Fetal Behavior Research Articles

Lateralization, praxis, and communicative gestures: Developmental and comparative perspectives

This special issue is the result of a workshop held in the fall of 2012 at Paris Descartes Universite, Paris, France. The goal of the workshop was to explore the relationships between different aspects of hand-use lateralization, that is, hand preference for praxis and communication through their developments in human infants, and by comparing them with nonhuman primates who also lack language. The workshop brought together an interdisciplinary group of scholars: comparative and developmental psychologists, ethologists, and neuroscientists convened for 1 day of talks and discussions. This special issue gathers the contributions of some of those participants. The first article (MacNeilage) places hand-use lateralization within a larger context by synthesizing evidence of left brain/right side asymmetries in routine whole-body actions in several species of marine mammals. The reported data suggest a commonality of patterns between humans and marine mammals for leading the right side in turning asymmetries. MacNeilage postulates that such asymmetries may be the result of a left-hemisphere intentional control and more generally, a left-hemisphere specialization for movement dynamics (Sainburg, 2005). Three articles are concerned with the lateralization of motor behavior in human fetuses and human infants. Hepper notes the early emergence of lateralized behaviors during the prenatal period (from 10 weeks gestation). He proposes that mediation of these behaviors is most likely genetic and that the pattern of fetal lateralization is the precursor of the laterality observed postnatally. Although it can be tempting to relate the behavioral biases with structural and functional differences between the hemispheres, Hepper cautions against interpreting the former as a casual effect of the latter. In her article, Fagard questions the relationships between hand preference and hemispheric specialization for language. Even as early fetal signs of lateralization become better known, she notes that there is still too little evidence about: (1) how genetic and environmental factors interact to lead to mature handedness and language lateralization; and (2) what exactly is the nature of the relationship between both processes of lateralization. Are handedness and hemispheric specialization for language causally related (and in which direction) or independent in origin? To answer these questions, Fagard calls for considering their codevelopment during early ontogeny. In their article, Michel and colleagues tackle the issue of the relationships of the development of handedness and that of hemispheric specialization for speech processing. They borrow the developmental sequence proposed by Arbib’s (2006) mirror system hypothesis about the linkage of action and language. This view is based on the idea that hand preference must reflect a lateralized difference in neural control of manual actions and speech actions (gestures) that will ultimately lead to speech. Michel and colleagues employ embodiment theory to suggest that Manuscript Received: 21 June 2013 Manuscript Accepted: 21 June 2013 Correspondence to: Jacques Vauclair Article first published online in Wiley Online Library (wileyonlinelibrary.com): 19 July 2013 DOI 10.1002/dev.21152 2013 Wiley Periodicals, Inc. Developmental Psychobiology

Assessment of motoric and hemodynamic parameters in growth restricted fetuses – case study

Objective: In order to more accurately assess fetal neurological status in five fetuses with severe intrauterine growth restriction (IUGR), combined assessment of their hemodynamics and motor activity was undertaken in this study.Method: Hemodynamic changes in the placental and fetal cerebral vessels were evaluated using the umbilical artery resistance index (URI), and the middle cerebral artery resistance index (CRI). The blood flow redistribution towards the fetal brain in response to fetal hypoxia was detected by the C/U (cerebro – umbilical) ratio, expressed as CRI/URI.Motoric parameters were assessed by new antenatal neurologic scoring test named Kurjak Antenatal Neurodevelopmental Test (KANET), based on evaluation of spontaneous motor activity using four-dimensional (4D) ultrasound.Results: KANET has potential in recognizing pathologic and borderline behavior in IUGR fetuses with or without blood flow redistribution towards the fetal brain. Very low values of C/U ratio and abnormal KANET score have indicated adverse pregnancy outcome.Conclusion: In some pregnancies complicated with IUGR, estimation of the risk of hypoxia versus prematurity can be extremely puzzling. Combined assessment of hemodynamic and motoric parameters in IUGR fetuses could allow construction of an algorithm, which would be helpful in the decision making process of pregnancy termination.

The Assessment of Fetal Behavior of a Fetus with Lissencephaly by 4D Ultrasound

ABSTRACT Lissencephaly is malformation of gyral and sulcal structures of the cerebrum as a result of abnormal neuronal migration. The most common clinical manifestations of lissencephaly are severe psychomotor retardation, developmental defects, seizures, failure to thrive, and infant or early childhood deaths. Because direct assessment of functional development of the central nervous system in fetus and infant is not feasible, patients with lissencephaly who survive infancy are usually not diagnosed until childhood. Recently, the analysis of fetal behavior has been proposed as a measure of neurological maturation, which would be valuable in the diagnostic pathway of lissencephaly. In our knowledge the assessment of fetal behavior in a fetus with lissencephaly was not published yet in the literature. How to cite this article Yi—iter AB, Gönenç G, ¤Õçi H, Güdücü N. The Assessment of Fetal Behavior of a Fetus with Lissencephaly by 4D Ultrasound. Donald School J Ultrasound Obstet Gynecol 2013;7(2):208-212.

History of perinatal loss and maternal–fetal attachment behaviors

Maternal-fetal attachment (MFA) is an important requirement for optimal maternal-infant adaptation. Current studies showed conflicting findings about whether a history of perinatal loss (fetal/neonatal death) affects maternal attachment in pregnancy. "Does a history of perinatal loss affect maternal-fetal attachment behaviors?" One hundred women with and without a history of PL were recruited using a convenience method of sampling, from prenatal care services affiliated to Shahid Behesti University of Medical Sciences. Data collected by questionnaires from a convenience sample of multiparous women in the 3rd trimester of pregnancy with no surviving children were compared with data from a selected cohort of primigravid women. The two groups of women were matched for health and literacy. The data collected included demographic characteristics and responses to 24 questions in five groups of behaviors on the Persian version of Cranly's Maternal-Fetal Attachment Scale. Data were analyzed by SPSS 13 and using t, ANOVA, Chi square, Pearson correlation and Mann-Whitney tests. Finding showed that total score of MFA for women with a history of PL (68.95±9.20%) is not significantly different from this score for women without such a history (71.22±11.75%; p<0.05). Women with a history of PL had a significantly lower score for a subgroup of behaviors "differentiation of self from fetus" compared to women without of a history of PL (78.25 vs. 83.21%; p<0.05). But, there were no statistically significant differences between two groups respecting to other subgroups of behaviors between two groups. In this study, a history of pregnancy loss was found to be associated with disturbances in the group of maternal-fetal attachment behaviors related to "differentiation of self from fetus" in a subsequent pregnancy.

How to Measure Prenatal Stress? A Systematic Review of Psychometric Instruments to Assess Psychosocial Stress during Pregnancy

A growing body of literature documents associations of maternal psychosocial stress during pregnancy with fetal, infant and child behaviour and development. However, findings across studies are often inconsistent, which may in part be due to differences in stress definitions and assessments. We systematically reviewed methods applied to assess maternal psychosocial stress during pregnancy in studies looking at associations with biobehavioural outcomes in the offspring. A systematic literature search was performed on Web of Science and PubMed for the time period between January 1999 and October 2009. Psychometric instruments assessing maternal psychosocial stress during pregnancy were identified and described if data on psychometric properties were available. We identified 115 publications that assessed psychosocial stress during pregnancy with validated methods. These publications applied overall 43 different instruments assessing constructs falling under seven categories, ordered according to their frequency of use: anxiety, depression, daily hassles, aspects of psychological symptomatology (not reduced to anxiety or depression), life events, specific socio-environmental stressors and stress related to pregnancy and parenting. If available, we provide information on validity and reliability of the instruments for samples of pregnant women. Within the 'prenatal stress' research, a broad range of instruments is applied to assess psychosocial stress during pregnancy. Prenatal stress research should take into consideration that the variety of methods in use might hamper the comparability of stress research results. In each category of stress constructs, one instrument with good psychometric properties in pregnant women is highlighted as the best currently available measure.

The study of fetal neurobehavior in twins in all three trimesters of pregnancy

Aim: The aim was to assess the onset and the frequencies of the first intertwin contacts by four-dimensional ultrasound (4D US) in the 1st trimester of pregnancy. In the second part of the study, fetal behavior and Kurjak Antenatal Neurodevelopmental Test (KANET) score of twins compared to singletons in the 2nd and the 3rd trimesters was assessed.Patients and methods: Transvaginal 4D assessment was performed in 20 women in the 1st trimester between 56 and 69 postmenstrual days (PMD), while trans-abdominal approach was performed from 70 PMD onwards and at weekly intervals until 112 PMD. Fetal behavior was assessed by 4D UD US between 28 and 36 gestational weeks in 49 twin pregnancies.Results: The first intertwin contacts appeared at 61 PMD, while complex body movements appeared at 68 PMD. The complexity of intertwin contacts increased from 84 PMD. With increasing gestational age, a higher frequency of movements was observed. The number of abnormal, borderline, and normal KANET scores between singletons and twins was not statistically significant. Scores for isolated eye blinking, mouthing, grimacing, hand to head movement, finger movements, Gestalt perception and general movements differed significantly in twins and singletons.Conclusions: Two types of activities were observed: spontaneous and reactive. Although twins showed less activity and different behavioral pattern than singletons, a considerable proportion of overall motility was due to intertwin contacts.

Fetal Behavior and Heart Rate in Twin Pregnancy: A Review

Fetal movements and fetal heart rate (FHR) are well-established markers of fetal well-being and maturation of the fetal central nervous system. The purpose of this paper is to review and discuss the available knowledge on fetal movements and heart rate patterns in twin pregnancies. There is some evidence for an association or similarity in fetal movement incidences or FHR patterns between both members of twin pairs. However, the temporal occurrence of these patterns seems to be for the most part asynchronous, especially when stricter criteria are used to define synchrony. The available data suggest that fetal behavior is largely independent of sex combination, fetal position, and presentation. Conversely, chorionicity appears to have some influence on fetal behavior, mainly before 30 weeks of gestation. There is preliminary evidence for the continuity of inter-individual differences in fetal activity and FHR patterns over pregnancy. Comparisons between studies are limited by large methodological differences and absence of uniform concepts and definitions. Future studies with high methodological quality are needed to provide a more comprehensive knowledge of normal fetal behavior in twin pregnancy.

Fetal Behavior in 4D Ultrasound in the Progress of Perinatal Medicine

It has been suggested that the assessment of fetal behavior and developmental processes in different periods of gestation may make possible the distinction between normal and abnormal brain development, as well as early diagnosis of various structural or functional abnormalities. Early detection and prevention of perinatal neurological damage are one the most important tasks of perinatal medicine. Development of modern imaging method, four dimensional sonography, provided us new insight into fetal behavior. The aim of this review is to present prenatal neurologic screening test for the assessment of fetal behavior, based on four dimensional ultrasound. Test is named Kurjak Antenatal Neurodevelopmental Test (KANET). Up to know assessment of fetal behavior using KANET provided very promising results.

Quantitative Analysis of Fetal Actocardiogram: Update

Abstract Aims: The actocardiogram (ACG), which recorded fetal heart rate (FHR) and movements, was quantitatively analyzed, due to its advantage to the FHR patterns diagnosis, to recognize the effect of fetal movement on FHR, to solve controversial FHR problems, to correctly evaluate fetal disorders, and to evaluate the loss of variability and acceleration. Methods: FHR changes were diagnosed by the FHR score, fetal movements were evaluated by 4 ACG parameters, fetal behavior and abnormal FHR were quantitatively determined, physiologic sinusoidal FHR was diagnosed by the ACG and FHR frequency analysis, the developing mechanism of FHR acceleration and variability were studied to diagnose the brain damage in the loss of FHR variability. 1.3 Results: The FHR score, neural network analysis and A/B ratio predicted short and long term outcomes in the 1st stage of labor or even in pregnancy. The ACG and frequency analysis differentiated physiologic sinusoidal from the true one, Contoversial problems in FHR were solved by the quantitative ACG analysis. The loss of FHR variability was the sign of fetal brain damage even in fetal non-hypoxic insults. Results: The FHR score, neural network analysis and A/B ratio predicted short and long term outcomes in the 1st stage of labor or even in pregnancy. The ACG and frequency analysis differentiated physiologic sinusoidal from the true one, Contoversial problems in FHR were solved by the quantitative ACG analysis. The loss of FHR variability was the sign of fetal brain damage even in fetal non-hypoxic insults. Conclusion: Quantitative analyses of FHR and fetal movements in ACG were indispensable in the fetal diagnosis even in general insults. Since cerebral palsy (CP) could develop in the loss of FHR variability, C-section is recommended to perform before the loss of FHR variability.

Assessment of fetal behavior using four-dimensional ultrasonography: current knowledge and perspectives

In the last decades, the development of real-time ultrasonography has allowed the direct view of the fetus in the uterus, as well as assessing its activity. The advent of three-dimensional ultrasonography (3D) at the end of the 80s initiated a new era in diagnostic imaging for Obstetrics, dramatically increasing the possibility of studying the fetus. Recently, a new technique allowing the 3D image to be transformed into real-time was introduced: the four-dimensional (4D) ultrasonography. It allows the continuous monitoring of fetal face and other surface areas, such as the extremities. Some studies have already assessed this new methodology for fetal behavior observation during different stages of pregnancy, trying to understand better the relationship between fetal central nervous system maturation and the implications for its behavior. In this article, the authors review the current use of 4D ultrasonography in the assessment of fetal behavior, and discuss the possibilities of the technique to show the neurological development of the fetus, by means of watching movement and facial expressions. They also highlight the potential applicability of this new method in this new research area of fetal medicine.

703: Association between psychosocial disorder during pregnancy and childhood attention deficit hyperactivity disorder by gestational age and race/ethnicity

pregnancy and childhood attention deficit hyperactivity disorder by gestational age and race/ethnicity Darios Getahun, Michael Fassett, Steven Jacobsen Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA, West Los Angeles Medical Center, Kaiser Permanente Southern California, Department of Obstetrics and Gynecology, Los Angeles, CA OBJECTIVE: Psychosocial distress disorder (PSD) during pregnancy is known to increase the risk of adverse perinatal outcomes. Because stressors during pregnancy may alter development of the fetal nervous system function and behavior later in life, we examined the association between PSD and childhood ADHD and whether the risk varies by gestational age and maternal race/ethnicity. STUDY DESIGN: A nested case-control study of singleton born children age 3-11 years delivered at 28 weeks of gestation (n 81,678) in Kaiser Permanente Southern California (KPSC) hospitals (1991-2006) was performed using the Perinatal Service System, Hospital Inpatient, Outpatient physician encounter, and Pharmacy records. ICD-9 codes from hospitalizations during pregnancy and infant birth certificates as well as pharmacy records on medication specific for PSD were used to ascertain the exposure and outcomes of interest. Adjusted odds ratio (OR) and 95% confidence interval (CI) were used to quantify the associations. RESULTS: Five percent of pregnancies were complicated by PSD. Compared with control children, case children were more likely to be male and of White or African-American race/ethnicity. Case children were more likely than control children to be exposed to PSD (OR 1.6, 95%CI 1.41.8). A stratified analysis by gestational age revealed that case children born at 34-36, and 37-42 weeks of gestation, were significantly more likely to be exposed to PSD (1.8-fold [95%CI 1.3, 2.5], and 1.6-fold [95%CI 1.4-1.8], respectively). PSD was associated with increased odds of ADHD across all racial/ethnic groups except Asian/Pacific Islanders. CONCLUSION: The results suggest that maternal PSD during pregnancy is associated with increased risk of childhood ADHD. Identification of at-risk children may provide the opportunity for early diagnosis and initiate treatment when it is more effective.

Neurodevelopmental fetal assessment using KANET scoring system in low and high risk pregnancies

Objective: To assess and compare fetal behavior and neurodevelopment (KANET) between low and high risk pregnancies. Methods: Prospective, comparative, cohort study. One hundred and fifty-two consecutive pregnant women presenting for routine 2nd trimester and 3rd trimester scan had four dimensional ultrasound examinations (4D US) in order to assess fetal behavior and neurodevelopment. This was achieved by the study of: (1) isolated head movements, (2) isolated hand movements, (3) isolated leg movements, (4) cranial sutures, (5) hand to face/head movements, (6) finger movements, (7) yawning – mouthing, (8) facial expressions, (9) isolated eye blinking, (10) “Gestalt” perception. According to the maternal background risk, the population of the study was classified in low risk pregnancies (n = 78) and high risk pregnancies (n = 74) with IUGR fetuses (n = 12), diabetes mellitus (n = 24), and pre-eclampsia (n = 38). Results: The neurodevelopmental score was statistically significant higher in the low risk group compared to the high risk group (p < 0.0004). The diabetes subgroup score was statistically significantly higher compared to the IUGR and the pre-eclampsia subgroup (p = 0.0001). Conclusions: The neurodevelopment fetal assessment by 4D ultrasound appears to be a feasible technique in the evaluation of high risk pregnancies. Further studies where any association between KANET score and neurological outcome of the childhood are warranted.

The Assessment of Fetal Neurobehavior with Four-dimensional Ultrasound: The Kurjak Antenatal Neurodevelopmental Test

ABSTRACT Fetal neurology is an evolving field in prenatal diagnosis and fetal medicine with great interest. The identification and diagnosis of brain damage prenatally has been a great challenge in obstetrics for many years and early identification of this damage would have implications on the perinatal management and is of great importance in cases of medical litigation. Defining normal and abnormal fetal neurological function in utero in order to better predict antenatally which fetuses are at risk for adverse neurological outcome still is under investigation. Several attempts have been made in the past to form a system that could detect fetuses with compromised central nervous system (CNS) function or brain impairement. Assessment of fetal behavior gave a promising opportunity to understand the hidden function of the developmental pathway of the fetal CNS. The assessment of normal neurobehavioral development by fourdimensional (4D) ultrasound gave the opportunity to investigate functional characteristics of the fetus that could predict neurological developmental dysfunction. These series of studies lead to the formation of Kurjak's antenatal neurodevelopmental test (KANET). KANET combines the assessment of fetal behavior, general movements and three out of four signs that have been postnatally considered as symptoms of possible neurodevelopmental impairment (neurological thumb, overlapping sutures and small head circumference). Assessment of fetal behavior by 4D ultrasound and application of KANET scoring test has been recently published in several journals and summarized results are presented in this review How to cite this article Antsaklis P, Antsaklis A. The Assessment of Fetal Neurobehavior with Four-dimensional Ultrasound: The Kurjak Antenatal Neurodevelopmental Test. Donald School J Ultrasound Obstet Gynecol 2012;6(4):362-375.

Book Review: Fetal Behaviour: A Neurodevelopmental Approach

Book Review: Fetal Behaviour: A Neurodevelopmental Approach

Selective Serotonin Reuptake Inhibitors in Pregnancy

The use of antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), during pregnancy is rapidly increasing. To date, the effects of SSRI on pregnant women and fetuses are controversial and still a matter of debate. Although a number of studies have shown that these antidepressants are not teratogenic, some of them have reported an increase of congenital malformations after antenatal exposure to SSRIs. Moreover, fetal behavior is affected by these drugs, 30% of infants suffer from neonatal withdrawal symptoms and long term sequelae have not yet been excluded. Since there are no clear guidelines for SSRI treatment in pregnancy, potential risks must be balanced against the effects of untreated maternal depression. Treatment with SSRIs before and during pregnancy should only be considered in case of real necessity. Milder forms of depression should be treated with alternative methods. In this paper we have reviewed the literature on effects of SSRIs on embryonic, fetal and infant development.

Relaxation During Pregnancy

Previous studies have reported associations between maternal stress during pregnancy and obstetric outcomes as well as fetal development and neonatal adaptation. These findings highlight the importance of identifying pregnant women who experience severe stress and the need for interventions that commence early in pregnancy. The aim of this study was to review studies that investigated the effects of relaxation techniques during pregnancy, including maternal, fetal, and neonatal outcomes. In addition, studies examining maternal endocrine and physiological alterations were reviewed. PubMed was searched using the following key words: maternal well-being, maternal stress, relaxation techniques, pregnancy, fetal neurobehavior, fetal heart rate, neonatal adaptation, and neonatal behavior. (1) Relaxation had a positive impact on women's emotional state. (2) Pregnancy outcomes improved with fewer admissions to the hospital, fewer obstetric complications, longer gestation, reduction of caesarean sections, and fewer postpartum complications. (3) Fetal heart rate and fetal motor activity were reduced as a result of relaxation and therefore interpreted as improved result. (4) Higher-birth-weight and improved performance on the Neonatal Behavioral Assessment Scale was related to relaxation. (5) Relaxation training was associated with reductions in maternal physiological and endocrine measures. Relaxation during pregnancy is associated with salutogenic effects that include regulation of emotional states and physiology. Relaxation is also associated with positive effects both on fetal behavior and on obstetric and neonatal outcomes. Identifying pregnant women at risk and instituting treatment early in pregnancy could improve obstetric and developmental outcomes for both the mother and her fetus.

P13.24: Behaviour of fetuses with choroid plexus cyst

Choroid plexus cyst detected during 20th week screening without other abnormalities is a case of controversy. The risk of trisomie 18 is 1:30–1:50. Incidence of choroid plexus cyst vary from 0.18% to 3.6%. The aim of our work was to find out, if fetuses with unilateral plexus cyst have normal fetal behaviour. Accessing of fetal behaviour by 3/4 D ultrasound was assayed on population of pregnant women during second trimestral ultrasound.1340 pregnant women were examined. Unilateral choroid plexus cyst without other sonografic anomalies was detected in 11 cases (0.82%). All patients had born healthy children without any neurological defect. The control group consist of random 31 singleton pregnancies with normal morphological findings. Fetal behaviour was assessed during 15 minutes by ¾ D. Frequency and speed of antebrachium movements was detected. The hand movements was slected to two goups: rapid movement (more than 0.1 m/s); and slow movement (less than 0.1 m/s). 31 fetuses of control group made 2964 movements of antebrachium during assessing time (15 min.). The average number of movements was 95.6. thereof 72.4 rapid movements and 23 slow movements. 873 movements were observed by fetuses with choroid plexus cyst. The average movement frequency was 79.3 movement/15 min, thereof 42.5 rapid movements and 37 slow movements. Differences between two groups were evaluated by Student t-test. Fetuses with choroid plexus cyst were different in behaviour. Frequency of movements was similar, but the quality was different. Fetuses with choroid plexus cyst made more slow antebrachial movements (P < 0.01) and less rapid movements (P < 0.05) compared with the control group. It seems that, the quality of behaviour of fetuses with choroid plexus cyst reminds of the behaviour older fetuses with maturated connections of cereberal and cerebral structures. These startling results show a new point of view on maturation of fetal central nervous system and cerebral tracts.

Umbilical cord accidents

Umbilical cord accidents

Experimental Study to Evaluate the Significance of Musical Stimuli in Reorientation of Fetal Head Position

ABSTRACT The effect of music on fetal behavior and deploying music therapy to reorient the breech baby has been reported. This study aims to statistically evaluate the degree of significance of using music for such applications. It is hypothesized that the musical stimulus can elicit enough fetal response to make it change its position. Quad- instrumental is composed and applied to the mother’s abdomen near the fetal head in controlled environment. The fetal basic parameters such as fetal age, fetal weight, gender, etc. are observed and the type of instrument that causes the maximum change is recorded. Out of the 46 subjects there were 32 female and 14 male fetuses. Thirteen showed displacement when stimulus was moved away from the head. The percentage of success is 28.2 hence not positive but still helpful to analyze the parametric differences between favorable and unfavorable outcomes in terms of displacement. Overall, responses of the fetuses to the given stimulus were positive and discussed. While the success rate is lower than expected, this study examined many factors that could influence the displacement results. The experiment results do not support the hypothesis that musical instruments can consistently elicit head movements from fetuses.

4D Sonography in Assessment of Fetal Neurobehavior

ABSTRACT ‘Observation of fetal behavior reflects the functioning of the central nervous system, and behavioral assessment of the fetus enables the function of the brain to be examined’.1 The introduction of four-dimensional (4D) sonography techniques would facilitate fetal behavioral assessment in three dimensions in real time during pregnancy. We describe the latest 4D sonographic studies on fetal neurobehavior in all three trimesters of pregnancy. 4D sonography also facilitated the evaluation of interhuman contact and intrapair stimulation in twin pregnancies in utero. This novel technique may assist in the evaluation of fetal neurobehavior and intertwin contact and intrapair stimulation and offer potential advantages relative to conventional two-dimensional sonography. 4D sonography may become an important modality in future research on fetal neurobehavioral development and the prenatal identification of severely brain-damaged infants. How to cite this article Hata T, Sato M, Kanenishi K, Hanaoka U, Tanaka H. 4D Sonography in Assessment of Fetal Neurobehavior. Donald School J Ultrasound Obstet Gynecol 2012;6(2):121-131.