Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG.

Journal Article (Journal Article)


Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR.


Prospective case-control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2-3 months, was measured at birth.


538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother-child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (- 0.49-0.18), p < 0.001].


Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied.

Trial registration

Clinical trial registration: NCT03389178.

Full Text

Duke Authors

Cited Authors

  • Lobmaier, SM; Müller, A; Zelgert, C; Shen, C; Su, PC; Schmidt, G; Haller, B; Berg, G; Fabre, B; Weyrich, J; Wu, HT; Frasch, MG; Antonelli, MC

Published Date

  • February 2020

Published In

Volume / Issue

  • 301 / 2

Start / End Page

  • 405 - 414

PubMed ID

  • 31781889

Electronic International Standard Serial Number (EISSN)

  • 1432-0711

International Standard Serial Number (ISSN)

  • 0932-0067

Digital Object Identifier (DOI)

  • 10.1007/s00404-019-05390-8


  • eng