Biomedical subjects

E J Mulder

Publications and source records attributed to E J Mulder.

49 records · Page 3Linked to original sources

PubMed1991

Growth and motor development in fetuses of women with type-1 diabetes. II. Emergence of specific movement patterns.

In 20 women with type-1 diabetes, the emergence of fetal movement patterns was studied using real-time ultrasound. One-hour recordings were made once a week between the 7th and 17th week of gestation. Data were compared to those obtained in uncomplicated pregnancy. The diabetic women were being treated with continuous subcutaneous insulin infusion (CSII) therapy. Except for breathing movements, there was a 1-2 week delay in the first appearance of all movement patterns which normally emerge during the first 12 weeks of pregnancy. Breathing movements were observed for the first time at an earlier age than in the control fetuses (P less than 0.02). When the emergence of frequently occurring movement patterns was plotted against fetal crown-rump length, which is usually smaller in diabetic pregnancy, there was still a general delay in comparison with the control group. The delay in motor development therefore does not run completely parallel with the delay in growth. This indicates the possible existence of a specific diabetes-related influence on the functional development of the embryonic and fetal nervous system. Hyperglycaemia, for example, may be responsible, as the delay in the emergence of fetal general movements was most profound in the women whose periconceptional quality of glucose control was poor.

Anthropometry↗

PubMed1991

Growth and motor development in fetuses of women with type-1 diabetes. III. First trimester quantity of fetal movement patterns.

Delayed emergence of movement patterns and disturbances in the development of behavioural states are often observed in the fetuses of diabetic women. The developmental course of specific fetal movement patterns was studied in 20 women with type-1 diabetes during the first trimester of pregnancy. The aim was to investigate whether maternal diabetes also has an effect on the rate of occurrence and temporal patterning of fetal movements. Real-time ultrasound recordings with a duration of 1 h were made once a week between the 7th and 17th week postmenstrual age in order to quantify fetal movements. The data were compared to those obtained in a group of uncomplicated pregnancies. The developmental trends in the occurrence of movement patterns were similar to those in the control fetuses, with the exception of startles. Before the 9th week of gestation, fetal movements occurred less frequently; this was related to the quality of maternal glucose control. After 12 weeks, the overall incidence was higher than in the control group, due to an increase in the incidence of breathing movements. The rate of breathing movements was generally slower than in the control group.

Blood Glucose↗

PubMed1991

The effects of maternal hyperoxia on fetal breathing movements, body movements and heart rate variation in growth retarded fetuses.

In hypoxemic intrauterine growth-retarded fetuses (IUGR) there is a reduction in the incidence of fetal movements and in fetal heart rate variation. A causal relationship with the impairment of fetal oxygenation has been suggested. In 16 IUGR fetuses and in 13 normally grown fetuses maternal hyperoxygenation was applied for 40 min to increase fetal PO2 levels. All IUGR fetuses had abnormal Doppler blood velocity waveforms of the umbilical artery suggesting an impaired uteroplacental exchange. The effect of hyperoxygenation on fetal breathing and body movements and on fetal heart rate was evaluated. In the IUGR fetuses there was a significant increase in fetal breathing and body movements and in heart rate variation during hyperoxygenation as compared to the preceding control period of 40 min. No significant changes in fetal breathing and body movements were found in the normally grown control fetuses. A surprising observation was the increase of the number of heart rate decelerations after discontinuation of the maternal hyperoxygenation. It is concluded that in IUGR fetuses the increase in fetal heart rate variation and the increase in the incidence of breathing and body movements during maternal hyperoxygenation substantiates the relationship between these variables and the oxygenation status of the fetus.

Female↗

PubMed1990

Body and breathing movements in near-term fetuses and newborn infants of type-1 diabetic women.

The generation of body and breathing movements was studied in relation to behavioural states in near-term fetuses (n = 12) and newborn infants (n = 7) of women with well-controlled type-1 diabetes. Results obtained from low-risk fetuses (n = 12) and neonates (n = 14) were used for comparison. Before birth, 2-h recordings were made of fetal heart rate and of fetal body movements, breathing and eye movements; the neonates were studied polygraphically during 6 h for heart rate, body movements, respiration, eye movements and EEG-pattern. The generation of body movements was similar in the fetuses of the diabetic and control groups. After birth, the duration per burst was longer in the diabetic group, both in state 1 and state 2, resulting in increased incidences. The incidence of fetal breathing movements tended to be higher in the diabetic group, but differences with the control group did not reach statistical significance. Breathing rate was considerably slower in fetuses of diabetic women than in control fetuses, both in C1F (P less than 0.001) and C2F (P less than 0.002). This indicates altered regulation of breathing movements in diabetic pregnancy. In the neonates, breathing rate was identical in both groups. In either group breathing was slower in state 1 than in state 2; such a difference was not present before birth. Periodic breathing occurred more often in the infants of diabetic women, especially in state 2 (P less than 0.02). Behavioural state organization was poor in the diabetic group, both before and after birth and resembled that of more immature fetuses and infants. The continuity of the poor behavioural state regulation from prenatal into postnatal life indicates that this cannot be attributed to the instantaneous unfavourable condition before birth.

Female↗

PubMed1989

Vibro-acoustic stimulation of the human fetus: effect on behavioural state organization.

Vibro-acoustic stimulation of the human fetus in being increasingly performed both antenatally and during labour, to differentiate between poor and good fetal health in cases of flat or otherwise suspect fetal heart rate patterns. In a controlled study we investigated the effect of the electronic artificial larynx (EAL) on fetal behavioural state organization. In 10 healthy women with normal pregnancies of 38-40 weeks of gestation, recordings of fetal heart rate, body movements and eye movements, with a duration of 120-210 min, were carried out during two consecutive days. In each fetus, 3-4 episodes of state 1F and consecutive state 2F were studied, one of which served as a control observation. EAL stimulation during state 1F was associated with excessive fetal movements and with a state change in 7 out of 9 observations (four times into 2F; three times into 4F). Stimulation during state 2F was associated with a change into 4F in four of the nine observations. On days with EAL stimulation the fetuses spent more time in state 4F or in an episode not classifiable (because of an atypical FHR pattern with tachycardia and small accelerations) than control fetuses (21% vs. 3% of time). Disorganized states or periods of state 4F sometimes lasted for more than 1 h following the stimulation. It is concluded that stimulation with the EAL induces excessive fetal movements, a prolonged tachycardia, non-physiological state changes and a disorganisation and change in the distribution of fetal behavioural states. Until more is known regarding the safety and risks of vibro-acoustic stimulation, it should not be used in a routine clinical setting.

Acoustic Stimulation↗

PubMed1989

The effect of (induced) maternal emotions on fetal behaviour: a controlled study.

In ten healthy near-term pregnant women the effect of induced maternal emotions on fetal motor behaviour was studied. Emotions were induced by showing a film of a normal delivery. Fetal behaviour was recorded by means of real-time ultrasound observations of general movements and eye movements and by fetal heart rate monitoring. The observations had a duration of 2 h. The data were compared with those obtained during a 2-h control period, which took place the day before (n = 5) or after the study period (n = 5). Maternal emotions (induced) were measured by means of psychological tests. No effects on fetal motor activity or on behavioural state organization could be found as a result of this film. There was, however, a significant positive correlation (P less than 0.01) between the mean level of anxiety of the women and the motor activity of the fetuses.

Adult↗

PubMed1987

Braxton Hicks' contractions and motor behavior in the near-term human fetus.

The transient relationship between Braxton Hicks' contractions and fetal motor behavior was studied in 14 healthy nulliparous women near term. Two-hour recordings of fetal heart rate and uterine contractions and of real-time scanning for fetal body movements, breathing, and eye movements were made. The recordings were divided into state 1F and non-state 1F. Braxton Hicks' contractions were not influenced by fetal behavioral states and state changes were not related to these contractions. Fetal body movements did not stimulate contractions, but contractions coincided with a specific clustering of body movements during the ascending part of contractions. Breathing was clustered during the descending part of short-lasting contractions but decreased gradually during the long-lasting ones. Heart rate variation was increased during contractions.

Female↗

PubMed1987

Diurnal and other variations in fetal movement and heart rate patterns at 20-22 weeks.

It was investigated when diurnal and other variations in fetal movements and in heart rate pattern emerge during the course of pregnancy. Real-time ultrasound observations were made at 13 weeks of gestation in 7 nulliparous women and at 20-22 weeks in 10 nulliparous women. The observations took place at 0800, 1300 and 2200 and lasted 60 min/session at 13 weeks and 120 min at 20-22 weeks. The fetal heart rate was recorded for 24 h at 20-22 weeks using electrocardiographic electrodes. No diurnal variations were found for any of the movement patterns at 13 weeks. At 20-22 weeks, however, significant diurnal changes were observed in the total activity, the incidence of general movements and the breathing movements, with the lowest values in the morning and the highest during the evening. Fetal breathing movements already appeared to be related to maternal meals at 20-22 weeks as their incidence was significantly lower during the third hour after meals compared to the second hour. The rank order of the incidence of movements (from high to low incidence) was fairly constant over the course of the day both at 13 and at 20-22 weeks. This confirms earlier findings that the rank order of movements is strictly age dependent. Diurnal rhythms were observed for both the fetal heart rate and its variation. The fetal heart rate was lowest between 2400 and 0600 and the heart rate variation was lowest between 0600 and 1100. The incidence of accelerations and decelerations showed no systematic fluctuations over the 24-h period. Decelerations occurred more frequently than accelerations. Episodes of high heart rate variation were associated with an increased incidence of general movements. The various diurnal variations over 24 h at 20-22 weeks generally followed the same temporal sequence as those found near term, although the changes were considerably smaller.

Circadian Rhythm↗

PubMed1987

Emergence of behavioural states in fetuses of type-1-diabetic women.

The aim of this study was to investigate the effects of tightly controlled maternal (type-1-)diabetes mellitus on the development of fetal behavioural states. Seventeen diabetic women, who required insulin (White's class C predominantly) and were treated with continuous subcutaneous insulin infusion (CSII) therapy, participated in the study. Adjustment to an insulin-pump occurred before conception or during early pregnancy. In all diabetic women (near-)normoglycemia was achieved during pregnancy, with glycosylated hemoglobin-values within the normal range (6-8.5%). Fifty-three 2-h recordings of fetal heart rate, uterine contractions and of real-time ultrasound scanning for fetal body movements, breathing and eye movements were obtained from the 17 fetuses. The fetuses were longitudinally studied between 32 and 40 weeks post menstrual age, at intervals of 2 weeks. The 3 state variables, fetal heart rate, body movements and eye movements, were analyzed for the presence of combinations meeting the definitions of the four fetal behavioural states. Findings in the fetuses of diabetic women were compared with those obtained from 28 low risk fetuses. The criteria of states were met in only 3 of 8 fetuses studied at 38 weeks and in one of two studied at 40 weeks. For comparison: in low risk fetuses studied at 38 and 40 weeks, states were present in 70% and 90% of the cases, respectively. This poorly developed state organization exhibited by the near term fetuses of the diabetic group, was related to maternal parity, but not to pre- or postconceptional onset of CSII-treatment. Fetuses of nulliparous diabetic women showed more often asynchrony of transitions (greater than 3 min) and interruption of periods of concordant association. This resulted in significantly higher percentages of 'no-coincidence' and in low incidence of behavioural states as compared with control fetuses of nulliparous women. In the few multiparous diabetic cases studied near term the development of fetal behavioural states was normal. We conclude therefore that, despite tight control of maternal diabetes, the development of behavioural states is disturbed in fetuses of nulliparous diabetic women.

Adult↗

PubMed1987

Heart rate variation and movement incidence in growth-retarded fetuses: the significance of antenatal late heart rate decelerations.

In 37 intrauterine growth-retarded fetuses, combined 1-hour recordings of fetal heart rate and body movements were made within 24 hours of elective cesarean section. Fetal body movements were recorded simultaneously by use of real-time ultrasound. The study group was divided into two subgroups, according to the presence (n = 29) or absence (n = 8) of antepartum late heart rate decelerations. Correlations were made with umbilical blood gas values obtained immediately after cesarean section. Baseline heart rate variation was reduced below the normal range in 88% of the intrauterine growth-retarded fetuses with decelerations but in only 37% of the group without decelerations. A reduction in fetal heart rate accelerations and body movements and an increase in mean heart rate also were observed only in the group with decelerations. Late heart rate decelerations were associated with low PO2 values in both umbilical artery and vein. It is concluded that in intrauterine growth-retarded fetuses reduced heart rate variation and movement incidence correlate with the presence of late heart rate decelerations before birth and with hypoxemia at birth.

Cesarean Section↗

PubMed1986

Fetal behaviour in type-1 diabetic women.

Real-time ultrasound observation of fetal movement patterns can be used to assess the development of the motor component of the nervous system. Data are presented on the emergence of fetal movements in the first trimester of pregnancy, and on the development of fetal behavioural states in the third trimester, in women with type-1 (insulin dependent) diabetes. In the first trimester there is a delay in emergence of movement patterns. This delay is, however, not specific but parallels that of growth. In the third trimester there is a delay in emergence of fetal behavioural states. It is concluded that a tight metabolic control, achieved with continuous insulin infusion, does not prevent these disturbances in development.

Diabetes Mellitus, Type 1↗

PubMed1986

Abnormal fetal behavioural state regulation in a case of high maternal alcohol intake during pregnancy.

In the near term human fetus disturbed behavioural state organization has been found in cases of intra-uterine growth retardation or maternal type-1-diabetes. The present case report describes abnormal fetal behavioural state organization found in combination with maternal alcohol abuse during pregnancy. The abnormalities included frequent interruptions of the periods of concordant association of 2F-parameters, reflected by a high proportion of no-coincidence, and spontaneous awakenings (State 4F), always following stable periods of State 1F. The latter phenomenon was not found thus far by us or others, neither in normal nor in complicated pregnancies. After birth normal state organization was found. It is suggested that the abnormalities in fetal behaviour might have been due to maternal alcohol abuse, whereas a possible withdrawal effect might have occurred in utero.

Adult↗

PubMed1985

Delayed emergence of fetal behaviour in type-1 diabetic women.

In pregnancies complicated by maternal type-1 diabetes early fetal growth delay is common and it is suggested that there might be a common mechanism behind this growth delay and the induction of abnormal embryogenesis. As some of the most frequent congenital malformations involve the nervous system, the following study was performed in order to determine whether there is a specific delay in development of neural activity in these embryos and fetuses. In ten women with type-1 diabetes the emergence of specific fetal movement patterns, which are an expression of the functional motor development of the nervous system, was studied weekly by 1 h real-time ultrasound observations, starting at or before 8 weeks of gestation. Data were compared with those obtained in uncomplicated pregnancies. In all women a tight metabolic control was achieved with continuous subcutaneous insulin infusion. In six patients this treatment was started before conception. In all but one of the movement patterns emerging in the first 12 weeks of gestation a delay of 1-2 weeks was found in their first appearance. Only breathing movements were observed for the first time at the same gestational age as in the control group. Plotted according to crown-rump length the emergence of fetal movement patterns occurred, however, almost at the same time as in the control group. It is concluded, that in well controlled diabetic pregnancy there is a delay in functional motor development of the embryonic and fetal nervous system; this delay is not very specific but mostly parallels that of growth; breathing movements emerge relatively early as compared to growth.

Adult↗