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The autonomic nervous system (ANS) regulatory capacity begins before birth asthe sympathetic and parasympathetic activity contributes significantly to thefetus' development. Several studies have shown how vagus nerve is involved inmany vital processes during fetal, perinatal and postnatal life: from theregulation of inflammation through the anti-inflammatory cholinergic pathway,which may affect the functioning of each organ, to the production of hormonesinvolved in bioenergetic metabolism. In addition, the vagus nerve has beenrecognized as the primary afferent pathway capable of transmitting informationto the brain from every organ of the body. Therefore, this hypothesis paperaims to review the development of ANS during fetal and perinatal life, focusingparticularly on the vagus nerve, to identify possible "critical windows" thatcould impact its maturation. These "critical windows" could help cliniciansknow when to monitor fetuses to effectively assess the developmental status ofboth ANS and specifically the vagus nerve. In addition, this paper will focuson which factors (i.e. fetal characteristics and behaviors, maternal lifestyleand pathologies, placental health and dysfunction, labor, incubator conditions,and drug exposure) may have an impact on the development of the vagus duringthe above-mentioned "critical window" and how. This analysis could helpclinicians and stakeholders define precise guidelines for improving themanagement of fetuses and newborns, particularly to reduce the potentialadverse environmental impacts on ANS development that may lead to persistentlong-term consequences. Since the development of ANS and the vagus influencehave been shown to be reflected in cardiac variability, this paper will rely inparticular on studies using fetal heart rate variability (fHRV) to monitor thecontinued growth and health of both animal and human fetuses.

The role of the vagus nerve during fetal development and its relationship with the environment