Trends in Heart Rate and Heart Rate Variability During Pregnancy and the 3-Month Postpartum Period: Continuous Monitoring in a Free-living Context

Abstract

Background: Heart rate variability (HRV) is a noninvasive method that reflects the regulation of the autonomic nervous system. Altered HRV is associated with adverse mental or physical health complications. The autonomic nervous system also has a central role in physiological adaption during pregnancy, causing normal changes in HRV.

Objective: The aim of this study was to assess trends in heart rate (HR) and HRV parameters as a noninvasive method for remote maternal health monitoring during pregnancy and 3-month postpartum period.

Methods: A total of 58 pregnant women were monitored using an Internet of Things-based remote monitoring system during pregnancy and 3-month postpartum period. Pregnant women were asked to continuously wear Gear Sport smartwatch to monitor their HR and HRV extracted from photoplethysmogram (PPG) signals. In addition, a cross-platform mobile app was used to collect background and delivery-related information. We analyzed PPG signals collected during the night and discarded unreliable signals by applying a PPG quality assessment method to the collected signals. HR, HRV, and normalized HRV parameters were extracted from reliable signals. The normalization removed the effect of HR changes on HRV trends. Finally, we used hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters.

Results: HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P=.006). Time-domain HRV parameters, average normal interbeat intervals (IBIs; average normal IBIs [AVNN]), SD of normal IBIs (SDNN), root mean square of the successive difference of normal IBIs (RMSSD), normalized SDNN, and normalized RMSSD decreased significantly during the second trimester (P<.001). Then, AVNN, SDNN, RMSSD, and normalized SDNN increased significantly during the third trimester (with P=.002, P<.001, P<.001, and P<.001, respectively). Some of the frequency-domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF, decreased significantly during the second trimester (with P<.001, P<.001, and P=.003, respectively), and HF increased significantly during the third trimester (P=.007). In the postpartum period, normalized RMSSD decreased (P=.01), and the LF to HF ratio (LF/HF) increased significantly (P=.004).

Conclusions: Our study indicates the physiological changes during pregnancy and the postpartum period. We showed that HR increased and HRV parameters decreased as pregnancy proceeded, and the values returned to normal after delivery. Moreover, our results show that HR started to decrease, whereas time-domain HRV parameters and HF started to increase during the third trimester. The results also indicated that age was significantly associated with HRV parameters during pregnancy and postpartum period, whereas education level was associated with HRV parameters during the third trimester. In addition, our results demonstrate the possibility of continuous HRV monitoring in everyday life settings.

Keywords: PPG; continuous monitoring; heart rate; heart rate variability; mobile phone; postpartum; pregnancy.

Figure 1

Data analysis pipeline. HR: heart rate; HRV: HR variability; IBI: interbeat interval; PPG: photoplethysmogram.

Figure 2

Weekly mean and 95% CI of heart rate (HR) and time-domain HR variability parameters during pregnancy and postpartum period. The number of participants with reliable data per week is also indicated. The vertical line indicates pregnancy week 28 and separates the second and third trimesters. AVNN: average normal interbeat intervals; RMSSD: root mean square of the successive differences of normal interbeat intervals; nRMSSD: normalized RMSSD; SDNN: SD of normal interbeat intervals. nSDNN: normalized SDNN.

Figure 3

Weekly mean and 95% CI of frequency-domain heart rate variability parameter during pregnancy and postpartum period. The number of participants with reliable data per week is also indicated. The vertical line indicates pregnancy week 28 and separates the second and third trimesters. HF: high-frequency power; LF: low-frequency power; nHF: normalized HF; nLF: normalized LF.