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Recurrent Pregnancy Loss Without Current PregnancyNCT07045818

Altered Interhemispheric DLPFC Coordination and Cardiac Hyperreactivity During Multisensory Aversive Challenge in Recurrent Pregnancy Loss With Comorbid Anxiety

An observational study of Recurrent Pregnancy Loss Without Current Pregnancy and Anxiety Disorder, run by Shenyang Medical College at 4 sites in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This exploratory clinical study, NEURO-CARD-2, will use simultaneous functional near-infrared spectroscopy (fNIRS) and electrocardiography (ECG) to investigate interhemispheric dysfunction in the dorsolateral prefrontal cortex (DLPFC) and its association with autonomic sympathetic activation in women with recurrent… Read more about this study

Who is it for?
Ages 18 to 45 years, women only
What is being tested?
Multisensory aversive emotional challenge task
How many people
70 participants
Where
4 sitesChina
Study dates
2 Jul 2025to 25 Apr 2026
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 45 years
  • Women only
  • No healthy volunteers
  • Adult

Study population: Recruitment is expected to occur through obstetrics and gynecology outpatient clinics, as well as community outreach via flyers and media campaigns.

Who may be able to join

  • Female, age 18 to 45 years, right-handed;
  • Diagnosis of recurrent pregnancy loss, defined as two or more consecutive spontaneous miscarriages before 28 weeks of gestation;
  • Not currently pregnant, or diagnosed with missed abortion at the time of assessment;
  • Completed a structured psychiatric evaluation conducted by licensed psychiatrists at each center, with diagnostic confirmation according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5);
  • For participants assigned to the RPL with anxiety group: meets DSM-5 diagnostic criteria for generalized anxiety disorder, has a Hamilton Anxiety Rating Scale score of at least 14, and has a 17-item Hamilton Depression Rating Scale score of 17 or lower;
  • For participants assigned to the RPL without anxiety group: does not meet DSM-5 diagnostic criteria for generalized anxiety disorder, has a Hamilton Anxiety Rating Scale score below 14, and has a 17-item Hamilton Depression Rating Scale score of 17 or lower.

Who cannot join

  • Use of psychotropic medication within the past month, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, benzodiazepines, antipsychotics, or mood stabilizers;
  • Unstable or uncontrolled blood pressure, defined as systolic blood pressure greater than 180 mmHg or less than 90 mmHg at screening;
  • Major comorbid organic conditions that could affect autonomic or neural measurements, including hyperthyroidism, atrial fibrillation, clinically significant valvular heart disease, prior stroke, epilepsy, traumatic brain injury, or chronic pulmonary disease;
  • Significant sensory or communication barriers that could impair task performance or stimulus perception, including hearing impairment, language difficulty, or sensory neuropathy;
  • High suicide risk or severe psychiatric comorbidity, including psychotic disorders, bipolar disorder, or substance use disorders;
  • Marked intolerance to auditory, visual, or cold stimuli based on medical history or pre-test report;
  • Any other condition judged by the study physician to interfere with safe participation in the multisensory aversive stimulation protocol.

Trial locations and contacts

4 sites in 1 country.

China4 sites
  • The Second Affiliated Hospital of Shenyang Medical College

    Shenyang, Liaoning, 110001

  • Central Hospital Affiliated to Shenyang Medical College

    Shenyang, Liaoning, 110024

  • 157 Hospital of Liaoning Health Industry Group

    Shenyang, Liaoning, 110045

  • 242 Hospital Affiliated to Shenyang Medical College

    Shenyang, Liaoning, 110086

Other trials in China

About this study

Official title: Altered Interhemispheric DLPFC Coordination and Cardiac Hyperreactivity During Multisensory Aversive Challenge in Recurrent Pregnancy Loss With Comorbid Anxiety: a Multicenter Simultaneous fNIRS-ECG Study (NEURO-CARD-fNIRS)

This exploratory clinical study, NEURO-CARD-2, will use simultaneous functional near-infrared spectroscopy (fNIRS) and electrocardiography (ECG) to investigate interhemispheric dysfunction in the dorsolateral prefrontal cortex (DLPFC) and its association with autonomic sympathetic activation in women with recurrent pregnancy loss (RPL) and comorbid anxiety. Using a standardized multisensory aversive emotional stimulation paradigm, the study will assess cortical and cardiac responses within a Brain-Heart-Emotion interaction framework. The objective will be to identify neurobiological signatures of emotion-autonomic dysregulation in this population and to inform the future development of precision-targeted interventions.

Read the detailed description

For this protocol, recurrent pregnancy loss (RPL) was defined as two or more consecutive spontaneous miscarriages before 28 weeks of gestation. RPL affects approximately 2-5% of reproductive-age couples worldwide and imposes a substantial clinical and emotional burden. In addition to its reproductive consequences, RPL is associated with a substantial psychological burden, and approximately 50% of affected women experience chronic anxiety. This emotional burden has been linked to persistent sympathetic activation, including elevated resting heart rate and reduced heart rate variability, which may contribute to cardiovascular and reproductive risk.

Contemporary psycho-cardiology models, including statements from the American Heart Association, emphasize the close relationship between emotional dysregulation and autonomic dysfunction. The neural mechanisms linking altered central emotion regulation to cardiac autonomic outcomes in women with RPL remain insufficiently characterized, particularly in those with comorbid anxiety.

Emerging work in interoceptive neuroscience suggests that higher-order brain regions may provide shared neural substrates for anxiety and sympathetic overactivation. The dorsolateral prefrontal cortex (DLPFC), a key node in the cognitive control network and central autonomic network, is of particular interest. Neuroimaging and neuromodulation studies have shown hemispheric asymmetry within the DLPFC. The right DLPFC has been associated with threat processing, anxiety, and sympathetic arousal, whereas the left DLPFC has been associated with cognitive reappraisal, emotional inhibition, and parasympathetic modulation.

A Brain-Heart-Emotion interaction model underlies this study. Within this framework, effective autonomic adaptation during negative emotional challenge is hypothesized to depend on coordinated bilateral DLPFC recruitment. Functional decoupling, expressed as right-lateralized DLPFC dominance, may weaken emotion regulation capacity and promote sympathetic overactivation. In women with RPL and comorbid anxiety, this pattern is hypothesized to contribute to the convergence of emotional dysregulation and cardiac dysfunction, with potential implications for reproductive and cardiovascular risk.

To evaluate this hypothesis, this prospective exploratory clinical study will use simultaneous fNIRS and ECG during a standardized multisensory emotional provocation paradigm. Patterns of interhemispheric DLPFC activation and their associations with heart rate dynamics will be examined in women with RPL with and without comorbid anxiety within the proposed Brain-Heart-Emotion framework.

If confirmed, the findings may provide mechanistic insight and empirical support for neurobiologically informed precision-targeted interventions. Potential implications may include support for inhibitory neuromodulation targeting the right DLPFC, with possible benefits for emotional regulation, autonomic balance, long-term cardiovascular risk reduction, and reproductive outcomes in this high-risk population.

Being tested
Multisensory aversive emotional challenge task
Keywords
recurrent pregnancy loss, anxiety, emotion-autonomic dysregulation, dorsolateral prefrontal cortex, functional near-infrared spectroscopy
Medical subject headings
Anxiety Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Multisensory aversive emotional challenge taskBehavioural

    Participants will undergo a standardized multisensory aversive stimulation paradigm during simultaneous fNIRS and ECG recording. The protocol will use a block design with 12 stimulation blocks, each comprising a 20 s resting phase followed by a 30 s multisensory stimulation phase. During stimulation, participants will view six negative high-arousal images per block selected from the Geneva Affective Picture Database, while concurrently being exposed to time-locked band-limited white noise calibrated to approximately 90 dB(A) and placing both hands on a 0.5 liter bottle filled with ice water maintained at approximately 0 °C. The auditory stimulus will have spectral energy restricted to 2-6 kHz. This standardized multisensory protocol will be used to elicit negative affect and sympathetic arousal.

Study groups in NCT07045818
Study groupRoleWhat they receive
Women with recurrent pregnancy loss and comorbid anxietyWomen with recurrent pregnancy loss who will meet DSM-5 criteria for a comorbid anxiety disorder. Participants in this cohort will undergo the same protocol-assigned multisensory aversive stimulation paradigm during simultaneous fNIRS and ECG recording. This cohort will be compared with women with recurrent pregnancy loss without comorbid anxiety to evaluate DLPFC activation, interhemispheric coherence, heart-rate responses, and brain-heart coupling features.
Receives: Behavioral: Multisensory aversive emotional challenge task
Women with recurrent pregnancy loss without comorbid anxietyWomen with recurrent pregnancy loss who will not meet DSM-5 criteria for a comorbid anxiety disorder. Participants in this cohort will undergo the same protocol-assigned multisensory aversive stimulation paradigm during simultaneous fNIRS and ECG recording. This cohort will serve as the comparison group for evaluating DLPFC activation, interhemispheric coherence, heart-rate responses, and brain-heart coupling features.
Receives: Behavioral: Multisensory aversive emotional challenge task

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Group-dependent hemispheric asymmetry of DLPFC activation during aversive emotional stimulation (group × hemisphere interaction)

    The primary endpoint will be the group-by-hemisphere interaction in task-evoked DLPFC HbO activation during aversive emotional stimulation, comparing women with recurrent pregnancy loss (RPL) with anxiety versus without anxiety. Hemisphere will be defined as right versus left DLPFC, measured within the same participant. The participant-level activation metric will be the DLPFC HbO response estimate (β) derived from the prespecified fNIRS analysis pipeline. The primary hypothesis will be tested using a linear mixed-effects model (LME) fitted by restricted maximum likelihood, with prespecified covariates including age, education, body mass index, miscarriage etiology category, and resting heart rate. The primary confirmatory test will evaluate whether the right-minus-left difference in DLPFC activation differs by group.

    Measured: Single-session fNIRS-ECG protocol (Day 1)

Secondary outcomes (2)
  1. Group difference in interhemispheric synchronization of DLPFC activity

    Interhemispheric DLPFC synchronization will be assessed using wavelet transform coherence (WTC) between homologous left and right DLPFC HbO signals. For each participant, coherence values will be averaged across the task-relevant low-frequency band (0.01-0.08 Hz) and across the stimulation period, background-corrected using the 3-minute resting period, and Fisher z-transformed to yield a participant-level synchronization metric. Between-group differences will be summarized descriptively and tested using a two-sample independent t test and a covariate-adjusted linear regression model with prespecified covariates. Prespecified supporting analyses will repeat the same computation and inferential framework across four additional prefrontal subregions to assess spatial specificity.

    Measured: Single-session fNIRS-ECG protocol (Day 1)

  2. Group difference in mean heart-rate increase during aversive emotional stimulation

    Autonomic reactivity will be assessed as the mean heart-rate increase during aversive stimulation relative to the resting baseline, derived from ECG over the prespecified task window using a uniform preprocessing pipeline across participants. Preprocessed R-R intervals will be resampled at 11 Hz, filtered with a fourth-order low-pass Butterworth filter with a 0.1 Hz cutoff, detrended, segmented into 40-second epochs consisting of 10 seconds before stimulus onset and 30 seconds during stimulation, and baseline-corrected using the 10-second prestimulus period. The resulting heart-rate increase will be averaged across the 12 blocks for each participant. Between-group differences will be tested using a two-sample independent t test and a covariate-adjusted linear regression model.

    Measured: Single-session fNIRS-ECG protocol (Day 1)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Jul 2025
  2. Study start2 Jul 2025
  3. Primary completion25 Apr 2026
  4. Study completion25 Apr 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Other
Time perspective
Prospective
Enrolment
70 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07045818
Sponsor's protocol ID
NEURO-CARD-fNIRS_Version3
Status last verified
Sep 2025
First submitted
22 Jun 2025
Last updated
18 Aug 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-dentified individual participant data, together with the full study protocol, MATLAB analysis scripts, and all supporting materials, will be released in full at the time of publication of the final manuscript. All materials will be deposited on one internationally recognized open science repository selected by the research team, such as Open Science Framework (https://osf.io), Zenodo (https://zenodo.org), or GitHub (https://github.com). Access will be granted for non-commercial research purposes. Requests for additional information may be directed to the corresponding author.

Questions about this trial

What is this clinical trial studying?

An observational study of Recurrent Pregnancy Loss Without Current Pregnancy and Anxiety Disorder, run by Shenyang Medical College at 4 sites in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Group-dependent hemispheric asymmetry of DLPFC activation during aversive emotional stimulation (group × hemisphere interaction) (time frame: Single-session fNIRS-ECG protocol (Day 1)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Aug 2026.

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