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Fetal heart rate, heart rate variability, and heart rate/movement coupling in the Safe Passage Study



To determine normative values for heart rate patterns in healthy fetuses.


This research is from the Safe Passage Study conducted by the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network. A standardized protocol assessed fetal heart rate (FHR), heart rate variability (HRV), and movement from 1655 fetuses at three-time points during gestation (20–24 weeks, 28–32 weeks, 34–38 weeks gestation).


FHR decreased while HRV increased over gestation. At the latter two ages, males had significantly lower FHR than females while there were no sex differences in FHR at 20–24 weeks. When accounting for the fetal state during late gestation (34–28 weeks), we found that males had significantly lower FHR than females in the active fetal state only.


Results demonstrate significant state, gestational age, and sex-related changes in cardiac activity, somatic activity, and autonomic function as the fetus approaches birth.

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The authors gratefully acknowledge the cooperation of the study participants, PASS investigators, the PASS Steering Committee Chairman Gary D.V. Hankins, MD, and members of the NICHD advisory safety monitoring board: Elizabeth Thom, PhD (Chair); Reverend Phillip Cato, PhD; James W. Collins, Jr, MD, MPH; Terry Dwyer, MD, MPH; George Macones, MD; Philip A. May, PhD; Jeff Murray, MD; Richard M. Pauli, MD, PhD; Raymond W. Redline, MD; and Michael Varner, MD. The PASS Research Network is supported by the National Institute on Alcohol Abuse and Alcoholism, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institute on Deafness and Other Communication Disorders through the Cooperative Agreement Mechanism (U01HD055154, U01 HD045935, U01 HD055155, U01HD045991, and U01 AA016501). The following institutions and researchers comprise the PASS Network (additional network members other than authors listed): DCAC: Co-Director: Lisa M. Sullivan, PhD; Biostatistics: Tara Tripp, MA; Project. Management/Regulatory Affairs: Julie M. Petersen, BA; Rebecca A. Young, MPH; Data. Management/Information Technology: Travis Baker, BS; Derek Petersen, BS; Gregory Toland MS. DBPC: Director: Hannah C. Kinney, MD, Assistant Director: Robin L. Haynes, PhD; Co- investigators: David S. Paterson, PhD; Kevin G. Broadbelt, PhD; Kyriacos Markianos, PhD, Ingrid A.Holm; MD, Theonia Boyd, MD; Drucilla Roberts, MD; Richard G. Goldstein, MD; Hanno Stein, PhD; Technicians: Claire Maggiotto, BS; Catherine Hassett, BS. CCS NP: Co-investigators: Donald Habbe, MD; H. Eugene Hoyme, MD; William Massello III, MD; Bradley Randall, MD; Mary Ann Sens, MD, PhD; Catherine Stoos, MD, Peter Van Eerden, MD; Project Management: Whitney Adler, BA; Elizabeth Berg, RN; Jessica Gromer, RN; Bethany Norton, MA; Liz Swenson, RN; Deb Tobacco, MA. CCS SA: Project Management: Erna Carstens, RN, Mandy Potter, RN, Lucy Brink, MSc, Sylvia Abrahams, RN; Allison Borchardt, RN; Noorjahan Bosman, RN; Ciska Botha, BSocSc; Lehana Breytenbach, RN; Lucy Brink, M.Sc.; Lucille Burger, RN; Carina Carstens, BCur (Nursing); Erna Carstens, RN; Weslin Charles, Hons BA (Psychol.); Milly de Jager, RN; Carlie du Plessis, RN; Sandra Felix, RN; Nicola James (Nel), MCur (Nursing); Ronnie Jurgens, RN; Belda Klukowski, RN; Mugeleigh Lakay, MCur (Nursing); Samacia Maloy, RN; Marilyn Mentor, RN; Petra Opperman, RN; Berenice Pillay, RN; Mandy Potter, RN; Earl Prinsloo, BA Hons (Sociology); Sonja Schell, RN; Marisa van der Spuy, BCur (Nursing); Mariëtta Warwick, RN. PAC: Project Management: Carmen Condon, BA; Daianna Rodriguez, BA; Albany Perez, BA; Data Processing: Margaret C. Shair, BA; Tracy Thai, BA. NIH: Project Scientists: Marian Willinger, PhD (NICHD); Dale Herald, PhD (NIAAA); Howard J. Hoffman, PhD (NIDCD); Chuan-Ming Li, MD, PhD (NIDCD); Program Officers: Bill Dunty, PhD (NIAAA); Tonse Raju, MD, DCH (NICHD); Gordon B. Hughes, MD (NIDCD). Further, the following individuals made significant contributions to the research and warrant recognition: DCAC: Idania Ramirez, MPH; Jamie Collins, MA; Laura Spurchise, MPH; DBPC: Richard A. Belliveau, BA; Kristin McMillan, BA; Megan Minter, MS; PAC: Johnston T. Grier, BA; Emilia F. Vignola, BA; Joseph J. Violaris, BA. The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the Indian Health Service (IHS) or the National Institutes of Health, the National Institute of Mental Health, the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), or the National Institute on Deafness and Other Communication Disorders (NIDCD).


This research was supported by grants T32MH016434-40 issued by the National Institute of Mental Health, U01HD055154, U01HD045935, U01HD055155, U01HD045991 and U01AA016501 issued by the National Institute on Alcohol Abuse and Alcoholism, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute on Deafness and Other Communication Disorders.

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Correspondence to Lauren C. Shuffrey.

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Shuffrey, L.C., Myers, M.M., Odendaal, H.J. et al. Fetal heart rate, heart rate variability, and heart rate/movement coupling in the Safe Passage Study. J Perinatol 39, 608–618 (2019).

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