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 language | English |
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Journal | BMC Medicine |
Publication status | Accepted/In press - 23 Sept 2021 |