REVIEW ARTICLE

Fetuses can Listen, Learn, and Remember: We Need to be

Cautious about What and How We Say It!
Adrianna Frydrysiak-Brzozowska1,2 , Kedar Jape3, Gayatri Athalye-Jape4, Kinga Piórkowska1, Srijan Singh2,5 ,
Thierry AGM Huisman2,6, Akhil Maheshwari2,7,8
Received on: 29 July 2024; Accepted on: 28 August 2024; Published on: 20 December 2024

A b s t r ac t
T he fetal auditory system becomes functional during mid-gestation or possibly even earlier. Existing data show that fetuses can respond to
maternal voice and different types of music, both vocal and instrumental. The ability to receive and transmit sound waves, and then recognize
and retain some memory of these auditory stimuli could possibly be one of the most important developmental sensory milestones that we
need to learn about. Unfortunately, we still have limited evidence for the precise role and timing of prenatal sound simulation. There is a need
for methodologically strong, randomized controlled trials with rigorously designed interventions and standardized reporting measures. We may
need to compare different durations and types of musical (sound) intervention. At a minimum, these interventions can improve maternal–fetal
bonding and family-centered outcomes. Any evidence of neurodevelopmental gains would be an important scientific/medical advancement.
In certain conditions such as neonatal abstinence syndrome, emerging evidence suggests that early, in utero intervention with music therapy
can be helpful; these findings bring hope for new therapeutic tools to enhance the neurological development of at-risk fetuses. Considering
that prenatal music exposure might have positive effects on the fetus and newborn infant, we need carefully conducted studies of intrauterine
neurosensory organization with long-term follow-up.
Keywords: Fetus, Mother’s cardiotocographic parameters, Music therapy, Neonatal behavior, Neonatal neurological system, Newborn, Pregnancy,
Rhythm, Sound, Speech.
Newborn (2024): 10.5005/jp-journals-11002-0102

K e y P o i n ts 1
Faculty of Health Science, Collegium Medicum, The Masovian
• In terms of structure, the fetal hearing system is recognizable University in Płock, Płock, Poland
at early as 3–6 weeks of pregnancy. Functionally, the inner, 2
Global Newborn Society, Clarksville Maryland, United States of
middle, and outer ear are sufficiently developed at 24–25 weeks’ America
gestation to identify/distinguish between vibroacoustic stimuli. 3
Department of Obstetrics and Gynaecology, Joondalup Health
• Fetuses and newborn infants can respond to maternal voice Campus, Perth, Western Australia
across her abdominal wall. They also respond to different types 4
Department of Neonatology, Child and Adolescent Health Service,
of music, both vocal and instrumental. King Edward Memorial Hospital, Perth, Western Australia, Australia
• In utero exposure to music and speech induces stimulus-specific 5
Department of Neonatology, Kailash Hospital, Noida, Uttar Pradesh,
memory traces in the fetus. These stimuli may promote brain India
6
growth and possibly even short- and long-term cognitive gains. Edward B. Singleton Department of Radiology, Texas Children’s
• There is some evidence that music therapy can help in disorders Hospital and Baylor College of Medicine, Houston, United States of
such as neonatal abstinence syndrome. Possibly, timely in utero America
7
intervention may also enhance neurological development in Department of Neonatology/Pediatrics, Louisiana State University
other high-risk conditions. Health Sciences Center – Shreveport, Louisiana, United States of
• We need to carefully evaluate the immediate and long- America
8
term effects of music therapy on intrauterine neurosensory Banaras Hindu University Institute of Eminence, Varanasi, Uttar
organization. Pradesh, India
Corresponding Author: Adrianna Frydrysiak-Brzozowska, Faculty
of Health Sciences, Collegium Medicum, The Masovian University in
Introduction Płock, Płock, Poland, Phone: +243665414 216, e-mail: a.frydrysiak-
The fetus is exposed to a variety of auditory stimuli from as [email protected]
maternal heart sounds, voice, respiratory and bowel sounds, and How to cite this article: Frydrysiak-Brzozowska A, Jape K, Athalye-
environmental stimuli.1 Since hearing is acquired early during Jape G, et al. Fetuses can Listen, Learn, and Remember: We Need to be
Cautious about What and How We Say It! Newborn 2024;3(4):281–291.
pregnancy, there is a possibility that planned antenatal exposure
to music might have a have a role in fetal learning.2,3 Considering Source of support: Nil
that music also has a calming effect on the mother with few known Conflict of interest: Drs. Gayatri Athalye-Jape, Thierry AGM Huisman,
adverse effects,4 There is curiosity as to whether music could/should and Akhil Maheshwari are associated as the Editorial board members of
this journal and this manuscript was subjected to this journal’s standard
be a routine intervention during pregnancy. 5 In this article, we review procedures, with this peer review handled independently of
have reviewed the information available on the impact of prenatal these Editorial board members and their research group.
exposure to music on the growing fetus. We have assimilated

© The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
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 Fetuses can Listen, Learn, and Remember

information from an extensive review of the literature utilizing responding to music in the second trimester.33 Singing by pregnant
key terms in multiple databases including PubMed, EMBASE, and women provides auditory stimulation to their unborn child.33,34
Science Direct.6,7 To avoid bias in the identification of studies, Language acquisition and development of hearing could
keywords were short-listed a priori from anecdotal experience and be enhanced by rhythmic melodies. 33,34 Cognitive abilities and
PubMed’s Medical Subject Heading (MeSH) thesaurus.8–12 habituation for music can be demonstrated in fetuses and young
infants. 35 Arguably, the ability to discriminate speech stimuli
The Beginnings of Sound Reception in Fetal in utero can promote acquisition of native language fundamentals
Development during fetal life.36 Neonates prefer their mother’s voice and also
At the time of birth, a newborn baby is largely equipped with all the the language their mothers used while pregnant with them. 37–39
senses available to an adult.13 The ability to receive and transmit
stimuli in sound waves is important and matures rapidly in the Sleep Regulation and Relaxation
second trimester.14 Training becomes possible in later pregnancy.15 In newborn infants, soothing melodies and instrumental
The development of the auditory system begins between 3 and compositions can help establish healthy sleep patterns in both
6 weeks of pregnancy.16 At 24–25 weeks’ gestation, the structures the mother and a newborn infant.40 Similarly, music can promote
of the inner, middle, and outer ear are sufficiently developed to natural sleep in both the pregnant mother and her fetus by reducing
recognize vibroacoustic stimuli.17 In the developing central nervous stress.41 As shown in late preterm infants, these effects could
system (CNS), auditory stimuli can promote the maturation of the possibly be mediated by the release of endorphins in the CNS.40,42,43
temporal lobe regions that help recognize low-frequency sounds.18
The fetus hears sounds coming from the mother’s body first, such as Bonding and Maternal Heartbeat
those emanating from her cardiac contractions, blood flow in larger In the antenatal period, mother’s heartbeat is a familiar and
vessels, intestinal peristalsis, or airflow in the respiratory tract. The comforting rhythm for the baby. 44 Rhythmic melodies and
hearing threshold between 27 and 28 weeks’ gestation is about instrumental compositions can simulate maternal heartbeat
40 dB.19,20 The fetuses then respond to sounds with a frequency of and promote mother–fetal bonding, which might extend into the
250–500 Hz.21,22 Ongoing myelination of nerve fibers in the CNS postnatal period.29,45–47
continues to improve impulse conduction.23 Between 29 and 30
weeks’ gestation, the fetus can perceive higher-frequency sounds Enhanced Sensory Development
such as the mother’s voice, an infant’s cry, or an alarm.24 During the Music can promote the development of the fetal sensory pathways
34–35 weeks period, fetuses no longer seem to get alarmed with and sensory integration.31 Vibrations caused by music can be felt
sounds that previously caused arousal. They begin to respond to by the fetus, creating a multisensory experience that involves
sounds with frequencies of 1000–3000 Hz. At term, the hearing hearing, movement, and consequently, touch with the uterine walls,
threshold is 13.5 Hz.25 the umbilical cord, and even its own face.42,48,49 The movements
During pregnancy, extraneous sounds are usually first indicate their engagement with the auditory stimuli, thereby
transmitted from the air, through the abdominal wall, the uterus, preparing them for the postnatal sensory experiences.30
and finally to the amniotic fluid and the head of the fetus.26
Intra-uterine sounds might be more important. The sound of the
Maternal–Fetal Interactions
mother’s heartbeat is 25 dB above basic noise, dominating the Fetal activities can be observed and followed since early
fetal environment.24 Her voice is heard almost 4 times louder in pregnancy.50 The maturation of these activities is closely related
the womb than outside.27 Most sounds in the fetal environment to the development of the sense organs even in utero. Fetal motor
are dominated by lower frequencies.28 Energy above 0.5 kHz is activity can be identified as early as at 6–8 weeks’ gestation.51 At 12
attenuated by 40–50 dB. The fetus easily detects vowels, whereas weeks, the movements can now be characterized as “kicking,” “fetal
consonants, which are higher in frequency and less intense than rotation,” “opening/closing of the fist,” “nodding,” “sucking-like oral
vowels, are largely unavailable.28 activity,” and “reactions to touch.”51 As pregnancy progresses, these
activities become more frequent, mature with larger amplitude
The Importance of Music in the Prenatal Period and improved coordination of muscle groups.52 These movements
Music stimulation of a growing fetus is plausibly a positive stimulus are brief but the frequency progressively increases toward term
to promote a range of positive outcomes for both the mother and gestation.53
the fetus, the child. In 2015, Marx and Nagy showed that fetuses reacted with arm,
head, and oral movements when the mother touched the belly.54,55
Emotional Bonding and Stress Reduction Her voice evoked head and arm movements. Third-trimester fetuses
Long-standing cultural practices view music as a likely catalyst for showed more yawning (regulatory), resting (crossed arms), and
emotional connection, allowing a mother to establish a deeper independent touch (hands touching body) responses to stimuli
bond with her unborn child.29 Soothing songs and singing lullabies compared with those seen during the second trimester. Two years
have been encouraged as a means to decrease stress and promote later, the same investigators used 3- and 4-dimensional ultrasound
relaxation and emotional well-being. The harmonious vibrations of to examine fetal responses to tactile stimuli on maternal abdomen.
music can help to create a serene environment, fostering a sense Touching the belly by the mother, father, and a stranger was
of peace and tranquility for both the mother and baby. compared. In the control group, the fetal response was examined
while at rest, without touching the abdomen. When the mother
Language Development and Cognitive Stimulation touched her abdominal wall, the third-trimester fetus touched
Prenatal music and speech form stimulus-specific memory traces the uterine wall for significantly longer periods than those in the
during the fetal period,30,31 thereby stimulating brain growth, second trimester. The third-trimester fetuses showed stronger/
cognitive development, and long-term neural effects.32 Fetuses start longer responses when touched by their mother. These differential

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 Fetuses can Listen, Learn, and Remember

responses in older fetuses may reflect the maturation of the CNS

and the emergence of proprioceptive self-awareness.54
In 2021, Nagy at al.56 examined fetal responses to maternal
touch and voice. The sensorimotor competencies of the fetus
clearly suggest that communication readiness begins to develop
prior to birth. In response to maternal abdominal touch, fetuses
show responses that have been variably perceived by different
observers as cross-communication or self-stimulation. When the
mother touched her abdominal wall and spoke in a gentle voice,
fetal movements paused for some time. Similar responses were
seen during conversations with a third person (interpersonal
conversation). The fetuses showed a longer mouth-opening time
during these period. The results suggest that third trimester fetuses
can distinguish between interactive and non-interactive external
stimuli and also distinguish these from incidental, other interactions.
In 2012, Kisilevsky et al. 57 examined the impact of auditory
stimuli on fetal heart rate (HR) and heart movements in diabetic
and overweight pregnancies. Fetuses in overweight pregnancies Fig. 1: Sounds activate specific temporal lobe regions in children:
responded to their mother’s voice with increased HR. These altered A passive-listening functional-magnetic resonance imaging (fMRI)
reactions to the maternal voice in diabetic pregnancies may task comprised of a series of words and non-language noise induced
indicate relatively immature nervous or auditory system, increased bilateral activation in the posterior superior temporal gyri. This particular
sensorineural threshold, lower levels of thyroid hormones, or iron fMRI image is from a 5-year old with a hypothalamic hamartoma who
underwent fMRI for surgical planning; sounds were delivered using
deficiency in the mother.
headphones. The image shows that we now have the technology to
Lee et al.58 compared fetuses in women with hypertension vs study the impact of sounds on specific areas of the brain and can study
controls upon hearing maternal voice. In the maternal hypertension developmental changes in young infants
group, the fetuses showed increased HR upon listening to the
mother’s voice. However, if the voice was recreated, there was no low- and high-risk premature infants begin to respond to sounds
increase in fetal HR. The differential responses of the fetus to the at the same gestational age. The varied responses observed during
maternal voice in pregnancies complicated by maternal hypertension pregnancy in the high-risk group most likely indicate diversified
may reflect a functional increase in the sensorineural threshold functional development of the auditory system.61
or a delay in the maturation of the auditory system, which may The maturation of the fetal response to music was characterized
indicate functional differences during fetal life or subtle differences in the last trimester of pregnancy using a 5-minute piano recording
in the development of the CNS. Recent observations of maternal of Brahms’ Lullaby played at an average volume level of 95, 100,
voice recognition provide evidence for residual memory and learning 105, or 110 dB.62 Within 30 seconds of turning on the music, the
in healthy fetuses. We still need to investigate higher-order auditory youngest fetuses (28–32 weeks of gestation) showed an increase
processing in maternal hypertension, which is associated with in HR limited to the two highest dB levels. During pregnancy, the
reduced and/or compromised uteroplacental blood flow. threshold level decreased and a shift in response from acceleration
Knowledge of memory is based largely on observing newborns to deceleration was observed at lower dB levels, indicating attention
who seem to recognize their mother’s voice. A few studies have to the stimulus. During 5 minutes of music, fetuses over 33 weeks
assessed the biological processes that facilitate fetal responses to of gestation showed a sustained increase in HR. Changes in body
the maternal voice in utero.59 Fetal HR and motor activity have been movement occurred at 35 weeks of pregnancy. These findings
recorded at 36 weeks’ gestation while pregnant women read aloud suggest a change in the processing of complex sounds around
from a neutral passage.60 Compared with the resting period, fetuses the 33rd week of gestation, with response limited to the acoustic
showed reduced motor activity and slower HR within 10 seconds properties of the signal in younger fetuses, while episodes of
after the onset of maternal speech. Subsequent analyses showed focusing were observed in older fetuses.62
that the fetal response was modified by both maternal and fetal An attempt was also made to examine the impact of lullabies
factors. The behavior of fetuses whose mothers were previously sung by mothers on the bond and behavior of newborns. There was
awake and talking was analyzed; a period of fetal orientation can no significant effect on prenatal attachment. Only the postnatal
be measured when a mother starts reading aloud. Compared bond was significantly greater in the group of singing mothers
with women who rested and remained silent, the fetuses reacted 3 months after birth. In the same group of singing mothers, episodes
with increased HR and movements. The fetal response was also of newborn crying in the first month, as well as infantile colic, were
dependent on the initial variability of the fetal HR; the greatest significantly less common. At the same time, a reduction in the
response was shown during periods of low variability, when the frequency of night awakenings was observed. It can be concluded
mothers had been resting and were silent. The results indicate that that singing lullabies by mothers can improve the bond between
fetal response is influenced by both maternal and fetal conditions, mother and child. It may also have a positive impact on the behavior
which has an impact on understanding the fetus’s learning of the of newborns and thus reduce the stress level in the young mother
mother’s voice in neutral settings.60 The reaction to sounds was (Fig. 1).63
also compared with those of premature infants. In high-risk infants,
the cardiac and motor responses were recognizable at 30 weeks’ The Mozart Effect
gestation. At 33 weeks, high-risk infants showed increased HR There are two complementary communication systems in humans—
compared with low-risk fetuses. The results indicate that both language and music and functional imaging studies suggest these

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are processed in nearby brain regions. Music affects many aspects of low- or high-risk pregnancy, and in non-stress tests (NSTs), music
human behavior, encourages social interactions and promotes trust appeared to reduce maternal anxiety.90–92
and cooperation within groups of culturally compatible individuals. During pregnancy, maternal stress can affect fetal development,
Music acts on the limbic system, is rewarding and motivating, and including altered fetal HR patterns.93 In a recent systematic review,
can facilitate learning and memory.64–66 Shimada et al.94 noted improved maternal relaxation, decreased
Oxytocin is vital to the attachment between infants and parents anxiety, psychosocial stress and depression, reduced pain,
through early contact and interaction can influence developing increased maternal bonding with her fetus, improved sleep quality,
brain functions in infants culminating in behavioral changes improved blood pressure profiles, lower fetal HR, and lower need
in the child.67,68 Maternal behavior is mediated by oxytocin, a for medications after surgery. Music therapy during the pre- and
neuropeptide synthesized in the paraventricular nucleus (PVN).69–71 perinatal periods may be benefit both the pregnant women and
The central nucleus of amygdala (CeA) expresses oxytocin receptors their newborns infants. Maul et al.95 performed a systematic
and interacts with the reward circuit to motivate maternal review to assess maternal mental health outcomes after musical
behaviors.72–74 Experiments in rats have shown that maternal intervention from 14 randomized controlled trials (RCTs) including
behaviors are influenced by environmental factors in pregnancy; 2,375 pregnancies. They showed reduced maternal stress, anxiety,
being reduced by stress and enhanced by enriched environments. and depression. These data are consistent with the beliefs that
The “Mozart effect” influenced the licking of offspring by mother modulation of maternal physiological parameters through music
rats and such offsprings had decreased behavioral anxiety and may influence fetal well-being.5
stress responses as adults.75,76 Increased maternal oxytocin levels Neural processing of music involves an extremely complex
lead to greater affectionate contact behaviors in mothers following and extensive network of cortical and subcortical structures which
mother–infant contact.67 The changes in rearing behaviors due integrate auditory, sensory motor, and cognitive functions as well
to music are due to modulation of the oxytocinergic system by as emotional changes.4 As expected from our understanding of
activation of oxytocin receptors and neuromodulation of the the neurosensory development of the fetal auditory system, initial
oxytocinergic system.72,74,77 responsiveness to different sound frequencies begins around
23 weeks’ gestation. By 24 weeks, fetuses demonstrate a startle
Placental Programming response to vibroacoustic stimulation. These responses are seen
Hereditary and environmental stimuli are assimilated as placental consistently at 28–30 weeks. 33,96,97 Indeed, music may improve
epigenetics which influence the fetal development. Fetal brain fetal autonomic responses and learning/memory formation. 30,32,98
development in the third trimester is impacted by plasticity and
hence neurobehavioral phenotype can be altered by prematurity. Evidence from RCT s
Prenatal music stimulation has a positive epigenetic effect on fetus
by virtue of placental programming.78 Effect of Music Exposure on FHR
The auditory cortex is located in the posterior-medial part of In a prospective RCT, James et al.99 examined whether prenatal
Heschl’s gyrus. This region corresponds with the Brodmann’s area exposure to a musical stimulus altered fetal behavior and whether
41, a highly plastic epigenetic area vital to prenatal learning.79,80 these responses persisted after birth into the newborn period. Using
Acoustic environments influence the functional organization and an exposure-learning model, music was played to 10 fetuses via
processing capabilities of the auditory cortex.81,82 a headphone on the maternal abdomen and 10 controls had the
headphone without sound. All fetal studies took place within 72 hour
Music Therapy and Memory prior to elective delivery. After delivery, all 20 newborns were exposed
Musical intervention has a therapeutic role in dementia or to the same music on postnatal days 3–5. Computerized assessment
Alzheimer’s disease because music elicits feelings and memories.83 of FHR and activity was documented and neonatal behavioral states
Music therapy induces plastic changes in brain networks, thereby were recorded. For the 1st hour of the study, neonates that had had
facilitating brain recovery processes and modulation of emotions in utero exposure showed higher mean HR and showed longer periods
and communication. 84 Hence, it is a propitious modality of of high HR variation. These findings, however, were not statistically
rehabilitation. different from controls. However, by the 4th hour, the exposed
It has been reported that listening to classical music, specifically fetuses began to show significantly more HR variation (p = 0.04) and
selections from Mozart can result in a temporary improvement more state transitions (p = 0.01) compared with unexposed fetuses.
in cognitive functions like abstract/spatial reasoning tests. 85 These effects persisted into the neonatal period with the same music
The “Mozart Effect” is attributed to the arousal due to the pleasure stimulus evoking more state transitions (p = 0.01) and leading to
of listening to music, rather than a direct impact on cognitive longer awake states (p = 0.05). Thus, prenatal exposure to music
ability.86,87 altered the fetal behavior that persisted after birth.
Granier-Deferre et al.100 showed that repetitive prenatal exposure
Influence of Music on Fetal Cardiotocographic to specific melodies influenced neonatal auditory perception and
Parameters memory that was retained for 3–4 days to 6 weeks. In the test arm
Although music has long been recognized for its effect on human of the study, fetuses were given precisely controlled exposure to
emotions, physiological responses, and overall well-being, the a descending piano melody twice a day during weeks 35–37 of
mechanisms remain largely unknown. 88 Machin and Dunbar gestation. After 6 weeks, cardiac responses of 25 exposed infants
proposed that activation of the endogenous opioid system, and 25 naive control infants to the descending melody and to an
including β-endorphins and encephalins, which are known to ascending control piano melody were examined during quiet sleep.
foster and maintain social bonds, improve mood and reduce the The melodies had precisely inverse contours, but similar spectra,
sensation of pain, are a possible mechanism.89 In women with a identical duration, tempo and rhythm, and thus, nearly identical

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amplitude envelopes. All infants displayed a significant change in Effect of Prenatal Music Exposure on Neonatal ECG
HR. In exposed infants, the descending melody evoked a cardiac and Neuro-behavioral Response
deceleration that was twice larger than the decelerations elicited In a pilot study, Lang et al. showed that newborns displayed
by the ascending melody and by both melodies in control infants. distinct reactions to maternal voice at 2 and 5 weeks after birth on
Brillo et al.101 randomized 30 healthy mother–fetus dyads in a physiological level and identifiable with ECG and EEG changes.106
a 1:1:1 ratio to one of three groups: (1) fetuses were submitted to Basic memory traces were formed in utero and shaped neonatal
pre-listening phase (330 –363 week) and listening sessions during autonomic and neuronal reactions to speech and voice stimuli.
4 NST; (2) fetuses were submitted to listening sessions during 4 Newborns exposed to nursery rhymes prenatally showed distinctly
NST only; and (3) 4 NST without any listening. Mean fetal HR, fetal different reactions than those not exposed. The authors concluded
HR accelerations/decelerations, fetal movements, and uterine that fetal brain is “programmed” for the predicted postnatal
contractility were assessed. The 1st group fetuses, who had heard environment and maternal voice.
a particular piece of music during previous sessions, showed In an open-labeled RCT, Arya et al. 3 evaluated the effects
significantly increased HR accelerations and movements during of antenatal music exposure in healthy primigravidae on the
the music listening session of the last NST. Uterine contractions did behavior of their term appropriate-for-date newborns, assessed
not change in frequency. They concluded that fetuses respond to using 7 clusters of the Brazelton Neonatal Behavioral Assessment
familiar but not to unknown music. Scale (BNBAS). Primigravida mothers aged 19–29 years who had a
Catalgol and Ceber Turfan randomized 100 (50 intervention, 50 singleton pregnancy, at ≤20 weeks’ gestation, and did not have
control) primipara women. The NST was applied in 36–38 weeks’ any chronic medical diseases or significant hearing impairment,
gestation.102 During the test, music was played to the intervention were randomized to listen to a pre-recorded music cassette for
group, while the control group received routine care. The music approximately 1 hour/day in addition to standard antenatal care
group showed lower mean scores of State Anxiety Inventory during (intervention arm) or standard care only (control arm). Perinatal
NST. Acceleration, mean number of fetal movements and fetal HR factors with adverse effect on neonatal behavior were deemed as
reactivity were significantly higher in the intervention group. Thus, protocol violations. One hundred and twenty-six newborns (music
music therapy in pregnant women decreased maternal anxiety and group) and 134 (controls) were tested. Infants of mothers exposed
had positive effects on NST findings. to music during pregnancy performed significantly better on 5
Soylu et al.103 showed that music affected vital signs, fetal of the 7 BNBAS clusters. The maximal beneficial effect was seen
movements, and lowered the state and trait anxiety levels during with respect to orientation (ES 1.13, 95% CI: 0.82–1.44, p < 0.0001)
NST in pregnant women. In 74 (37 music and 37 control group) and habituation (ES 1.05, 95% CI: 0.53–1.57, p = 0.0001). Prenatal
pregnant women, post-music exposure HRs were lower than music exposure to mother significantly and favorably influenced
the pre-procedure values (p < 0.001). The groups did not differ in neonatal behavior.
baseline fetal HR, variability, fetal movement, presence/number As seen above, many systematic reviews were of mixed
of accelerations-decelerations, and NST parameters. The number methodological quality and showed ambiguous efficacy of
of fetal movements was higher in the music group than controls auditory stimulation of preterm infants. Hence, a meta-analysis of
(p < 0.001). The state anxiety inventory scores were lower in the several studies was performed.107–132 The authors evaluated the
music group than controls (p < 0.001). impact of parallel and cluster-RCTs on preterm infants <37 weeks’
In a cross-over RCT, Oh et al.104 tested the effects of musical gestation during hospitalization, and also studied the effects on
intervention on maternal anxiety, fetal HR, and testing time during parents who were involved in the intervention. The evaluated
NST. Sixty pregnant women in 28–40 weeks’ gestation were randomly interventions included any live/recorded music or vocal stimulation
assigned to either an experimental (n = 30) or a control group (n = for >5 minutes, administered >3 times, by a music therapist, a
30). The experimental group showed significantly lower scores in parent, or a healthcare professional, and these were compared with
state anxiety than controls. There two groups showed no difference standard care. Many studies had to be excluded from this analysis
in systolic blood pressure and HR. Baseline fetal HR was significantly because of inadequate data.42,133–191
lower and frequency of acceleration was significantly increased in The authors studied 25 trials including 1,532 infants born at
the experimental than in the control group. 25–36 weeks’ gestation and 691 parents (21 parallel-group RCTs,
Estrella-Juarez enrolled 343 full-term pregnant women in a 4 cross-over RCTs). The intervention did vary in type, delivery,
RCT and divided them into three parallel groups: (1) music therapy frequency, and duration; music and voice that were typified
intervention (n = 104), (2) virtual reality intervention (n = 124), and as calm, soft, musical parameters in lullaby style were often
(3) controls (n = 115).105 The interventions were delivered during integrated with mother’s voice. There was considerable variability
NST in the third trimester and during labor. Measures included in the risk of bias in included studies. Music/vocal interventions
the Spielberger State-Trait Anxiety Inventory, maternal blood reduced HRs in infants during intervention (mean difference, MD,
pressure, maternal and fetal HRs, and labor and birth outcomes. −1.38, 95% CI: −2.63 to −0.12; p = 0.03; 1014 infants; 11 studies;
Women in the music therapy and virtual reality groups had less moderate-certainty evidence) and after intervention (MD –3.8,
anxiety after NST (p < 0.001), and the women were more likely to 95% CI: −5.05 to −2.55; p < 0.00001; 903 infants, 9 studies; high-
have a reactive NST (p < 0.001) than controls. Following completion certainty evidence). There were no reported adverse effects.
of NST and intervention, music therapy and virtual reality groups There was no change in oxygen saturations during care. Similarly,
had lower systolic blood pressure (p < 0.001), diastolic blood there was no difference in infant development (Bayley Scales of
pressure (p < 0.001), and maternal HR (p = 0.003) than controls. Infant and Toddler Development with the cognitive composition
Furthermore, fetuses in the control group were more likely to show score; motor composition score; and the language composition
non-reassuring fetal HR tracings than those in the music therapy score). Parents showed no difference in the incidence of anxiety
and virtual reality groups, respectively (p = 0.004). or depression.

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Evidence from Non-RCTs C o n c lu s i o n

Kumar et al.41 examined the impact of music therapy for feto- Prenatal sound stimulation including music and mother’s speech
maternal monitoring in nine pregnant women. They found that influences the development and function of the fetal/neonatal
fetal HR increased from 146 to 169 beats per minute after exposure neurological system. Fetuses seem to respond to various forms
to music from headphones paced around the mother’s abdomen. of music that they have been exposed to. Further studies can be
The increase in HR was consistent with a reactive NST. Music could beneficial.
serve as a means of communication with the fetus through sounds
and voices. Caressing the fetus through the abdomen, producing
soft and melodic sounds, using lights and vibrations were pleasant
Orcid
for the fetus. Adrianna Frydrysiak-Brzozowska https://orcid.org/0000-0003-
In a prospective observational study in 100 uncomplicated 2547-7748
pregnant women, between 32 and 41 weeks gestation, Erkun Srijan Singh https://orcid.org/0000-0002-2103-5232
Dolker and Basar showed significant differences between the Akhil Maheshwari https://orcid.org/0000-0003-3613-4054
music-exposed and control groups in terms of mean numbers of
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