A better understanding of the association between maternal perception of fetal movements and late stillbirth - findings from an individual participant data metaanalysis

John M.D. Thompson, Jessica Wilson, Billie F. Bradford, Minglan Li, Robin S Cronin, Adrienne Gordon, Camille H Raynes-Greenow, Tomasina Stacey, Vicki M Culling, Lisa M Askie, Louise M O'Brien, Edwin A Mitchell, Lesley ME McCowan, Alexander Heazell

Research output: Contribution to journalArticlepeer-review

Abstract

Background : Late stillbirth continues to affect 3-4/1,000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced fetal movements are frequently reported by women prior to fetal death, but there remains poor understanding of the reasons, and how to deal with this symptom clinically, particularly during the preterm phase of gestation. We aimed to determine which women are at greatest odds of stillbirth in relation to maternal report of fetal movements in late pregnancy (≥28 weeks’ gestation). Methods : This is an individual participant data meta-analysis of all identified casecontrol studies of late stillbirth. Studies included in the IPD were two from New Zealand, one from Australia, one from the United Kingdom and an internet based study based out of the United States of America. There were a total of 851 late stillbirths, and 2,257 controls with ongoing pregnancies. Results : Increasing strength of fetal movements was the most commonly reported (>60%) pattern by women in late pregnancy, which were associated with a decreased odds of late stillbirth (adjusted Odds Ratio (aOR) = 0.20 95% CI: 0.15 to 0.27). Compared to no change in strength or frequency women reporting decreased frequency of movements in the last two weeks had increased odds of late stillbirth (aOR = 2.33 95% CI: 1.73 to 3.14). Interaction analysis showed increased strength of movements had a greater protective effect and decreased frequency of movements greater odds of late stillbirth at preterm gestations (28-36 weeks’ gestation). Fetal hiccups (aOR = 0.45 95% CI: 0.36 to 0.58) and regular episodes of vigorous movement (aOR = 0.67 95% CI: 0.52 to 0.87) were associated with decreased odds of late stillbirth. A single episode of unusually vigorous movement was associated with increased odds (aOR = 2.86 95% CI: 2.01 to 4.07), which was higher in women at term. Conclusions : Reduced fetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Fetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks’ gestation, whereas a single episode of vigorous movement is associated with stillbirth at term
Original languageEnglish
JournalBMC Medicine
Publication statusAccepted/In press - 23 Sept 2021

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