Development of a clinical marker of the fetal autonomic maturation

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Disturbances of the intrauterine maturation permanently alter the development already in the prenatal period. This has implications for serious health problems in later age. Postnatal therapies cannot completely compensate those 'fetal programmed' maladjustments. The high plasticity of the prenatal developmental process causes the possibility of new primary preventive therapy strategies already during the gestation. Since morphological imaging reflects most serious intrauterine maturation disturbances only, novel approaches of prenatal diagnosis are necessary for an early identification of maladjustments on the functional level. In that context the applicants developed a maturation score (functional Autonomic Brain Age Score, fABAS). Considering the activity of the autonomic nervous system, that can be assessed by means of noninvasive heart rate recordings, a key function of the fetal functional maturation is investigated. The objective of the present project is an advancement of fABAS with respect to precise and robust use in research and clinical application. Using high quality fetal magnetocardiographic (fMCG) recordings it will be investigated, to which extent the score can be adjusted to maternal autonomic tone, fetal movements and fetal behavioural states. The resulting score will be validated using an external fMCG data set. Furthermore, it will be investigated to which extent those results can be transferred to widespread established, but technically restricted recording technologies (Cardiotocography CTG, fetal electrocardiograph fECG). The resulting fABAS system will be made available for the international scientific community. Finally, fABAS system will be tested in pilot studies of the assessment of maturation disturbances in order to design and initiate multicenter prospective studies.