背景:自主神经系统(ANS)在妊娠诱导的适应中起着核心作用,所需适应的失败与不良的新生儿和产妇结局相关。在健康妊娠中定位母体ANS功能可能有助于了解ANS功能。
目的:本研究旨在系统回顾关于使用心率变异性(HRV)监测来测量妊娠期ANS功能的研究,并确定在妊娠期是否已确定代表正常ANS功能的特定HRV模式。
方法:系统评价和荟萃分析(PRISMA)指南的首选报告项目用于指导系统评价。TheCINAHL,PubMed,Scopus,和WebofScience数据库进行搜索,以全面识别文章,没有时间跨度限制。如果他们在怀孕或分娩期间至少一次评估健康孕妇的HRV,有或没有对照组(例如,复杂的怀孕)。纳入文献的质量评估使用国家心脏,肺,和血液研究所(NHLBI)工具。采用叙事综合方法进行数据提取和分析,由于文章的范围不同,方法,方法,和评估的变量,这排除了传统的荟萃分析方法的使用。
结果:经过全面筛查,8项研究符合纳入标准。在88%(7/8)的研究中,使用心电图测量HRV,并以3种不同的方式进行操作:线性频域(FD),线性时域(TD),和非线性方法。全部测量FD(8/8),TD为75%(6/8),和非线性方法在25%(2/8)的研究中。评估持续时间从5分钟到24小时不等。在大多数研究中(5/7,71%),TD指数和大多数FD指数从孕早期到晚期下降。在FD指数中,从妊娠早期到晚期,低频(LF[nu])和LF/高频(HF)比率呈上升趋势,表明妊娠末期交感神经活动增加。
结论:我们确定了3种HRV操作方法以及潜在的指示性HRV模式。然而,我们没有发现选择测量工具的理由,测量时间范围,和操作方法,这威胁到模式发现的普遍性和可靠性。需要更多的研究来确定用于确定健康孕妇中与ANS功能相对应的HRV模式的标准和方法。
BACKGROUND: The autonomic nervous system (ANS) plays a central role in pregnancy-induced adaptations, and failure in the required adaptations is associated with adverse neonatal and maternal outcomes. Mapping maternal ANS function in healthy pregnancy may help to understand ANS function.
OBJECTIVE: This study aimed to systematically review studies on the use of heart rate variability (HRV) monitoring to measure ANS function during pregnancy and determine whether specific HRV patterns representing normal ANS function have been identified during pregnancy.
METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to guide the systematic review. The CINAHL, PubMed, SCOPUS, and Web of Science databases were searched to comprehensively identify articles without a time span limitation. Studies were included if they assessed HRV in healthy pregnant individuals at least once during pregnancy or labor, with or without a comparison group (eg, complicated pregnancy). Quality assessment of the included literature was performed using the National Heart, Lung, and Blood Institute (NHLBI) tool. A narrative synthesis approach was used for data extraction and analysis, as the articles were heterogenous in scope, approaches, methods, and variables assessed, which precluded traditional meta-analysis approaches being used.
RESULTS: After full screening, 8 studies met the inclusion criteria. In 88% (7/8) of the studies, HRV was measured using electrocardiogram and operationalized in 3 different ways: linear frequency domain (FD), linear time domain (TD), and nonlinear methods. FD was measured in all (8/8), TD in 75% (6/8), and nonlinear methods in 25% (2/8) of the studies. The assessment duration varied from 5 minutes to 24 hours. TD indexes and most of the FD indexes decreased from the first to the third trimesters in the majority (5/7, 71%) of the studies. Of the FD indexes, low frequency (LF [nu]) and the LF/high frequency (HF) ratio showed an ascending trend from early to late pregnancy, indicating an increase in sympathetic activity toward the end of the pregnancy.
CONCLUSIONS: We identified 3 HRV operationalization methods along with potentially indicative HRV patterns. However, we found no justification for the selection of measurement tools, measurement time frames, and operationalization methods, which threaten the generalizability and reliability of pattern findings. More research is needed to determine the criteria and methods for determining HRV patterns corresponding to ANS functioning in healthy pregnant persons.