Music and Unborn Babies Statistics on Music and Unborn Babies

Int J Pediatr. 2012; 2012: 901812.

Maternal Music Exposure during Pregnancy Influences Neonatal Behaviour: An Open-Label Randomized Controlled Trial

Ravindra Arya

¹Partition of Neurology, Cincinnati Children's Hospital Medical Middle, MLC 2015, 3333 Burnet Avenue, Cincinnati, OH 45229, U.s.a.

Maya Chansoria

ⁱⁱDepartment of Pediatrics, North.S.C.B. Medical College, Jabalpur 482003, Bharat

Ramesh Konanki

³Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India

Dileep Yard. Tiwari

⁴Department of Pediatrics, Deen Dayal Upadhyay Infirmary, New Delhi 110064, India

Received 2011 Jul 11; Revised 2011 Oct 24; Accustomed 2011 Nov 6.

Abstract

Objective. This study evaluated the issue of antenatal music exposure to primigravida healthy mothers on the behaviour of their term appropriate-for-date newborns assessed using Brazelton Neonatal Behavioral Assessment Scale (BNBAS). Methods. This was a single-centre, randomized, open-label controlled trial. Primigravida mothers aged 19–29 years, costless of chronic medical diseases or significant deafness, with singleton pregnancy, with a gestation of twenty weeks or less, were randomized to listen to a pre-recorded music cassette for approximately ane hr/day in addition to standard antenatal care (intervention arm) or standard care only (control arm). Perinatal factors with agin outcome on neonatal behaviour were accounted every bit protocol violations. Outcome measure included scores on 7 clusters of BNBAS. Principal analysis was per protocol. The trial is registered with ClinicalTrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT01278329","term_id":"NCT01278329"}}NCT01278329). Results. One hundred and twenty-6 newborns in the music group and 134 in the command group were subjected to BNBAS assessment. The infants of mothers exposed to music during pregnancy performed significantly improve on 5 of the 7 BNBAS clusters. The maximal beneficial effect was seen with respect to orientation (ES 1.13, 95% CI 0.82–1.44, P < 0.0001) and habituation (ES 1.05, 95% CI 0.53–one.57, P = 0.0001). Conclusion. Prenatal music exposure to mother significantly and favourably influences neonatal behaviour.

1. Introduction

The developing nervous system in utero is exposed to myriad influences with potentially far reaching consequences. Well-nigh of the research in this surface area is directed towards understanding the adverse influences and their structural or functional pathogenesis [ane]. Withal, it is likewise attractive to investigate if foetal neurodevelopment tin can be positively influenced or enhanced in an analogous manner. In that location is testify that appropriate vibroacoustic stimulation by exposure to music alters foetal behaviour and is carried forrad to the newborn flow [ii, 3]. Music is a noninvasive, culturally adequate intervention with multiple putative direct and indirect beneficial furnishings on mother and foetus through the pregnancy and perinatal menstruation. In animals, prenatal music exposure has been shown to meliorate postnatal spatial learning and retentivity; to reduce isolation stress [iv]. Music has been found to beneficially affect stress response and recovery from disquisitional affliction or surgery [5, 6]. Using optical topography and salivary cortisol equally a marker of stress, music has been documented to simulate pleasure and happiness [7]. On a molecular level, music has been shown to alter dominergic neurotransmission and have straight effect on neurotrophic growth factors including brain derived neurotrophic factor and tyrosine kinase receptor B [5, 8]. Besides straight influence on emotions, behavior, and neurotransmitter systems, there are multiple endocrine effects of music exposure including altered levels of adrenal and gonadal steroids. These changes in a significant woman can influence neuroblast proliferation, axonogenesis, synaptogenesis, and neuronal organization with effects on cerebral performance and behavioural gestalt. The nowadays study was carried out to test the hypothesis that music exposure to mother during pregnancy tin can affect the neonatal behaviour.

2. Methods

This was a single-heart, open-label, randomized controlled trial (RCT) conducted at a teaching infirmary from January 2003 to Dec 2005. The study was approved past institutional ideals committee and is registered with ClinicalTrials.gov ({"blazon":"clinical-trial","attrs":{"text":"NCT01278329","term_id":"NCT01278329"}}NCT01278329).

2.1. Participants

All consecutive primigravida mothers of 19 to 29 years of age with singleton pregnancy attending the antenatal clinic of the study establishment starting time fourth dimension, at or before xx weeks of gestation, were eligible for inclusion. Mothers with significant coexisting medical diseases or severe to profound hearing loss were excluded (Effigy 1). Demographic details were recorded on a structured information sheet. Mothers were then randomized to music and command groups using a printed random number table. Two groups were generated using block randomization method, using variable length of blocks. Allocation to the groups was concealed from the investigator (RA) performing event cess. All mothers received standard antenatal care. Mothers randomized to music group were given a cassette thespian and a prerecorded music audio cassette and were demonstrated their use.

two.2. Interventions

Mothers in the music group were provided a prerecorded "Garbh Sanskar" audio cassette (Times Music Inc., Mumbai, India) with a running duration of approximately l minutes and a cassette histrion with headphones. This contains a medley of instrumental music, natural sounds, and chants from religious scriptures. They were asked to listen to the recorded music daily in the evening just before going to the bed with a minimum of ambience noise. They were also asked to maintain a record of their music listening activeness by making a check mark on a printed calendar. Mothers were then followed up with conventionally scheduled antenatal visits. At each visit, the compliance was ascertained past reviewing the calendar. Criteria for protocol violation included noncompliance with music listening for more 2 weeks, development of preeclampsia or eclampsia in the mother, delivery of the newborn at a gestation of less than 37 or more than than 42 completed weeks, commitment of the baby by emergency caesarean section, requirement of full general anaesthesia even in case of elective caesarean section, neonatal birth weight less than 2500 grams or more 4000 grams, or presence of significant neonatal disease precluding application of outcome cess. Each protocol violation was counted only once in a mutually sectional way.

ii.3. Outcomes

All healthy term appropriate for appointment neonates born of spontaneous vaginal delivery or elective caesarean section conducted under epidural amazement were subjected to issue assessment. Hence, the primary analysis was per protocol.

Consequence measures consisted of the operation on Brazelton Neonatal Behavioral Assessment Calibration (BNBAS). The BNBAS is a ways of scoring interactive behaviour for term and stable preterm infants. The calibration consists of 27 behavioural items, each scored on a 9-point scale, and 20 elicited responses, each scored on a iii-point calibration. In nearly cases, the infant's score is based on the best performance, not an average performance [ix].

The BNBAS was administered once to each babe in the written report on day two or three of life. The cess was performed by the investigator (R.A.) who has received prior training in its application, and the items were scored as recommended in the manual [9]. Infants were tested midway between feeds in a tranquility, dimly lit room with an ambient temperature of 32–34°C. The items were grouped equally recommended by Lester into the following 7 clusters: habituation, orientation, motor performance, range of state, regulation of state, autonomic stability, and reflexes [10].

2.four. Sample Size Interpretation and Statistical Analysis

Sample size estimation for this study presented many challenges. A prior prospective study with similar design used a sample size of 20 believing information technology to capture "significant differences in fetal behavior" [three]. A airplane pilot report was not feasible because of long follow-upward period from enrolment of the mother to delivery of the newborn; lack of single primary outcome measure. Hence, it was decided to bear the written report in an open up-concluded way limited past time of enrolment (January 2003 to March 2005) rather than number of mothers enrolled.

The data was entered in a Microsoft Excel spreadsheet (MS Office version 2003). Hateful scores in each cluster were compared using t-test for contained samples. Issue size and 95% confidence intervals (CI) for the same were calculated. Baseline variables were compared using t- and χ ²-statistics. The open up source freeware "OpenStat" was used for calculations [11]. All mothers gave written informed consent before enrolment. The study was approved by institutional ideals committee.

three. Results

A full of 352 primigravida females attending antenatal clinic for the first fourth dimension at a gestation of twenty weeks or less were evaluated for participation. Ten females were excluded because of chronic medical diseases including rheumatic heart affliction [five], chronic hepatitis [2], uncontrolled blazon ane diabetes, chronic obstructive pulmonary affliction, and vesicoureteric reflux-associated chronic renal failure (1 each). Two females were unwilling to participate, and ane was found to accept 90 dB hearing loss on audiometric evaluation. The remaining 339 females were randomized to receive music exposure in add-on to standard antenatal care (intervention arm, due north = 169) and standard care alone (control arm, northward = 170). The groups were comparable at baseline (Table 1). The primary analysis was per protocol, and BNBAS assessment was applied to 126 newborns in the music exposure group and 134 newborns in the control group (Figure i).

Table i

Baseline comparisons of relevant maternal and neonatal variables between music and control groups.

Variable	Music group (n = 126)	Control group (n = 134)	Examination statistic	P value
Maternal factors
Maternal historic period (years) (mean ± SD)	23.viii ± one.9	24.ix ± two.iii	t = −1.14, df = 258	0.2542
Gestational age at enrolment (completed weeks) (mean ± SD)	thirteen.1 ± 2.4	12.vii ± 2.9	t = 1.21, df = 258	0.2283
Family socioeconomic class (I, II and III, IV, and 5)	4, 88, 34	seven, 91, 36	χ 2 = 0.68, df = 2	0.7117
Maternal professional person status (working, housewife)	45, 81	49, 85	χ 2 = 0.02, df = 1	0.8862
Way of delivery (vaginal, caesarean section)	97, 29	98, 36	χ 2 = 0.51, df = one	0.4737
Neonatal factors
Sexual practice (male : female)	69, 57	71, 63	χ 2 = 0.08, df = 1	0.7739
Birth weight (grams) (mean ± SD)	2693.5 ± 94.vii	2686.1 ± 89.9	t = 0.646, df = 258	0.5186

The infants built-in to mothers exposed to music during their pregnancy scored significantly college on 5 of the 7 BNBAS clusters including habituation, orientation, range of state, regulation of state, and autonomic stability. In all these clusters, the 95% confidence interval (CI) for effect size (ES) remained on 1 side of the signal of no difference (Table two). The maximal beneficial effect was seen in the clusters of orientation (ES 1.thirteen, 95% CI 0.82–1.44, P < 0.0001) and habituation (ES 1.05, 95% CI 0.53–i.57, P = 0.0001). The newborns of music exposure group also showed a pregnant trend towards better motor performance (ES 0.25, 95% CI 0.0–0.5, P = 0.0479); notwithstanding, the lower bound 95% CI touched the point of no departure. There was no difference between the infants of intervention and control artillery on the reflexes cluster.

Table 2

Comparison of BNBAS clusters scores between music and control groups.

Cluster	Music group (n = 126) (Mean ± SD)	Control group (n = 134) (Hateful ± SD)	Outcome size (95% CI)	Test statistic	P value
Habituation	5.72 ± i.nine	iv.67 ± 2.three	1.05 (0.53, 1.57)	t = 3.999, df = 258	0.0001
Orientation	6.51 ± ane.ane	5.38 ± ane.iv	1.13 (0.82, one.44)	t = seven.207, df = 258	<0.0001
Motor performance	four.56 ± one.2	iv.31 ± 0.8	0.25 (0.00, 0.l)	t = 1.987, df = 258	0.0479
Range of state	iv.35 ± 0.five	4.04 ± 0.half dozen	0.31 (0.17, 0.45)	t = iv.511, df = 258	<0.0001
Regulation of country	four.33 ± ane.0	iii.79 ± 1.1	0.54 (0.28, 0.lxxx)	t = 4.134, df = 258	<0.0001
Autonomic stability	v.88 ± 0.7	5.62 ± 0.9	0.26 (0.06, 0.46)	t = 2.589, df = 258	0.0102
Reflexes	v.19 ± ane.ix	5.24 ± 2.four	−0.05 (−0.58, 0.48)	t = −0.185, df = 258	0.8530

There were 43 (25.four%) protocol violations in the mothers randomized to music grouping and 36 (21.2%) in the command group (z = 0.9292, P = 0.3528). The breakup of causes for protocol violations is provided in Figure 1. Compliance for listening to music was assessed using cocky-maintained record. The mean duration of music exposure in mothers of intervention arm was institute to exist 173.3 (±18.nine) hours.

four. Word

The present study supports the hypothesis that maternal exposure to music during pregnancy tin beneficially influence neonatal behaviour. Behavioral responses test the integrity of neonatal nervous system at several levels including perception, afferent conduction, integration, witting decision, and efferent motor apparatus [9].

The maximum effect of music exposure was seen in the orientation cluster (hateful difference 1.xiii points) (Tabular array 2). Orientation items test the infants' response to animate and inanimate, auditory, and visual stimuli presented separately or together and constitute the "Social Interactive parcel" of BNBAS [9]. The mean score of infants belonging to music group in this cluster was vi.five which implies that the average infant was able to follow the visual stimulus with smoothen coordinated movement of head and optics in 30–60° arcs horizontally and probably also vertically; exhibited alerting and searching behaviour in response to sound stimulus [9].

The habituation cluster also showed significantly better scores in infants born to mothers exposed to music during pregnancy (hateful divergence one.05 points) (Table 2). The "Habituation package" of BNBAS tests response decrement to repeated stimuli, including visual (low-cal), auditory (rattle and bell), and tactile (pivot prick to foot) stimuli [9]. The average infant in the intervention arm scored 5.7 in this cluster which implies shutdown of trunk movements and some diminution of blinks and respiratory changes later few repetitions of visual or auditory stimuli. For the tactile stimulation item, this score implies a response localized to stimulated leg or foot later five trials with no motion in residual of the body [9]. Such motor behaviour belongs to the Volpe's category of "high level" responses which depend on intact integration part in central nervous arrangement (CNS) [12].

The infants of the mothers of music group as well showed significantly better performance than the control group with respect of range and regulation of behavioural states and autonomic stability (Table two). The neonatal baby displays a rich repertoire of behavioural states; the interplay of these states, their transition, and variety presented by the newborn is akin to examining the "higher mental functions" of the developed. In that location was also a trend towards ameliorate motor performance in the infants belonging to intervention arm, but it failed to achieve statistical significance.

The effects of maternal experiences on foetal or neonatal behaviour have been studied previously and explored for the possibility of modifying this behaviour. A prospective RCT studied the effect of music played to ten foetuses (median gestation 38 weeks) with a headphone on the maternal abdomen. A silent headphone taped to belly of some other x mothers comprised the control arm. The exposed foetuses showed higher mean eye rates (FHR) and college FHR variation in the first hour itself, with significantly more state transitions past fourth hour. These newborns also showed more country transitions and spent a college proportion of time in awake state, when exposed to same music stimulus subsequently birth [3]. The authors concluded that this suggests the occurrence of a simple grade of foetal programming or learning.

Some other written report has been conducted to examine whether foetal response to music differs from that to man voice. Ten healthy term foetuses were exposed to music, voice, and sham in random guild for three 15 second intervals. Foetuses were found to respond by increased FHR and motor response to both music and vocalization which was significantly different from sham exposure but not different between themselves [2]. It has too been demonstrated that foetal repertoire of responses to music exhibits a pattern of maturation with the gestation. In response to piano recordings, younger foetuses (28–32 weeks gestation) responded past transient increase or subtract in centre charge per unit depending on sonic intensity, probably indicating selective attention to stimulus; whereas the more mature foetuses displayed sustained elevation in heart rate (>33 weeks) and change in torso movements (35 weeks) [13]. The authors concluded that processing of complex sounds changes at 33 weeks of gestation [thirteen].

Feel in the nowadays study agrees with published literature that music exposure in utero does influence neonatal behaviour. Nonetheless, there are sure of import differences. This written report enrolled mothers in get-go one-half of pregnancy and the foetus was exposed to a mean duration of 173 hours of music before birth, whereas other studies accept exposed the foetus only for a few hours prior to nativity. Also, the nowadays written report used conventional headphones worn by the mother over her ears instead of the one taped to her belly as in other studies. Although this would probable accept resulted in less direct sonic stimulation of the foetus, the practical implications of this approach are more because of its meliorate adaptability to routine clinical practise. A limitation of the present study was no standardization of the intensity of music stimulus. However, this might exist relevant in case of straight applied stimulus over maternal belly where it conveys both vibratory and audio-visual sensations [xiv], only not in present circumstances where information technology was improve to allow individual mothers determine near the volume of music every bit per their convenience.

The onset of foetal hearing occurs at about 24 weeks of gestation [15]. In the present report, mothers were exposed to music from early on gestation (≤20 weeks). It is not known when the favourable effect of maternal music exposure started, and hence optimal timing for such stimulation in clinical practice cannot exist ascertained. Information technology is improbable in the present study that music directly had any auditory furnishings on the foetus. The effects are more probable to exist mediated via endocrine changes produced in the female parent. Music is known to have multiple endocrine effects including increased growth hormone which modulates the production of certain cytokines, increased ovarian steroid secretion, changes in the biorhythms and levels of cortisol, testosterone, and estrogen [5, 16]. Corticosteroids have several regulatory effects on growth of neuroblasts, myelination, and metabolism in developing brain [17]. They have been demonstrated to influence important enzymes, for instance, sodium-potassium ATPase, and growth factors, for example, basic fibroblast growth factor (bFGF-2) in developing cerebrum in animals [17]. Over 200 steroid responsive genes have been identified in the rat hippocampus involved in axonogenesis, synaptogenesis, cell adhesion, and point transduction [17]. Thus, music exposure in the mother might influence neurogenesis and cerebral plasticity in the foetus through mechanisms mediated by steroids.

In conclusion, this report provides preliminary evidence that maternal music exposure beneficially affects neonatal behaviour. A trained clinician tin utilize the behavioural system of the newborn baby to proceeds insights into the intrauterine experience and the perinatal events which may take influenced the neonate's CNS organization [nine]. The present clinical trial was not designed to written report these aspects and provides no information regarding the mechanism behind the observed effect. Farther studies should confirm this observation with a more rigorous design and endeavour to elucidate the straight and endocrine-mediated mechanisms of the effect of music on foetus and newborn.

Disclosure

At that place was no external funding agency involved. R. Arya (2002–2005) and D. K. Tiwari (2004–2006) were Residents in the Section of Pediatrics, NSCB Medical Higher, Jabalpur, Republic of india, during the formulation and data collection phases of this study.

Conflict of Interests

None of the authors has whatsoever disharmonize of interests to report.

Authors' Contribution

R. Arya, Primary Investigator, was responsible for the design, conduct, and analysis of the study also as drafting the paper. Grand. Chansoria helped with Inputs to design, supervision of information collection, and critical review of paper. R. Konanki. Carried out data assay and drafting the paper. D. Chiliad. Tiwari conducted the data drove and the critical review of the paper.

Acknowledgment

The cost of study was borne by the report establishment (Department of Pediatrics, NSCB Medical College, Jabalpur, Bharat).

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299264/

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