Impact of Depressive Symptoms during the Second Trimester of Pregnancy on Maternal and Fetal Heart Rate Variability
Heeyeon Kim1,2,*, Kyungun Jhung3,*, Dukyong Yoon4,5,6, Jihoon Seo4, Hee Young Cho7, Jin Young Park1,2,5
1Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
2Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
3Department of Psychiatry, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
4Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Korea
5Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
6Institute for Innovation in Digital Healthcare, Severance Hospital, Seoul, Korea
7Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Jin Young Park
Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin 16995, Korea
E-mail: empathy@yuhs.ac
ORCID: https://orcid.org/0000-0002-5351-9549

Hee Young Cho
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
E-mail: hycho.md@gmail.com
ORCID: https://orcid.org/0000-0001-7064-5056

*These authors contributed equally to this study as first co-authors.
Received: November 7, 2024; Revised: January 16, 2025; Accepted: January 17, 2025; Published online: February 13, 2025.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: This study explores how maternal depressive symptoms during the second trimester, a critical phase for autonomic nervous system (ANS) development, affect maternal and fetal heart rate variability (HRV) in the third trimester, with implications for infant development.
Methods: We examined the effects of second trimester maternal depression on subsequent maternal and fetal HRV. A cohort of women in early or late second trimester completed depression assessments using the Edinburgh Postnatal Depression Scale (EPDS) and underwent HRV evaluations in the third trimester.
Results: Among 118 participants, 97 completed the EPDS at 14−20 weeks, with 12 showing depressive symptoms. At 21−28 weeks, 111 participants were assessed, and 24 were identified as possibly depressive. Depressive symptoms were linked to increased maternal pNN50% (percentage of successive NN intervals differing by more than 50 ms) and decreased detrended fluctuation analysis alpha, indicating hemodynamic shifts. Their fetuses showed reduced root mean square of successive differences, standard deviation of successive differences, and short-term and long-term variability indices, suggesting weakened parasympathetic activity.
Conclusion: Prenatal depression influences maternal physiological adaptation and fetal ANS development, highlighting HRV as a potential biomarker for predicting neurodevelopment. Early identification and treatment of mid-pregnancy depressive symptoms may help mitigate potential risks to infant neurodevelopment.
Keywords: Depression; Heart rate, fetal; Autonomic nervous system; Fetal development

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