneous ICG measurement. Agreement between devices was tested using Bland-Altman analysis. RESULTS: Bland-Altman analysis of the relationship between ICG and echocardiography demonstrated that the 95% limits of agreement exceeded acceptable or expected ranges. Measures of maternal and fetal anthropometry do not account for the lack of agreement. CONCLUSIONS: Absolute values of SV as determined by ICG are not valid in pregnancy. Further work is required to examine the ability of ICG to assess relative changes in maternal haemodynamics in late pregnancy.

Effects of high-intensity intermittent priming on physiology and cycling performance.

The pre-event warm-up or "priming" routine for optimising cycling performance is not well-defined or uniform to a specific event. We aimed to determine the effects of varying the intensity of priming on 3 km cycling performance. Ten endurance-trained male cyclists completed four 3 km time-trials (TT) on four separate occasions, each preceded by a different priming strategy including "self-selected" priming and three intermittent priming strategies incorporating 10 min of constant-load cycling followed by 5 × 10 s bouts of varying relative intensity (100% and 150% of peak aerobic power, Wpeak, and all-out priming). The self-selected priming trial (379 ± 44 W) resulted in similar mean power during the 3 km TT to intermittent priming at 100% (376 ± 45 W; -0.7%; unclear) and 150% (374 ± 48 W; -1.5%, unclear) of Wpeak, but significantly greater than all-out priming (357 ± 45 W; -5.8%, almost certainly harmful). Differences between intermittent and self-selected priming existed with regards to heart rate (6.2% to 11.5%), blood lactate (-22.9% to 125%) and VO2 kinetics (-22.9% to 8.2%), but these were not related to performance outcomes. In conclusion, prescribed intermittent priming strategies varying in intensity did not substantially improve 3 km TT performance compared to self-selected priming.

Changes of whole-body power, muscle function, and jump performance with prolonged cycling to exhaustion.

PURPOSE: To quantify how whole-body power, muscle-function, and jump-performance measures change during prolonged cycling and recovery and determine whether there are relationships between the different fatigue measures. METHODS: Ten competitive or recreationally active male cyclists underwent repeated 20-min stages of prolonged cycling at 70% VO2peak until exhaustion. Whole-body peak power output (PPO) was assessed using an all-out 30-s sprint 17 min into each cycle stage. Ratings of perceived exertion (RPE) were recorded throughout. Isometric and isokinetic muscle-function tests were made between cycle stages, over ~6 min, and during 30-min recovery. Drop-jump measures were tested at exhaustion and during recovery. RESULTS: PPO initially increased or was maintained in some subjects but fell to 81% of maximum at exhaustion. RPE was near maximal (18.7) at exhaustion, with the time to exhaustion related to the rate of rise of RPE. PPO first started to decline only when RPE exceeded 16 (ie, hard). Peak isometric and concentric isokinetic torque (180°/s) for the quadriceps fell to 86% and 83% of pretest at exhaustion, respectively. In contrast, the peak concentric isokinetic torque (180°/s) of the hamstrings increased by 10% before declining to 93% of maximum. Jump height fell to 92% of pretest at exhaustion and was correlated with the decline in PPO (r = .79). Muscle-function and jump-performance measures did not recover over the 30-min postexercise rest period. CONCLUSIONS: At exhaustion, whole-body power, muscle-function, and jump-performance measures had all fallen by 7-19%. PPO and drop-jump decrements were linearly correlated and are appropriate measures of maximal performance.