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Research suggests that fetuses open or close their mouth in relation to directed movements but it is unclear whether mouth opening anticipates the touch or is a reaction to touch, as there has been no analysis so far of (1) the facial area of touch and (2) the sequential ordering of touch and mouth movements. If there is prenatal development of the anticipation of touch we would expect the frequency of fetal mouth opening immediately preceding the arriving hand at the mouth area to increase with fetal age. Fifteen healthy fetuses, eight girls and seven boys, underwent four additional 4-D scans at 24, 28, 32, and 36 weeks gestation. Changes in the frequency of touch for different facial regions indicated a significant decline in touch of the upper and side parts of the face and a significant increase in touching lower and perioral regions of the face with increasing gestational age. Results supporting the hypothesis showed a significant increase in the proportion of anticipatory mouth movements before touch increasing by around 8% with each week of gestational age. Additionally there was a decrease in the proportion of reactive mouth movements decreasing by around 3% for each week of gestational age. © 2013 Wiley Periodicals, Inc. Dev Psychobiol 56: 955-963, 2014. [ABSTRACT FROM AUTHOR]

Ten children at mean ages of 0; 11.3 and 0; 15.3 and their monolingual German-speaking mothers were audio- and videotaped in their homes while having a meal with a spoon (ordinary situation) and while feeding a doll with a spoon (play situation). Sentences spoken by the mothers that were comparable in length and sentence type across situations were analysed acoustically. In both data-collection sessions, it was found that the mothers spoke with the same mean amplitude in the two situations but they used higher mean fundamental frequency when speaking during the play situation than during the ordinary situation. In the first data-collection session, when the infants did not yet use meaningful words or engage in pretend play, the mothers also used a wider pitch range in the play situation than in the ordinary situation. It is concluded that mothers use both pitch height and pitch range to introduce the preverbal infant to the difference between non-play and play situations, and they continue to use variations in pitch height to mark the same distinction after the children have become active participants in pretend play activities. Implications of the results are discussed in terms of possible longitudinal patterns associated with mothers' use of intonational key and register. [ABSTRACT FROM AUTHOR]

Background: The concept of fetal pain results from procedures conducted without anesthesia in preterm newborns and fetuses, which indicate that it is possible to examine fetal pain based on stress hormone, metabolic, and behavioral changes. Anatomical and physiological data suggest that fetuses become capable of processing nociceptive stimuli around midgestation, although the associated changes in fetal brain development remain unclear. What constitutes fetal pain remains controversial in the light of the definition of pain adopted by the International Association for the Study of Pain (IASP), which posits pain as an "unpleasant sensory and emotional experience.", Summary: Here, we examine the notion that human fetuses cannot "experience" pain and potential implications of this claim. We highlight the key scientific evidence related to fetal pain, including clinical studies on pain in fetuses and preterm newborns. We argue that consistent patterns of stress hormones, metabolic changes, body movements, hemodynamic changes, and pain-related facial expressions in fetuses exposed to invasive procedures overcome the need for subjective proof of pain as articulated in the IASP definition. No study to date has conclusively proven the absence of fetal pain beyond the age of viability., Key Messages: Based on the current evidence, we propose that all fetuses receive anesthesia regardless of the invasive procedures being performed to guarantee the least possible pain and physiological, behavioral, or hormonal responses without exposing the mother or her baby to unnecessary complications., (© 2024 S. Karger AG, Basel.)

Research indicates a higher prevalence of attention deficits in children exposed to HG in utero compared to controls with some claiming that the deficit is due to prenatal effects of malnutrition in HG mothers and others that it is due to maternal mental health after birth. The current study examines the effect of hyperemesis gravidarum (HG) diagnosis during pregnancy on infant attention controlling for maternal stress, depression anxiety and attachment. Thirty-eight infants mean age 4 months were videotaped with their mothers (19 mothers with a hyperemesis diagnosis and 19 controls) during play with a soft toy and looking at a picture book. Infant attention was operationalized as gaze direction towards the play activity, mother, and 'distracted' (indicated by looking away from play or mother). Mothers completed stress, depression, anxiety, and attachment questionnaires. HG exposed infants attended for significantly less time during play with a book or soft toy compared to controls. Maternal stress, depression, anxiety, and attachment did not differ in HG mothers and controls. Infant ability to attend to the toy, book, mother or being distracted did not relate to maternal postnatal attachment, or mental health. These results suggest that the prenatal environment, especially exposure to HG might be associated with reduced infant attention abilities independent of maternal postnatal health., Competing Interests: Conflict of interest The authors report no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Throughout pregnancy, fetuses are exposed to a range of chemosensory inputs influencing their postnatal behaviors. Such prenatal exposure provides the fetus with continuous sensory information to adapt to the environment they face once born. This study aimed to assess the chemosensory continuity through a systematic review and meta-analysis of existing evidence on chemosensory continuity from prenatal to first postnatal year. Web of Science Core. Collections, MEDLINE, PsycINFO, EBSCOhost ebook collection was searched from 1900 to 2021. Studies identified from the search were grouped according to type of stimuli the fetuses were exposed to prenatally that the neonatal infants' responses to were being evaluated, namely flavors transferred from the maternal diet, and the odor of their own amniotic fluid. Of the 12 studies that met the eligibility criteria for inclusion (k = 6, k = 6, respectively in the first and the second group of studies), and eight studies (k = 4, k = 4, respectively) provided sufficient data suitable for meta-analysis. Infants, during their first year of life, oriented their heads for significantly longer durations in the direction of the prenatally experienced stimuli with large pooled effect sizes (flavor stimuli, d = 1.24, 95% CI [0.56, 1.91]; amniotic fluid odor, d = 0.853; 95% CI [.632, 1.073]). The pooled effect size for the duration of mouthing behavior was significant in response to prenatal flavor exposure through maternal diet (d = 0.72; 95% CI [0.306, 1.136]), but not for the frequency of negative facial expressions (d = -0.87, 95% CI [-2.39, 0.66]). Postnatal evidence suggests that there is a chemosensory continuity from fetal to the first year of postnatal life., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ustun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The diet of pregnant women exposes fetuses to a variety of flavors consisting of compound sensations involving smell, taste, and chemesthesis. The effects of such prenatal flavor exposure on chemosensory development have so far been measured only postnatally in human infants. Here, we report the first direct evidence of human fetal responsiveness to flavors transferred via maternal consumption of a single-dose capsule by measuring frame-by-frame fetal facial movements. Pregnant women and their fetuses based in the northeast of England were involved in this study from 32 to 36 weeks' gestation. Fetuses exposed to carrot flavor ( n = 35) showed "lip-corner puller" and "laughter-face gestalt" more frequently, whereas fetuses exposed to kale flavor ( n = 34) showed more "upper-lip raiser," "lower-lip depressor," "lip stretch," "lip presser," and "cry-face gestalt" in comparison with the carrot group and a control group not exposed to any flavors ( n = 30). The complexity of facial gestalts increased from 32 to 36 weeks in the kale condition, but not in the carrot condition. Findings of this study have important implications for understanding the earliest evidence for fetal abilities to sense and discriminate different flavors.

Objective: To develop and evaluate Baby CHAT, a single-session psychoeducational intervention for expectant parents. Baby CHAT aims to improve parental reflective functioning (RF) and bonding., Background: The early years of a child's life, including pregnancy, are vital for healthy physical and emotional development. Caregivers who provide responsive parenting, enhanced through strong bonds and good RF, can aid healthy development.. However, limited interventions exist to enhance RF and bonding in expectant parents., Methods: Feasibility of Baby CHAT was assessed using a mixed methods randomised controlled trial design. It evaluated uptake and retention of participants, effect size calculations, and acceptability and satisfaction with Baby CHAT., Results: Participants (N = 20) were aged 30-39 years (n = 17) in their third trimester of pregnancy (n = 12). Nine males and 11 females were recruited. Content analysis of qualitative feedback after the intervention resulted in four themes; positive group aspects, group improvements, 4D scan footage and relating content to my baby., Conclusions: Baby CHAT can help expectant parents think about their baby as a separate person and has potential to improve prenatal RF and bonding. However, further research is required to assess the effectiveness of Baby CHAT to improve bonding and RF.

Aim: To assess whether foetal mouth movement frequency changes across gestation and whether there are differences between cigarette and e-cigarette exposure conditions in comparison to a non-exposed group of foetuses., Method: Pregnant women underwent 4-dimensional (4D) foetal ultrasound scans at 32 weeks (106 scans) and 36 weeks of gestational age (87 scans) at James Cook University Hospital, UK. The 4D scans were coded using the Fetal Observable Movement System (FOMS). Measures of maternal smoking status, stress, depression, anxiety, attachment and time of scan were also collected. There were four exposure groups: non-smokers, light smokers (<10 per day), heavy smokers (11-20 per day) and e-cigarette users., Results: No significant differences in relative frequency of mouth movements between the exposure groups at 32- and 36 weeks of gestational age were found. Foetal mouth movements declined from 32 to 36 weeks of gestation for non-exposed and e-cigarette-exposed foetuses., Conclusion: Due to variability in foetal behaviour, examining mouth movements alone may not be the most appropriate method for assessing group differences. However, in line with other research, mouth movement frequency declined between 32- and 36 weeks of gestational age. A combination of foetal behavioural assessments is needed to assess the effects of cigarette and e-cigarette exposure on foetal neurobehavioural development., (© 2021 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: Prenatal experiences, including maternal stress, depression and anxiety, form crucial building blocks affecting the maturation of the foetal central nervous system. Previous research has examined foetal movements without considering effects of maternal mental health factors critical for healthy foetal development. The aim of this research is to assess the effects of maternal mental health factors on foetal twin compared with singleton movement profiles., Method: We coded foetal touch and head movements in 56 ultrasound scans, from a prospective opportunity sample of 30 mothers with a healthy pregnancy (mean gestational age 27.8 weeks for singleton and 27.2 for twins). At the ultrasound scan appointment, participants completed questionnaires assessing their stress, depression and anxiety., Results: Maternal depression increased foetal self-touch significantly. In foetal twins, maternal stress significantly decreased and maternal depression significantly increased other twin touch. Maternal mental health factors affected the head movements of twins significantly more than singletons, with maternal depression decreasing head movement frequency for twins significantly., Conclusion: These results indicate that maternal mental health might have an impact on types of body schemata formed in utero, in twin compared with singleton pregnancies. Future research needs to examine whether these prenatal effects affect postnatal differences in body awareness., (© 2021 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: The aim of this exploratory qualitative analysis is to assess the perceptions of risks of cigarette and e-cigarette use during pregnancy., Background: An important public health aim is a reduction of smoking at time of delivery (SATOD) from 10.6% to less than 6% by 2022 in the United Kingdom (UK). In order to successfully meet this target, we need to have a better understanding of the perceived risks associated with cigarette smoking. Additionally, the use of e-cigarettes is increasing in the general population, with pregnant women being supported to use such products if it helps them remain smoke free. However, in contrast to cigarette smoking, there is little definitive research assessing the safety of e-cigarette use during pregnancy, with most information disregarding the health of the growing fetus. E-cigarettes are of special interest, given they are an unlicensed product for use during pregnancy, yet women are being supported to use them as a method of harm reduction. A better understanding of perceived risks is essential., Method: Fourteen interviews were conducted one month postpartum with women who smoked during pregnancy and continued to smoke after the birth. Thematic analysis was conducted., Findings: Two themes emerged for cigarette smoking; health and justifications. Six themes were identified for e-cigarette use; the unknown, experience, comparison to cigarettes, the product, advice and healthier option. A range of subthemes are discussed., Conclusion: Women provided a range of justifications for continuing to smoke during pregnancy. Women felt e-cigarettes were a riskier option than continuing to smoke., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Parental monitoring is a factor which affects verbal and nonverbal inhibition components of children's executive functions.,. Method: 112 sixth-grade Kurdish children (mean age: 11 years 5 months) participated in the study. Children were matched on level of hyperactivity. Parents completed the Parental Monitoring Assessment (PMA) and the Strengths and Difficulties Questionnaire (SDQ). Children completed theStop-Signal task, Modified Opposite Worlds and a challenging star puzzle in order to assess executive function components. PROCESS analysis was also used to perform the moderation analysis. Results: Children characterized by poor parental monitoring had deficits in inhibitory control and had significantly slower processing speeds and made significantly more errors than their matched controls. Furthermore, children with high levels of hyperactivity had difficulties in inhibitory control, accuracy, processing speed, and task persistence compared with the control group.Contrary to our prediction, there were no significant differences in reaction times compared with the control group. PROCESS analysis showed a significant moderating role of parental monitoring in the association between each of accuracy, verbal inhibition, and task persistence with hyperactivity. Conclusion: the current study suggests that, similar to hyperactivity, children with poor parental monitoring appear to have difficulties in executive function.

Background: Infant neurobehaviour provides an insight into the development of the central nervous system during infancy, with behavioural abnormalities highlighting a cause for concern. Research has demonstrated that prenatal exposure to cigarettes leads to deficits within neurobehavioural development, along with negative birth outcomes detrimental to subsequent development. With the growing use of e-cigarettes amongst pregnant women, this study explores how prenatal e-cigarette exposure compares to prenatal cigarette exposure., Methods: Eighty-three infants were involved in the study, either exposed prenatally to cigarettes or e-cigarettes or not exposed to either. Differences were assessed between these three groups for birth outcomes and scores on the Neonatal Behavioural Assessment Scale (NBAS) at one month of age., Findings: Both cigarette and e-cigarette exposed infants had a significantly greater number of abnormal reflexes ( p = ·001; p   =  ·002). For both self-regulation and motor maturity, cigarette exposed infants performed significantly worse ( p = ·010; p = ·002), with e-cigarette exposed infants having decreased motor maturity ( p = ·036) abilities and marginally decreased for self-regulation ( p = ·057). Birth outcomes, namely birthweight, gestation and head circumference, did not differ for e-cigarette exposed infants compared with infants who were not prenatally exposed to nicotine. Cigarette exposed infants had a significantly lower birthweight ( p = ·021) and reduced head circumference ( p = ·008) in comparison to non-exposed infants., Interpretation: To our knowledge, this is the first research study assessing a neurological outcome as a result of e-cigarette exposure. Findings of this have potentially important implications for public health policies regarding the safety and use of e-cigarettes throughout pregnancy., Funding: This research was funded by a doctoral training partnership scholarship via the ESRC, ES/P000762/1., Competing Interests: The authors declare there is no conflict of interest., (© 2020 The Author(s).)

Aim: Prenatal exposure to cigarettes leads to alterations in brain development during pregnancy. This has an impact on postnatal psychological and behavioural processes, affecting an infant's neurobehavioural profile with little known about which aspects are affected. The evidence was synthesised to assess the effects of prenatal cigarette smoke exposure on neurobehavioural outcomes within the first year of life., Methods: Six databases were searched (Web of Science Core Collections, MEDLINE, PsycINFO, CINAHL, EBSCOhost eBook Collection and OpenGrey) in November 2018. Eligible studies (n = 17) had to include a measure of prenatal cigarette exposure and a neurobehavioural assessment ≤1 year of age., Results: In the first year of life, specific areas of neurobehavioural functioning are related to prenatal cigarette exposure with eight out of 10 areas of neurobehaviour having significant medium (negative affect, attention, excitability, irritability and orientation) or small (muscle tone, regulation and difficult temperament) pooled effect sizes. Only lethargy and stress did not show any significant pooled effects., Conclusion: Prenatal cigarette exposure affects a significant range of behaviours during the first year of life., (© 2019 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Although the importance of parenting styles directly influencing child development is well established, fewer studied have examined whether parenting styles also affect children's behavioural problems indirectly, mediated through children's academic self-concept (ASC). We examined direct and shared effects of parenting styles on behavioural problems of 199 Kurdish primary school children with a mean age of 11 years 7 months (range 11 years 5 months to 12 years 3 months). Questionnaires measured parenting styles (child version of Alabama Parenting Questionnaire), assessed children's ASC (Myself-As-Learner Scale) and identified children's behavioural problems with the Strengths and Difficulties Questionnaire (SDQ). PROCESS analysis was used to perform the mediation analysis. The results revealed that positive and negative parenting composites are indirectly related to children's internalising behaviour problems. In addition, ASC partially mediated the relationship between the negative parenting composite and prosocial behaviour. However, the mediation analysis did not show the expected indirect effect of parenting styles on externalising problems as being mediated via ASC. Hence, we argue that the ASC serves as a significant mediator in the relationship between parenting styles with prosocial behaviour and internalising problems., (© 2016 International Union of Psychological Science.)

Background: Parenting interventions are rarely offered in developing countries and there is an urgent need to include low-income countries., Aims: To examine the effectiveness of Systematic Training for Effective Parenting (STEP) among Kurdish parents and their children., Methods: This was a randomized control pilot trial using pre- and post-test scores of 17 mothers (mean age 35.25 years, standard deviation 4.3 years; range: 29.58-45.3 years) who agreed to participate in the intervention. We utilized the Alabama Parenting Questionnaire (APQ) to assess parenting style; Parental Stress Scale (PSS) to investigate parental stress; and Step Parenting Assessment Technique (SPAT) to identify whether participants in the treatment group had learned the material of the intervention., Results: There were significant differences between the groups on 3 subscales of the APQ: mother involvement subscale, F(1.13) = 25.81, P < 0.001, η2 p = 0.67; inconsistent discipline subscale, F(1.13) = 25.46, P < 0.001, η2 p = 0.66; and corporal punishment subscale F(1.13) = 17.3, P < 0.005, η2 p = 0.57. A significant difference between groups was also found on the PSS, F(1.13) = 19.63, P < 0.001, η2 p = 0.60. The changes were sustained over a 3-month period. No significant differences were found in academic self-concept and behavioural problems between children whose mothers attended STEP and others whose mothers did not attend., Conclusions: The STEP programme appears to promote parenting style and reduce the level of parental stress in Kurdish mothers., Trial Registration: IRCT2016032527125N1., (Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

While there is an extensive literature on the tendency to mimic emotional expressions in adults, it is unclear how this skill emerges and develops over time. Specifically, it is unclear whether infants mimic discrete emotion-related facial actions, whether their facial displays are moderated by contextual cues and whether infants' emotional mimicry is constrained by developmental changes in the ability to discriminate emotions. We therefore investigate these questions using Baby-FACS to code infants' facial displays and eye-movement tracking to examine infants' looking times at facial expressions. Three-, 7-, and 12-month-old participants were exposed to dynamic facial expressions (joy, anger, fear, disgust, sadness) of a virtual model which either looked at the infant or had an averted gaze. Infants did not match emotion-specific facial actions shown by the model, but they produced valence-congruent facial responses to the distinct expressions. Furthermore, only the 7- and 12-month-olds displayed negative responses to the model's negative expressions and they looked more at areas of the face recruiting facial actions involved in specific expressions. Our results suggest that valence-congruent expressions emerge in infancy during a period where the decoding of facial expressions becomes increasingly sensitive to the social signal value of emotions.

Facial expressions of 5-6 month-old infants born preterm and at term were compared while tasting for the first time solid foods (two fruit and two vegetable purées) given by the mother. Videotapes of facial reactions to these foods were objectively coded during the first six successive spoons of each test food using Baby FACS and subjectively rated by naïve judges. Infant temperament was also assessed by the parents using the Infant Behaviour Questionnaire. Contrary to our expectations, infants born preterm expressed fewer negative emotions than infants born full-term. Naïve judges rated infants born preterm as displaying more liking than their full-term counterparts when tasting the novel foods. The analysis of facial expressions during the six spoonfuls of four successive meals (at 1-week intervals) suggested a familiarization effect with the frequency of negative expressions decreasing after tasting the second spoon, regardless of infant age, type of food and order of presentation. Finally, positive and negative dimensions of temperament reported by the parents were related with objective and subjective coding of affective reactions toward foods in infants born preterm or full-term. Our research indicates that premature infants are more accepting of novel foods than term infants and this could be used for supporting the development of healthy eating patterns in premature infants. Further research is needed to clarify whether reduced negativity by infants born prematurely to the exposure to novel solid foods reflects a reduction of an adaptive avoidant behaviour during the introduction of novel foods., (Copyright © 2016. Published by Elsevier Ltd.)

This study used Q-methodology to explore systematically parental judgements about infant immunisation. A total of 45 parents completed a 31-statement Q-sort. Data were collected after vaccination in general practitioner practices or a private day nursery. Q factor analysis revealed four distinct viewpoints: a duty to immunise based on medical benefits, child-orientated protection based on parental belief, concern and distress and surprise at non-compliance. Additionally, there was a common view among parents that they did not regret immunising their children. Implications of these results are discussed in terms of health-care policy and future research., (© The Author(s) 2013.)

Vaccination is one of the most effective ways of reducing childhood mortality. Despite global uptake of childhood vaccinations increasing, rates remain sub-optimal, meaning that vaccine-preventable diseases still pose a public health risk. A range of interventions to promote vaccine uptake have been developed, although this range has not specifically been reviewed in early childhood. We conducted a systematic review and meta-analysis of parental interventions to improve early childhood (0-5 years) vaccine uptake. Twenty-eight controlled studies contributed to six separate meta-analyses evaluating aspects of parental reminders and education. All interventions were to some extent effective, although findings were generally heterogeneous and random effects models were estimated. Receiving both postal and telephone reminders was the most effective reminder-based intervention (RD=0.1132; 95% CI=0.033-0.193). Sub-group analyses suggested that educational interventions were more effective in low- and middle-income countries (RD=0.13; 95% CI=0.05-0.22) and when conducted through discussion (RD=0.12; 95% CI=0.02-0.21). Current evidence most supports the use of postal reminders as part of the standard management of childhood immunisations. Parents at high risk of non-compliance may benefit from recall strategies and/or discussion-based forums, however further research is needed to assess the appropriateness of these strategies., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Due to technological advancements in functional brain imaging, foetal brain responses to visual and auditory stimuli is a growing area of research despite being relatively small with much variation between research laboratories. A number of inconsistencies between studies are, nonetheless, present in the literature. This article aims to explore the potential contribution of methodological factors to variation in reports of foetal neural responses to external stimuli. Some of the variation in reports can be explained by methodological differences in aspects of study design, such as brightness and wavelength of light source. In contrast to visual foetal processing, auditory foetal processing has been more frequently investigated and findings are more consistent between different studies. This is an early preview of an emerging field with many articles reporting small sample sizes with techniques that are yet to be replicated. We suggest areas for improvement for the field as a whole, such as the standardisation of stimulus delivery and a more detailed reporting of methods and results. This will improve our understanding of foetal functional response to light and sound. We suggest that enhanced technology will allow for a more reliable description of the developmental trajectory of foetal processing of light stimuli., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: One way to assess foetal health of smokers is to ask mothers to count perceived movements, an unreliable method hiding differences in prenatal development. The aim of this pilot study was to assess subtle foetal movements in ultrasound scans and establish whether they differ in foetuses of mothers who smoked and nonsmoking mothers., Methods: This longitudinal pilot study recruited twenty mothers (16 nonsmoking; 4 smoking) scanned four times from 24 to 36 weeks gestation (80 ultrasound scans). Two types of fine-grained movements were coded offline and analysed using a Poisson log-linear mixed model., Results: Foetuses of smoking mothers showed a significantly higher rate of mouth movements compared to foetuses of nonsmoking mothers (p = 0.02), after controlling for maternal stress and depression. As pregnancy progressed, these differences between the smoking and nonsmoking groups widened. Differences between the two groups in the rate of foetal facial self-touch remained constant as pregnancy progressed and were borderline significant (p = 0.07)., Conclusion: Rates of foetal mouth movement and facial self-touch differ significantly between smokers and nonsmokers. A larger study is needed to confirm these results and to investigate specific effects, including the interaction of maternal stress and smoking. Additionally, the feasibility of this technique for clinical practice should be assessed., (©2015 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

This longitudinal observational study investigated whether foetuses change their hand preference with gestational age, and also examined the effects of maternal stress on lateralized foetal self-touch. Following ethical approval, fifteen healthy foetuses (eight girls and seven boys) were scanned four times from 24 to 36 weeks gestation. Self-touch behaviours which resulted in a touch of the foetal face/head were coded in 60 scans for 10 min and analysed in terms of frequency of the foetuses using left and right hands to touch their face. The joint effects of foetal age, stress and sex on laterality were assessed. We modelled the proportion of right self-touches for each foetal scan using a generalized linear mixed model, taking account of the repeated measures design. There was substantial variability in hand preference between foetuses. However, there was no significant increase in the proportion of right-handed touches with foetal age. No sex differences in handedness were identified. However, maternally reported stress level was significantly positively related to foetal left-handed self-touches (odds ratio 0.915; p < .0001). This longitudinal study provides important new insights into the effect of recent maternal stress on foetal predominant hand use during self-touch.

Background: With advances of research on fetal behavioural development, the question of whether we can identify fetal facial expressions and determine their developmental progression, takes on greater importance. In this study we investigate longitudinally the increasing complexity of combinations of facial movements from 24 to 36 weeks gestation in a sample of healthy fetuses using frame-by-frame coding of 4-D ultrasound scans. The primary aim was to examine whether these complex facial movements coalesce into a recognisable facial expression of pain/distress., Methodology/findings: Fifteen fetuses (8 girls, 7 boys) were observed four times in the second and third trimester of pregnancy. Fetuses showed significant progress towards more complex facial expressions as gestational age increased. Statistical analysis of the facial movements making up a specific facial configuration namely "pain/distress" also demonstrates that this facial expression becomes significantly more complete as the fetus matures., Conclusions/significance: The study shows that one can determine the normal progression of fetal facial movements. Furthermore, our results suggest that healthy fetuses progress towards an increasingly complete pain/distress expression as they mature. We argue that this is an adaptive process which is beneficial to the fetus postnatally and has the potential to identify normal versus abnormal developmental pathways.

Background: Although some research suggests that fetuses yawn, others disagree arguing that is it simple mouth opening. Furthermore there is no developmental account of fetal yawning compared with simple mouth opening. The aim of the present study was to establish in a repeated measures design the development of fetal yawning compared with simple mouth opening., Methodology/findings: Video recordings were made of the fetal face and upper torso visualized by means of 4D full frontal or facial profile ultrasound recordings. Fifteen healthy fetuses were scanned four times at 24, 28, 32 and 36 weeks gestation. Yawning was distinguished from non-yawning in terms of the length of time it took to reach the apex of the mouth stretch, with yawns being defined as more than 50% of the total time observed. To assess changes in frequency, a Poisson mixed effects model was fitted to the count of number of yawn and simple mouth opening events with age and gender as fixed effects, and person as a random effect. For both yawns and simple mouth openings a smooth varying age effect was significant. The number of yawns observed declined with age from 28 weeks gestation, whereas simple mouth openings were less frequent and the decline was observed from 24 weeks. Gender was not significant either for yawn and simple mouth openings., Conclusions/significance: Yawning can be reliably distinguished from other forms of mouth opening with the potential of using yawning as an index of fetal healthy development.

Observations of prenatal movement patterns of mouth and lips essential for feeding could have the potential for an assessment of the readiness to feed after birth. Although there is some research on sucking per se, we know very little about prenatal preparatory movements for sucking, namely, the ability to co-ordinate opening the mouth widely and then pursing the lips as if around a teat or nipple in utero. The purpose of the present study was to test two hypotheses using an adapted version of the Facial Action Coding Scheme: first that mouth stretch (AU 27) will be followed by lip pucker (AU 18), and second that these coordinated movement patterns will increase as a function of gestational age. Fifteen healthy fetuses were scanned four times between 24 and 36 weeks gestation using 4D ultrasound visualization. Results showed a decreased number of mouth stretches with increasing fetal age. Contrary to our expectations, we did not find an increase in movement patterns of mouth stretch followed by lip pucker in preparation for feeding ex utero. The results are discussed in terms of sensory triggers in utero required to elicit preparatory movements for feeding ex utero.

Background: Fetal facial development is essential not only for postnatal bonding between parents and child, but also theoretically for the study of the origins of affect. However, how such movements become coordinated is poorly understood. 4-D ultrasound visualisation allows an objective coding of fetal facial movements., Methodology/findings: Based on research using facial muscle movements to code recognisable facial expressions in adults and adapted for infants, we defined two distinct fetal facial movements, namely "cry-face-gestalt" and "laughter- gestalt," both made up of up to 7 distinct facial movements. In this conceptual study, two healthy fetuses were then scanned at different gestational ages in the second and third trimester. We observed that the number and complexity of simultaneous movements increased with gestational age. Thus, between 24 and 35 weeks the mean number of co-occurrences of 3 or more facial movements increased from 7% to 69%. Recognisable facial expressions were also observed to develop. Between 24 and 35 weeks the number of co-occurrences of 3 or more movements making up a "cry-face gestalt" facial movement increased from 0% to 42%. Similarly the number of co-occurrences of 3 or more facial movements combining to a "laughter-face gestalt" increased from 0% to 35%. These changes over age were all highly significant., Significance: This research provides the first evidence of developmental progression from individual unrelated facial movements toward fetal facial gestalts. We propose that there is considerable potential of this method for assessing fetal development: Subsequent discrimination of normal and abnormal fetal facial development might identify health problems in utero.

Background: Although a number of studies have found that maternal stress affects the fetus, it is unclear whether jerky fetal movements observed on ultrasound scans are indicative of fetal stress, or whether they are part of normal development., Aims: The present study was designed to examine the relationship between jerky fetal arm movements in relation to fetal age and stress., Methods: Video recordings were made of routine ultrasound scans of 57 fetuses (age range 8 to 33 weeks) classified into three age groups: 1st trimester (8-12 weeks, N=9), 2nd trimester (13-24 weeks, N=38), and 3rd trimester (26-33 weeks, N=10). Following previous research on stress behaviour in neonates, a fetal index of stress was derived from frequency of hiccup, back arch and rhythmical mouthing., Results: Results indicated that while stress level was unrelated to fetal age, jerkiness of arm movements was significantly associated with the fetal stress index but not age., Conclusions: Our findings suggest that jerky arm movements in fetuses are suggestive of fetal stress., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Studies show that 65-85% of mothers cradle their infants to the left side of their body, but that this bias changes with maternal mood and stress. The present study examines the hypothesis that maternal stress and depression status will influence the cradling bias differentially., Method: As part of a larger study on mother-infant interaction, mothers (N = 79) were asked to pick up and briefly hold their children in their arms (44 boys, 35 girls; mean age 7.2 months, range 3 to 14 months)., Results: Results indicated that 86% of mothers who were neither stressed nor depressed cradled to the left and 14% to the right. Comparing the cradling side of stressed mothers with those who were neither stressed nor depressed, more in the former group showed right-sided cradling. In contrast, mothers who were just depressed preferred to cradle to the left., Conclusion: The lack of a left-sided cradling bias might be due to stress rather than depression experienced by mothers. Furthermore, this study provides evidence that the state of maternal mental health might be indicated by the side on which they cradle their child preferentially.