Fetal facial expression in response to intravaginal music emission

Marisa López-Teijón, Álex García-Faura, Alberto Prats-Galino, Marisa López-Teijón, Álex García-Faura, Alberto Prats-Galino

Abstract

This study compared fetal response to musical stimuli applied intravaginally (intravaginal music [IVM]) with application via emitters placed on the mother's abdomen (abdominal music [ABM]). Responses were quantified by recording facial movements identified on 3D/4D ultrasound. One hundred and six normal pregnancies between 14 and 39 weeks of gestation were randomized to 3D/4D ultrasound with: (a) ABM with standard headphones (flute monody at 98.6 dB); (b) IVM with a specially designed device emitting the same monody at 53.7 dB; or (c) intravaginal vibration (IVV; 125 Hz) at 68 dB with the same device. Facial movements were quantified at baseline, during stimulation, and for 5 minutes after stimulation was discontinued. In fetuses at a gestational age of >16 weeks, IVM-elicited mouthing (MT) and tongue expulsion (TE) in 86.7% and 46.6% of fetuses, respectively, with significant differences when compared with ABM and IVV (p = 0.002 and p = 0.004, respectively). There were no changes from baseline in ABM and IVV. TE occurred ≥5 times in 5 minutes in 13.3% with IVM. IVM was related with higher occurrence of MT (odds ratio = 10.980; 95% confidence interval = 3.105-47.546) and TE (odds ratio = 10.943; 95% confidence interval = 2.568-77.037). The frequency of TE with IVM increased significantly with gestational age (p = 0.024). Fetuses at 16-39 weeks of gestation respond to intravaginally emitted music with repetitive MT and TE movements not observed with ABM or IVV. Our findings suggest that neural pathways participating in the auditory-motor system are developed as early as gestational week 16. These findings might contribute to diagnostic methods for prenatal hearing screening, and research into fetal neurological stimulation.

Keywords: Ultrasound; fetal movements; hearing; music; prenatal diagnosis.

Figures

Figure 1
Figure 1
Measurement of intensity of sound or noise of each of the emitters/types of emission used in the study
Figure 2
Figure 2
Percentage of fetuses ≥ 16 weeks that are active (FA) and make mouthing (MT) and tongue expulsion (TE) movements, according to type of acoustic stimulus. In the group with intravaginal music, there was more FA during the stimulation than in the other two groups (a). Stimulation (stimulus ON) with vaginal music elicited MT (b) and TE (c) in significantly more fetuses than in the other groups. This effect remained in the 5 minutes after the stimulus was discontinued (stimulus OFF). TE was identified between 1 and 4 times in some fetuses in all groups, but ≥5 TEs during stimulation were seen only in fetuses in the vaginal music group (13.3%, white box in c). IV: intravaginal; AB: abdominal
Figure 3
Figure 3
Percentage of fetuses that are active (FA) and make mouthing (MT) and tongue expulsion (TE) movements, according to gestational age. The gestational age influenced the percentage of general activity (a), but not generally mouthing movements (b). Vibroacoustic stimulation did not elicit TE in fetuses 16.9% and 7.7% of fetuses at 24–31 and 32–39 weeks gestation, respectively, protruded their tongue ≥ 5 times in 5 minutes with intravaginal music (panel c)
Figure 4
Figure 4
Simplified outline of the main pathways and brainstem nerve centers possibly involved in the facial and mouth–tongue responses induced by fetal intravaginal music stimulation. The music would activate the ascending auditory pathway and the motor response could be mediated by circuits related with vocalization. The PAG would work as a center to integrate the auditory signals, acting as an effector center of the social behavior network. AHT: anterior hypothalamus; Amb: nucleus ambiguus; BNST-meAMY: bed nucleus of the stria terminalis-medial amygdala; Co: cochlea; CoN: cochlear nuclei; IC: inferior colliculus; IX: glossopharyngeal nerve; LL: lateral lemniscus; LS: lateral septum; mVN: motor trigeminal nucleus; PAG: periaqueductal gray; POA: preoptic area; rAmb: nucleus retroambiguus; SC: superior colliculus; SoC: superior olivary complex; V: trigeminal nerve; VC: vocalization center of the pontine reticular formation; VII: facial nerve; VIIN: facial nucleus; VIII: vestibulocochlear nerve; VMHT: ventromedial hypothalamus; X: vagus nerve; XI: accessory nerve; XII: hypoglossal nerve; XIIN: hypoglossal nucleus

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