The Impact of Wartime on Perinatal Outcomes in Kharkiv

The armed conflict changed the humanitarian situation in the frontline areas in Ukraine. Kharkiv is a city located close to the frontline since the beginning of the war. The influence of war on fetal health and perinatal pathologies is still not clear. The study was focused on the association between maternal heart rate variability (HRV), fetal HRV, gestational age at birth, neonatal biometric parameters, and Apgar scores in pregnant women from Kharkiv and internally displaced persons (IDPs).  Methods: This study was performed among 39 patients in 22-30 weeks of gestation who were enrolled in the study. The 20 residents were included in Group I. The 19 pregnant IDPs were included in Group II. Fetal HRV variables were obtained from an RR interval derived from the maternal abdominal wall via noninvasive fetal electrocardiography. The study protocol also included the term at birth, neonatal weight, length, head circumference, and Apgar score.  Results: The term of birth was significantly higher in Group I. PB occurred in 10% of Kharkiv residents. PB rate was higher in IDPs 42.1% (p= 0.0310). Group I newborns showed superior biometry to those born to IDPs. A moderate positive correlation was observed between fetal AC (acceleration capacity) and Apgar score (r = 0.34, p = 0.034), as well as between fetal DC (deceleration capacity) and Apgar score (r = 0.37, p = 0.019). The logistic regression model with the neonatal body weight showed the relationship with the AC maternal and maternal status (resident or IDP). The fetal growth demonstrated coupling with maternal autonomic regulation and maternal status. Such relationships among IDPs were stronger.

The rate for PB was significantly higher in IDPs. The term of birth, parameters of neonatal body weight, and body length were higher in the residents' group. Fetal AC/DC demonstrated a moderate positive correlation with Apgar score. Therefore, these variables could be of use for monitoring fetal health. Maternal AC impacted neonatal body weight. The mechanism of the relationship between maternal sympathetic regulation and fetal growth was not understood. Maternal IDP status had a relationship with neonatal body weight. The wartime conditions affected fetal growth and maturation negatively in IDPs.