A Feasibility Study of Heart Rate Variability Biofeedback on Maternal Baroreceptor and Fetal Movement Restricted; Files Only

Lazarus, Gershom Theophilus (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/x346d5242?locale=en
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Abstract

The human baroreceptor response is crucial in maintaining homeostasis. During human pregnancy, baroreceptor functioning is attenuated, and this can lead to maternal hypertension and preeclampsia with implications for fetal development. There is limited research on the use of biofeedback to activate the baroreceptor reflex in pregnant women. The feasibility of using heart rate variability (HRV) biofeedback in a pregnant population to activate the maternal baroreceptor was investigated using an ABAB’A’ design. The results indicated activation of the maternal baroreceptor that was associated with implementation of both the 1st and 2nd biofeedback. While there were initial increases in maternal HRV in association with the 1st biofeedback, the 2nd biofeedback was not associated with increased HRV. The overall fetal findings did not reveal any significant changes in fetal movement. Individual analysis of the fetal data revealed high variability of fetal movement changes that requires further investigation and currently there is no conclusive evidence to recommend the use of HRV biofeedback to target fetal movement changes. The results indicate the feasibility of using HRV biofeedback in a pregnant population to activate the maternal baroreceptor and the next step is to repeat this study in different pregnant populations.  

Table of Contents

Introduction………………………………………………………………………………………1

Present Study Overview…………………………………………………………………...1

Review of Literature………………………………………………………………………3

           Physiological Changes during Pregnancy (Baroreceptor and Heart Rate

Variability)……………………………………………………………………….. 3

           Relationship Between Fetal Movements and Maternal ANS Sensitivity…………....5

           Heart Rate Variability Biofeedback………………………………………………..6

           Mechanisms of Action in HRV Biofeedback……………………………………...6

Maternal “Adaptive” Intervention Affecting Changes in Maternal Baroreceptor, SDNN, or Fetal Behavior………………………………………………………...10

           Aims and Hypotheses……………………………………………………………………12

Methods………………………………………………………………………………………….13

           Research Design………………………………………………………………………….13

           Participants……………………………………………………………………………….14

Materials and Measures…………………………………………………………………...16

                       Maternal Assessments: Physiological ANS Indices………………………………..16

                       Maternal Assessments: Breathing Data…………………………………………....17

                       Fetal Assessment: Movement Amplitude.………………………………………....17

Procedure………………………………………………………………………………....17

Data Analysis Plan………………………………………………………………………...20

Results…………………………………………………………………………………………….21

Breathing Data (N=20; ABA)……………………………………………………………..21

           Maternal Autonomic Nervous System (N=20; ABA)……………………………………...22

Breathing Data (N=20; ABAB’A’)………………………………………………………...24

Compliance Data………………………………………………………………………….26

           Maternal Autonomic Nervous System (N=20; ABAB’A’)…………………………………27

           Fetal Movement Amplitude (N=20; ABAB’A’)…………………………………………....29

           Case-by-case Individual Analysis: Mean and Trend………………………………………..30

Discussion………………………………………………………………………………………...38

           Maternal Implications………………………………………………………………….......38

           Fetal Implications…………………………………………………………………..............42

           Limitations and Future Directions………………………………………………………43

           Conclusion……………………………………………………………………………....49

References………………………………………………………………………………………50

Appendix A……………………………………………………………………………………..55

Appendix B……………………………………………………………………………………..57

Appendix C……………………………………………………………………………………..

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