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Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation

Pediatric Research (2023)Cite this article

Abstract

Background

Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant’s ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction.

Methods

The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes.

Results

Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p’s < 0.05).

Conclusions

Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation.

Impact

  • Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV).

  • Prenatal stress is another risk factor for autonomic dysregulation.

  • Mild PAE impacts infant self-regulation, which can be assessed using HRV.

  • However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.

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Fig. 1: Flowchart of eligibility for study participants.
Fig. 2: Changes in HRV measures between baseline, noxious stimuli (heel lance), and recovery episodes (N = 80).

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Acknowledgements

The authors would like to thank Dominique Rodriguez, Laura Stacy, Sandra Beauman, Conra Lacy, Elizabeth Kuan, and Nicole Salazar for their help with data collection and data management.

Funding

Funding

Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R01AA021771. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pediatrics, University of New Mexico, Albuquerque, NM, Mexico

    Jessie R. Maxwell

  2. Department of Neurosciences, University of New Mexico, Albuquerque, NM, Mexico

    Jessie R. Maxwell

  3. Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico

    Jared DiDomenico, Melissa H. Roberts, Lidia Enriquez Marquez, Rajani Rai & Ludmila N. Bakhireva

  4. Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada

    Joanne Weinberg

  5. Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA

    Sandra W. Jacobson

  6. The Mind Research Network, a Division of Lovelace Biomedical Research Institute, University of New Mexico, Albuquerque, NM, Mexico

    Julia Stephen

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Contributions

J.M.: substantial contributions to acquisition of data and interpretation of data; drafting the manuscript; final approval of the version for publication. M.R.: substantial contributions to analysis and interpretation of data; Revising the manuscript critically for important intellectual content; final approval of the version for publication. L.E.M.: substantial contributions to acquisition of data; revising the manuscript critically for important intellectual content; final approval of the version for publication. R.R.: substantial contributions to acquisition of data; revising the manuscript critically for important intellectual content; final approval of the version for publication. J.D.: substantial contributions to analysis and interpretation of data; revising the manuscript critically for important intellectual content; final approval of the version for publication. J.W.: revising the manuscript critically for important intellectual content; final approval of the version for publication. S.J.: contributions to acquisition of data; revising the manuscript critically for important intellectual content; final approval of the version for publication. J.S.: substantial contributions to conception and design and interpretation of data; revising the manuscript critically for important intellectual content; final approval of the version for publication. L.B.: substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; Revising the manuscript critically for important intellectual content; final approval of the version for publication.

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Maxwell, J.R., DiDomenico, J., Roberts, M.H. et al. Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02799-5

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