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The evidence so far shows that the intrinsic fHRV is influenced by the fetal ANS activity and, conversely, also shapes the ANS activity into the postnatal period, at least in part via the afferent fibers of the vagus nerve (Herry et al., 2021). Med. Hill, M. A. Mayo Clin. 41, 225233. Nat. doi: 10.1002/icd.688, Praud, J.-P., Miura, Y., and Frasch, M. G. (2017). However, it is important to highlight that so far fHR monitoring has not been enough to prevent fetal injury during labor and, consequently, long-term complications. Solutions Cells 9:733. doi: 10.3390/cells9030733, Frasch, M. G., Herry, C. L., Niu, Y., and Giussani, D. A. Exp. Neurodevelopment: the impact of nutrition and inflammation during preconception and pregnancy in low-resource settings. Nat. (2020). Diagnosis of this condition requires clinical acumen to know whether these problems are reversible or not. 9:593889. doi: 10.3389/fped.2021.593889, Goldaber, K. G., Gilstrap, L. C., Leveno, K. J., Dax, J. S., and McIntire, D. D. (1991). The endotoxemia, through lipopolysaccharide molecules, seems to interfere with the cardiac pacemaker synchronization system, altering the fHRV pattern (Frasch and Giussani, 2020). Indeed, fetuses with intrauterine growth restriction (IUGR) frequently present an oxygenation impairment, with a decrease of breathing movements and GMs, and an increasing number of HR decelerations (Bekedam et al., 1991). A growing body of evidence suggests the placenta's role in modulating fetal development. It is noteworthy that earmuffs show ambiguous results, that is, they can both help oxygenation and sleep and provoke stress (Zahr and de Traversay, 1995; Aita et al., 2013; Almadhoob and Ohlsson, 2020). 100, 141146. Cardiovasc. Thorax 57, 555558. doi: 10.1007/s10803-020-04467-7. Clin. Am. doi: 10.18632/oncotarget.20110, Gordon, C. (2004). Autonomic nervous system depression at term in neurologically normal premature infants. Novel mechanism of human fetal growth regulation: a potential role of lanugo, vernix caseosa and a second tactile system of unmyelinated low-threshold C-afferents. doi: 10.1161/JAHA.119.012629, Norman, G. J., Cacioppo, J. T., Morris, J. S., Malarkey, W. B., Berntson, G. G., and Devries, A. C. (2011). Sleep and brain development: the critical role of sleep in fetal and early neonatal brain development. Assoc. First evidence that intrinsic fetal heart rate variability exists and is affected by hypoxic pregnancy. J. Perinatol. Progressive increase in arterial oxygen tension from 20 to 220 mm Hg resulted in progressive decrease in baseline heart rate and baseline arterial blood pressure indicating presence of chemoreceptor activity over this wide range of arterial oxygen tension. doi: 10.1017/S0954579417001730, Garzoni, L., Faure, C., and Frasch, M. G. (2013). (2019). The intrapartum deceleration in center stage: a physiologic approach to the interpretation of fetal heart rate changes in labor. doi: 10.2147/IJWH.S151845, Reich, D. A., Govindan, R. B., Whitehead, M. T., Wang, J., Chang, T., Kota, S., et al. 130, 403407. Higher maternal weight is related to poorer fetal autonomic function. Cardiac orienting to auditory stimulation in the fetus. 37, 668672. Obstet Gynecol. Lack of detection of a human placenta microbiome in samples from preterm and term deliveries. Semin. Early exposure of buprenorphine induces higher levels of fHRV, whereas at 3236 GWA fetuses display less suppression of motor activity (Jansson et al., 2011; Conradt et al., 2018), indicating the involvement of the vagus nerve system. 191, 217224. In fact, epidural analgesia itself does not show precise or significant changes in fHRV (Lavin, 1982), but it can interact with other aspects already existing in the mother. Gynecol. Meas. Decelerations from cord compression can lead to severe hypoxemia and decelerations from uteroplacental insufficiency can be present without acidemia. Indeed, a prone position improves oxygenation, increases PNS tone, and lowers both salivary cortisol and stress behavior (Gomes et al., 2019). Sci. doi: 10.1038/tp.2015.32, Nensi, A., De Silva, D. A., von Dadelszen, P., Sawchuck, D., Synnes, A. R., Crane, J., et al. 1032, 6384. Once born, newborns have to deal with the extrauterine environment that, especially for preterm babies, is constituted by the incubator. 2017 Feb;216(2):163.e1-163.e6. doi: 10.1016/j.clp.2012.12.012, Shea, C. A., Rolfe, R. A., and Murphy, P. (2015). Nurs. Am J Obstet Gynecol. 1993 Feb;461:431-49. Hill, M. A. 31, 189196. 14:601939. doi: 10.3389/fnbeh.2020.601939, Sherer, M. L., Posillico, C. K., and Schwarz, J. M. (2017). doi: 10.1016/j.earlhumdev.2010.05.018, Schneider, U., Frank, B., Fiedler, A., Kaehler, C., Hoyer, D., Liehr, M., et al. Hypertension 54, 6370. a. Evidence for adverse effect of perinatal glucocorticoid use on the developing brain.

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