Maternal-Fetal Heart Sound/Electrocardiogram Monitoring and Cardiac Risk Early Warning

Perinatal cardiovascular health poses significant threats to maternal and fetal safety. Pregnancy-associated heart disease remains the leading cause of non-obstetric maternal mortality in China. While conventional assessments rely on static and intermittent monitoring, dynamic changes in cardiac function during pregnancy often go undetected, leading to missed opportunities for early intervention.

Fetal congenital heart disease (CHD) and autoimmune-related fetal complete heart block (CHB) are major causes of adverse perinatal outcomes. Current diagnostic methods, primarily relying on fetal echocardiography, struggle to detect early electrophysiological abnormalities, resulting in delayed warning times.

This study integrates non-invasive wearable technology to dynamically collect maternal-fetal heart sound and ECG signals. It aims to establish normal reference standards, screen sensitive early warning indicators, construct predictive models for perinatal adverse events, and finally develop a clinical risk stratification workflow. Signal acquisition was initiated at the following gestational ages: fECG from approximately 12 weeks of gestation, fPCG from approximately 16 weeks of gestation, and maternal signals (mECG and mPCG) from the time of enrollment. All signals were acquired serially until delivery.

Inclusion criteria

• Pregnant women aged 18 to 45 years with singleton pregnancy;
• For maternal groups: diagnosed with heart disease (congenital, valvular, or cardiomyopathy) or healthy without cardiac disease;
• For fetal groups: diagnosed with congenital heart disease, anti-Ro/SSA antibody positive status, or normal cardiac structure;
• Able to cooperate with non-invasive monitoring and follow-up procedures;
• Voluntary written informed consent provided prior to enrollment.

Exclusion criteria

• Multiple pregnancy;
• Severe skin disease or thoracic deformity preventing placement of monitoring sensors;
• History of malignancy, severe hepatic or renal dysfunction;
• Inability to complete follow-up visits or monitoring;
• Contraindications to non-invasive monitoring procedures.