Alterations in maternal-fetal heart rate coupling strength and directions in abnormal fetuses

Ahsan H. Khandoker, Steffen Schulz, Haitham M. Al-Angari, Andreas Voss, Yoshitaka Kimura

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Because fetal gas exchange takes place via the maternal placenta, there has been growing interests in investigating the patterns and directions of maternal-fetal cardiac coupling to better understand the mechanisms of placental gas transfer. We recently reported the evidence of short-term maternal.fetal cardiac couplings in normal fetuses by using Normalized Short Time Partial Directed Coherence (NSTPDC) technique. Our results have shown weakening of coupling from fetal heart rate to maternal heart rate as the fetal development progresses while the influence from maternal to fetal heart rate coupling behaves oppositely as it shows increasing coupling strength that reaches its maximum at mid gestation. The aim of this study is to test if maternal-fetal coupling patterns change in various types of abnormal cases of pregnancies. We applied NSTPDC on simultaneously recorded fetal and maternal beat-by-beat heart rates collected from fetal and maternal ECG signals of 66 normal and 19 abnormal pregnancies. NSTPDC fetal-to-maternal coupling analyses revealed significant differences between the normal and abnormal cases (normal: normalized factor (NF) = -0.21 ± 0.85, fetus-to-mother coupling area (A-fBBI→mBBI) = 0.44 ± 0.13, mother-to-fetus coupling area (A-mBBI→fBBI) = 0.46 ± 0.12; abnormal: NF = -1.66 ± 0.77, A-fBBI→mBBI = 0.08 ± 0.12, A-mBBI→fBBI = 0.66 ± 0.24; p < 0.01). In conclusion, maternal-fetal cardiac coupling strength and direction and their associations with regulatory mechanisms (patterns) of developing autonomic nervous system function could be novel clinical markers of healthy prenatal development and its deviation. However, further research is required on larger samples of abnormal cases.

Original languageBritish English
Article number482
JournalFrontiers in Physiology
Issue numberAPR
StatePublished - 2019


  • Coupling
  • Fetal heart rate
  • Granger causality
  • Maternal heart rate
  • Partial directed coherence


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