arXiv subjects

Marta C. Antonelli

Publications and source records attributed to Marta C. Antonelli.

10 recordsLinked to original sources

arXiv2026

Prenatal Stress Detection from Electrocardiography Using Self-Supervised Deep Learning: Development and External Validation

Prenatal psychological stress affects 15-25% of pregnancies and increases risks of preterm birth, low birth weight, and adverse neurodevelopmental outcomes. Current screening relies on subjective questionnaires (PSS-10), limiting continuous monitoring. We developed deep learning models for stress detection from electrocardiography (ECG) using the FELICITy 1 cohort (151 pregnant women, 32-38 weeks gestation). A ResNet-34 encoder was pretrained via SimCLR contrastive learning on 40,692 ECG segments per subject. Multi-layer feature extraction enabled binary classification and continuous PSS prediction across maternal (mECG), fetal (fECG), and abdominal ECG (aECG). External validation used the FELICITy 2 RCT (28 subjects, different ECG device, yoga intervention vs. control). On FELICITy 1 (5-fold CV): mECG 98.6% accuracy (R2=0.88, MAE=1.90), fECG 99.8% (R2=0.95, MAE=1.19), aECG 95.5% (R2=0.75, MAE=2.80). External validation on FELICITy 2: mECG 77.3% accuracy (R2=0.62, MAE=3.54, AUC=0.826), aECG 63.6% (R2=0.29, AUC=0.705). Signal quality-based channel selection outperformed all-channel averaging (+12% R2 improvement). Mixed-effects models detected a significant intervention response (p=0.041). Self-supervised deep learning on pregnancy ECG enables accurate, objective stress assessment, with multi-layer feature extraction substantially outperforming single embedding approaches.

q-bio.QM↗

arXiv2026

Inter-Electrode Pulse Wave Velocity: A Direct Method for Maternal Arterial Stiffness Assessment During Pregnancy Using Multi-Channel ECG

Objective: To validate a novel inter-electrode pulse wave velocity (PWV) method that measures pulse propagation between ECG electrodes without left ventricular ejection time (LVET) estimation. Methods: We analyzed 43 three-channel ECG recordings (1000 Hz) from the FELICITy 2 cohort (approximately 19 and 35 weeks gestation). R-peaks were independently detected per channel using an ensemble approach. Time lags (Delta t) between matched R-peaks across electrode pairs were used to compute PWV as PWV = L / Delta t, where L is effective inter-electrode distance. Three channel pairs yielded independent PWV estimates. Temporal stability was assessed using sliding windows (1-15 minutes). To test whether Delta t reflects morphology or vascular propagation, we evaluated three QRS fiducials (R-peak, QRS onset, maximum dV/dt) and two bandpass filters (0.5-40 and 0.5-100 Hz). Longitudinal changes were compared between control (n=24) and yoga (n=20) groups. Results: PWV values were physiologically plausible and consistent with aortic PWV (5-10 m/s): control 7.40 +/- 1.51 vs 6.98 +/- 1.63 m/s; yoga 7.10 +/- 2.15 vs 8.16 +/- 0.91 m/s (early vs late pregnancy). PWV stabilized at 5 minutes (coefficient of variation 12.3 percent), with 2.6- to 5.2-fold lower variability than heart rate and heart rate variability. Inter-electrode delays (15-27 ms) persisted across fiducials and were minimally affected by filter settings (change -8.5 percent, not significant), arguing against purely morphological distortion; PWV remained within 6.8-9.1 m/s. Preliminary group trends differed (control -5.7 percent, yoga +14.9 percent; interaction p=0.07). Conclusions: Inter-electrode PWV enables direct spatial assessment of pulse propagation with physiologically valid values, is robust to fiducial and filtering choices, and shows promise for pregnancy-related arterial stiffness assessment with standard multi-channel ECG.

physics.med-ph↗

arXiv2026

Measuring the time-scale-dependent information flow between maternal and fetal heartbeats during the third trimester

Prenatal maternal stress alters maternal-fetal heart rate coupling, as demonstrated by the Fetal Stress Index derived from bivariate phase-rectified signal averaging. Here, we extend this framework using information-theoretical measures to elucidate underlying mechanisms. In 120 third-trimester pregnancies (58 stressed, 62 control), we computed transfer entropy (TE), entropy rate (ER), and sample entropy (SE) under multiple conditioning paradigms, employing mixed linear models for repeated measures. We identify dual coupling mechanisms at the short-term (0.5 - 2.5 s), but not long-term (2.5 - 5 s) time scales: (1) stress-invariant state-dependent synchronization, with maternal decelerations exerting approximately 60% coupling strength on fetal heart rate complexity - a fundamental coordination conserved across demographics; and (2) stress-sensitive temporal information transfer (TE), showing exploratory associations with maternal cortisol that require replication. A robust sex-by-stress interaction emerged in TE from mixed models, with exploratory female-specific coupling patterns absent in males. Universal acceleration predominance was observed in both maternal and fetal heart rates, stronger in fetuses and independent of sex or stress. We provide insight into the dependence of these findings on the sampling rate of the underlying data, identifying 4 Hz, commonly used for ultrasound-derived fetal heart rate recordings, as the necessary and sufficient sampling rate regime to capture the information flow. Information-theoretical analysis reveals that maternal-fetal coupling operates through complementary pathways with differential stress sensitivity, extending the Fetal Stress Index by elucidating causal foundations. Future studies should explore additional information-theoretical conditional approaches to resolve stress-specific and time-scale-specific differences in information flow.

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arXiv2022

Autism spectrum disorder: a neuro-immunometabolic hypothesis of the developmental origins

Fetal neuroinflammation and prenatal stress (PS) may contribute to lifelong neurological disabilities. Astrocytes and microglia, among the brain's non-neuronal glia cell populations, play a pivotal role in neurodevelopment, predisposition to and initiation of disease throughout lifespan. One of the most common neurodevelopmental disorders manifesting between 1-4 years of age is autism spectrum disorder (ASD). A pathological glial-neuronal interplay is thought to increase the risk for clinical manifestation of ASD in at-risk children, but the mechanisms remain poorly understood and integrative, multi-scale models are needed. We propose a model that integrates the data across the scales of physiological organization, from genome to phenotype, and provides a foundation to explain the disparate findings on the genomic level. We hypothesize that via gene-environment interactions, fetal neuroinflammation and PS may reprogram glial immunometabolic phenotypes that impact neurodevelopment and neurobehavior. Drawing on genomic data from the recently published series of ovine and rodent glial transcriptome analyses with fetuses exposed to neuroinflammation or PS, we conduct an analysis on the Simons Foundation Autism Research Initiative (SFARI) Gene database. We confirm 21 gene hits. Using unsupervised statistical network analysis, we then identify six clusters of probable protein-protein interactions mapping onto the immunometabolic and stress response networks and epigenetic memory. These findings support our hypothesis. We discuss the implications for ASD etiology, early detection, and novel therapeutic approaches. We conclude with delineation of the next steps to verify our model on the individual gene level in an assumption-free manner.

q-bio.GN↗

arXiv2021

Prenatal stress perturbs fetal iron homeostasis in a sex-specific manner

What is the influence of chronic maternal prenatal stress (PS) on fetal iron homeostasis? In a prospective case-control study in 164 pregnant women, we show that cord blood transferrin saturation is lower in male stressed neonates. The total effect of PS exposure on fetal ferritin revealed a decrease of 15.4% compared with controls. Electrocardiogram-based Fetal Stress Index (FSI) identified affected fetuses non-invasively during the third trimester of gestation. FSI-based timely detection of fetuses affected by PS can support early individualized iron supplementation and neurodevelopmental follow-up to prevent long-term sequelae due to PS-exacerbated impairment of the iron homeostasis.

q-bio.QM↗

arXiv2021

The role of the vagus nerve during fetal development and its relationship with the environment

The autonomic nervous system (ANS) regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. Several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors (i.e. fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure) may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses.

q-bio.TO↗

arXiv2021

Detection of Maternal and Fetal Stress from the Electrocardiogram with Self-Supervised Representation Learning

In the pregnant mother and her fetus, chronic prenatal stress results in entrainment of the fetal heartbeat by the maternal heartbeat, quantified by the fetal stress index (FSI). Deep learning (DL) is capable of pattern detection in complex medical data with high accuracy in noisy real-life environments, but little is known about DL's utility in non-invasive biometric monitoring during pregnancy. A recently established self-supervised learning (SSL) approach to DL provides emotional recognition from electrocardiogram (ECG). We hypothesized that SSL will identify chronically stressed mother-fetus dyads from the raw maternal abdominal electrocardiograms (aECG), containing fetal and maternal ECG. Chronically stressed mothers and controls matched at enrolment at 32 weeks of gestation were studied. We validated the chronic stress exposure by psychological inventory, maternal hair cortisol and FSI. We tested two variants of SSL architecture, one trained on the generic ECG features for emotional recognition obtained from public datasets and another transfer-learned on a subset of our data. Our DL models accurately detect the chronic stress exposure group (AUROC=0.982+/-0.002), the individual psychological stress score (R2=0.943+/-0.009) and FSI at 34 weeks of gestation (R2=0.946+/-0.013), as well as the maternal hair cortisol at birth reflecting chronic stress exposure (0.931+/-0.006). The best performance was achieved with the DL model trained on the public dataset and using maternal ECG alone. The present DL approach provides a novel source of physiological insights into complex multi-modal relationships between different regulatory systems exposed to chronic stress. The final DL model can be deployed in low-cost regular ECG biosensors as a simple, ubiquitous early stress detection and monitoring tool during pregnancy. This discovery should enable early behavioral interventions.

q-bio.QM↗

arXiv2020

Early Biomarkers and Intervention Programs for the Infant Exposed to Prenatal Stress

Functional development of affective and reward circuits, cognition and response inhibition later in life exhibits vulnerability periods during gestation and early childhood. Extensive evidence supports the model that exposure to stressors in the gestational period and early postnatal life increases an individual's susceptibility to future impairments of functional development. Recent versions of this model integrate epigenetic mechanisms of the developmental response. Their understanding will guide the future treatment of the associated neuropsychiatric disorders. A combination of non-invasively obtainable physiological signals and epigenetic biomarkers related to the principal systems of the stress response, the Hypothalamic-Pituitary axis (HPA) and the Autonomic Nervous System (ANS), are emerging as the key predictors of neurodevelopmental outcomes. Such electrophysiological and epigenetic biomarkers can prove to timely identify children benefiting most from early intervention programs. Such programs should ameliorate future disorders in otherwise apparently healthy children. The recently developed Early Family-Centered Intervention Programs aim to influence the care and stimuli provided daily by the family and improving parent/child attachment, a key element for healthy socio-emotional adult life. Although frequently underestimated, such biomarker-guided early intervention strategy represents a crucial first step in the prevention of future neuropsychiatric problems and in reducing their personal and societal impact.

q-bio.QM↗

arXiv2019

Microglial memory of early life stress and inflammation: susceptibility to neurodegeneration in adulthood

We review evidence supporting the role of early life programming in the susceptibility for adult neurodegenerative diseases while highlighting questions and proposing avenues for future research to advance our understanding of this fundamental process. The key elements of this phenomenon are chronic stress, neuroinflammation triggering microglial polarization, microglial memory and their connection to neurodegeneration. We review the mediating mechanisms which may function as early biomarkers of increased susceptibility for neurodegeneration. Can we devise novel early life-modifying interventions to steer developmental trajectories to their optimum?

q-bio.TO↗

arXiv2019

Fetus: the radar of maternal stress, a cohort study

Objective: We hypothesized that prenatal stress (PS) exerts lasting impact on fetal heart rate (fHR). We sought to validate the presence of such PS signature in fHR by measuring coupling between maternal HR (mHR) and fHR. Study design: Prospective observational cohort study in stressed group (SG) mothers with controls matched for gestational age during screening at third trimester using Cohen Perceived Stress Scale (PSS) questionnaire with PSS-10 equal or above 19 classified as SG. Women with PSS-10 less than 19 served as control group (CG). Setting: Klinikum rechts der Isar of the Technical University of Munich. Population: Singleton 3rd trimester pregnant women. Methods: Transabdominal fetal electrocardiograms (fECG) were recorded. We deployed a signal processing algorithm termed bivariate phase-rectified signal averaging (BPRSA) to quantify coupling between mHR and fHR resulting in a fetal stress index (FSI). Maternal hair cortisol was measured at birth. Differences were assumed to be significant for p value less than 0.05. Main Outcome Measures: Differences for FSI between both groups. Results: We screened 1500 women enrolling 538 of which 16.5 % showed a PSS-10 score equal or above 19 at 34+0 weeks. Fifty five women eventually comprised the SG and n=55 served as CG. Median PSS was 22.0 (IQR 21.0-24.0) in the SG and 9.0 (6.0-12.0) in the CG, respectively. Maternal hair cortisol was higher in SG than CG at 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg. At 36+5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (-0.49-0.18)]. Conclusion: Our findings show a persistent effect of PS affecting fetuses in the last trimester.

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