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Front Neurosci. 2021 Sep 20;15:721605. doi: 10.3389/fnins.2021.721605. eCollection 2021.

A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows.

Frontiers in neuroscience

Francesco Cerritelli, Martin G Frasch, Marta C Antonelli, Chiara Viglione, Stefano Vecchi, Marco Chiera, Andrea Manzotti

Affiliations

  1. Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.
  2. Department of Obstetrics and Gynecology and Center on Human Development and Disability, University of Washington, Seattle, WA, United States.
  3. Facultad de Medicina, Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis", Universidad de Buenos Aires, Buenos Aires, Argentina.
  4. Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
  5. Department of Pediatrics, Division of Neonatology, "V. Buzzi" Children's Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy.
  6. Research Department, Istituto Osteopatia Milano, Milan, Italy.

PMID: 34616274 PMCID: PMC8488382 DOI: 10.3389/fnins.2021.721605

Abstract

The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, 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. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.

Copyright © 2021 Cerritelli, Frasch, Antonelli, Viglione, Vecchi, Chiera and Manzotti.

Keywords: autonomic nervous system; cholinergic anti-inflammatory pathway; critical window; fetal development; heart rate variability; maternal health; vagus nerve

Conflict of interest statement

MF has patents on aECG (WO2018160890A1) and EEG technologies for fetal monitoring (US9215999). The remaining authors declare that the research was conducted in the absence of any commercial or financi

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