Are increased fetal movements during pregnancy a predictor of neonatal adverse outcomes?

Abstract

ObjectiveMaternal perception of fetal movement indicates fetal well-being and might be associated with parity, maternal body mass index and placental location,1Mohr Sasson A. Tsur A. Kalter A. Weissmann Brenner A. Gindes L. Weisz B. Reduced fetal movement: factors affecting maternal perception.J Matern Fetal Neonatal Med. 2016; 29: 1318-1321Crossref PubMed Scopus (9) Google Scholar,2Tuffnell D.J. Cartmill R.S. Lilford R.J. Fetal movements; factors affecting their perception.Eur J Obstet Gynecol Reprod Biol. 1991; 39: 165-167Abstract Full Text PDF PubMed Scopus (51) Google Scholar whereas reduced fetal movements are associated with several adverse neonatal outcomes, including stillbirth, fetal growth restriction, fetal distress, and preterm birth.3Heazell A.E.P. Budd J. Li M. et al.Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study.BMJ Open. 2018; 8e020031Crossref Scopus (31) Google Scholar,4Frøen J.F. Tveit J.V. Saastad E. et al.Management of decreased fetal movements.Semin Perinatol. 2008; 32: 307-311Crossref PubMed Scopus (64) Google Scholar Little is known about maternal perceptions of increased fetal movement (IFM).Previous reports have suggested a single episode of IFM is a sign of an upcoming stillbirth.3Heazell A.E.P. Budd J. Li M. et al.Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study.BMJ Open. 2018; 8e020031Crossref Scopus (31) Google Scholar,5Stacey T. Thompson J.M. Mitchell E.A. Ekeroma A. Zuccollo J. McCowan L.M. Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth Study.Birth. 2011; 38: 311-316Crossref PubMed Scopus (72) Google Scholar However, data regarding an association between IFM and neonatal outcomes are limited. We aimed to evaluate the characteristics and neonatal outcomes of pregnancies with perceived IFM, assuming it is a poor predictor of adverse neonatal outcomes.Study DesignThis retrospective cohort included singleton pregnancies delivered in a tertiary referral hospital from January 2014 to September 2020. Patients presenting to our obstetrical triage with a single, isolated complaint of IFM at >24 weeks of gestation (IFM group) were compared with a control group of patients presenting for routine fetal assessment during pregnancy or labor, reporting regular fetal movements. Patients presenting with reduced fetal movements during their pregnancies were excluded. The primary outcome was the severe composite adverse neonatal outcome of sepsis, respiratory distress or mechanical ventilation, cerebral injury, anemia or blood transfusion, or intrapartum death. The secondary outcome was the mild composite adverse outcome, including hypoglycemia, need for phototherapy, hypothermia, meconium aspiration syndrome, need for noninvasive ventilation, or umbilical cord pH of <7.1.ResultsOverall, 43,714 women were in the study cohort, including 282 (0.65%) presenting with IFM who were compared with 43,432 (99.35%) who reported no change in fetal movement during pregnancy. Women in the IFM group were more likely to be nulliparous and to have epidural anesthesia than the control group (53.7% vs 32.3% [P<.001] and 74.1% vs 61.3% [P<.001], respectively). Placental locations were comparable between groups. Induction of labor and vacuum-assisted delivery were more common in the IFM group than in the control group (30.5% vs 21.7% [P=.001] and 13.1% vs 8.0% [P=.001], respectively). However, these 2 differences were not seen after subgroup analysis for nulliparas. No difference was found between groups in terms of the severe and mild composite adverse neonatal outcomes and any other neonatal complication, including umbilical cord complications (around the neck, around the body, around body or neck, or true cord knot) (Table). No case of stillbirth or intrapartum death was found in the IFM group. A relatively large proportion of women (23 [8.2%]) in the IFM group had a previous visit (2 weeks earlier or more) with an abdominal injury because of an accidental fall or motor vehicle accident. Multivariable logistic regression found that IFM was a nonsignificant risk factor for composite adverse neonatal outcomes, induction of labor, and vacuum-assisted deliveries.TableNeonatal outcomes of the IFM group compared with that of the control groupVariableIFM group (n=282)Control group (no IFM) (n=43,432)P valueApgar score<7 at 5 min3 (1.1)270 (0.6).259pH<7.16 (7.2)510 (4.9).316pH<7.02 (2.4)124 (1.2).259Umbilical cord complications True knot4 (1.6)550 (1.4).787 Cord around body or neck81 (32.3)11,246 (29.6).363 Cord around body7 (2.8)1179 (3.1).772 Cord around neck74 (29.5)10,067 (26.5).292Birthweight (g)3261.4±413.33228.4±491.9.183Small for gestational age22 (7.8)3370 (7.8).979Large for gestational age22 (7.8)4138 (9.5).325Macrosomia8 (2.8)2049 (4.7).137NICU hospitalization7 (2.5)1068 (2.5).980Stillbirth0 (0.0)89 (0.2)1.000Sepsis0 (0.0)5 (0.0)1.000Respiratory distress1 (0.4)154 (0.0)1.000Cerebral injury0 (0.0)2 (0.0)1.000Anemia or blood transfusion0 (0.0)14 (0.0)1.000Intrapartum death0 (0.0)9 (0.0)1.000Severe composite neonatal outcome1 (0.4)185 (0.6)1.000Neonatal hypoglycemia0 (0.0)239 (0.7).272Need for phototherapy13 (4.7)1823 (5.3).680Hypothermia0 (0.0)2 (0.0)1.000Meconium aspiration0 (0.0)11 (0.0)1.000Need for noninvasive ventilation0 (0.0)2 (0.0)1.000Mild composite neonatal outcome19 (6.9)2503 (7.2).827Data are presented as number (percentage) or mean±standard deviation, unless otherwise specified.IFM, increase fetal movement; NICU, neonatal intensive care unit.Cohen. Fetal movement as a predictor of neonatal adverse outcomes. Am J Obstet Gynecol 2022. Open table in a new tab ConclusionMaternal perception of IFM did not seem to be associated with adverse neonatal outcomes or umbilical cord complications. The perception of IFM was more common among nulliparous women. In addition, it might be associated with greater awareness of fetal movements after sustaining abdominal trauma during the pregnancy. Placental location was not linked to IFM. ObjectiveMaternal perception of fetal movement indicates fetal well-being and might be associated with parity, maternal body mass index and placental location,1Mohr Sasson A. Tsur A. Kalter A. Weissmann Brenner A. Gindes L. Weisz B. Reduced fetal movement: factors affecting maternal perception.J Matern Fetal Neonatal Med. 2016; 29: 1318-1321Crossref PubMed Scopus (9) Google Scholar,2Tuffnell D.J. Cartmill R.S. Lilford R.J. Fetal movements; factors affecting their perception.Eur J Obstet Gynecol Reprod Biol. 1991; 39: 165-167Abstract Full Text PDF PubMed Scopus (51) Google Scholar whereas reduced fetal movements are associated with several adverse neonatal outcomes, including stillbirth, fetal growth restriction, fetal distress, and preterm birth.3Heazell A.E.P. Budd J. Li M. et al.Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study.BMJ Open. 2018; 8e020031Crossref Scopus (31) Google Scholar,4Frøen J.F. Tveit J.V. Saastad E. et al.Management of decreased fetal movements.Semin Perinatol. 2008; 32: 307-311Crossref PubMed Scopus (64) Google Scholar Little is known about maternal perceptions of increased fetal movement (IFM).Previous reports have suggested a single episode of IFM is a sign of an upcoming stillbirth.3Heazell A.E.P. Budd J. Li M. et al.Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study.BMJ Open. 2018; 8e020031Crossref Scopus (31) Google Scholar,5Stacey T. Thompson J.M. Mitchell E.A. Ekeroma A. Zuccollo J. McCowan L.M. Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth Study.Birth. 2011; 38: 311-316Crossref PubMed Scopus (72) Google Scholar However, data regarding an association between IFM and neonatal outcomes are limited. We aimed to evaluate the characteristics and neonatal outcomes of pregnancies with perceived IFM, assuming it is a poor predictor of adverse neonatal outcomes. Maternal perception of fetal movement indicates fetal well-being and might be associated with parity, maternal body mass index and placental location,1Mohr Sasson A. Tsur A. Kalter A. Weissmann Brenner A. Gindes L. Weisz B. Reduced fetal movement: factors affecting maternal perception.J Matern Fetal Neonatal Med. 2016; 29: 1318-1321Crossref PubMed Scopus (9) Google Scholar,2Tuffnell D.J. Cartmill R.S. Lilford R.J. Fetal movements; factors affecting their perception.Eur J Obstet Gynecol Reprod Biol. 1991; 39: 165-167Abstract Full Text PDF PubMed Scopus (51) Google Scholar whereas reduced fetal movements are associated with several adverse neonatal outcomes, including stillbirth, fetal growth restriction, fetal distress, and preterm birth.3Heazell A.E.P. Budd J. Li M. et al.Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study.BMJ Open. 2018; 8e020031Crossref Scopus (31) Google Scholar,4Frøen J.F. Tveit J.V. Saastad E. et al.Management of decreased fetal movements.Semin Perinatol. 2008; 32: 307-311Crossref PubMed Scopus (64) Google Scholar Little is known about maternal perceptions of increased fetal movement (IFM). Previous reports have suggested a single episode of IFM is a sign of an upcoming stillbirth.3Heazell A.E.P. Budd J. Li M. et al.Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study.BMJ Open. 2018; 8e020031Crossref Scopus (31) Google Scholar,5Stacey T. Thompson J.M. Mitchell E.A. Ekeroma A. Zuccollo J. McCowan L.M. Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth Study.Birth. 2011; 38: 311-316Crossref PubMed Scopus (72) Google Scholar However, data regarding an association between IFM and neonatal outcomes are limited. We aimed to evaluate the characteristics and neonatal outcomes of pregnancies with perceived IFM, assuming it is a poor predictor of adverse neonatal outcomes. Study DesignThis retrospective cohort included singleton pregnancies delivered in a tertiary referral hospital from January 2014 to September 2020. Patients presenting to our obstetrical triage with a single, isolated complaint of IFM at >24 weeks of gestation (IFM group) were compared with a control group of patients presenting for routine fetal assessment during pregnancy or labor, reporting regular fetal movements. Patients presenting with reduced fetal movements during their pregnancies were excluded. The primary outcome was the severe composite adverse neonatal outcome of sepsis, respiratory distress or mechanical ventilation, cerebral injury, anemia or blood transfusion, or intrapartum death. The secondary outcome was the mild composite adverse outcome, including hypoglycemia, need for phototherapy, hypothermia, meconium aspiration syndrome, need for noninvasive ventilation, or umbilical cord pH of <7.1. This retrospective cohort included singleton pregnancies delivered in a tertiary referral hospital from January 2014 to September 2020. Patients presenting to our obstetrical triage with a single, isolated complaint of IFM at >24 weeks of gestation (IFM group) were compared with a control group of patients presenting for routine fetal assessment during pregnancy or labor, reporting regular fetal movements. Patients presenting with reduced fetal movements during their pregnancies were excluded. The primary outcome was the severe composite adverse neonatal outcome of sepsis, respiratory distress or mechanical ventilation, cerebral injury, anemia or blood transfusion, or intrapartum death. The secondary outcome was the mild composite adverse outcome, including hypoglycemia, need for phototherapy, hypothermia, meconium aspiration syndrome, need for noninvasive ventilation, or umbilical cord pH of <7.1. ResultsOverall, 43,714 women were in the study cohort, including 282 (0.65%) presenting with IFM who were compared with 43,432 (99.35%) who reported no change in fetal movement during pregnancy. Women in the IFM group were more likely to be nulliparous and to have epidural anesthesia than the control group (53.7% vs 32.3% [P<.001] and 74.1% vs 61.3% [P<.001], respectively). Placental locations were comparable between groups. Induction of labor and vacuum-assisted delivery were more common in the IFM group than in the control group (30.5% vs 21.7% [P=.001] and 13.1% vs 8.0% [P=.001], respectively). However, these 2 differences were not seen after subgroup analysis for nulliparas. No difference was found between groups in terms of the severe and mild composite adverse neonatal outcomes and any other neonatal complication, including umbilical cord complications (around the neck, around the body, around body or neck, or true cord knot) (Table). No case of stillbirth or intrapartum death was found in the IFM group. A relatively large proportion of women (23 [8.2%]) in the IFM group had a previous visit (2 weeks earlier or more) with an abdominal injury because of an accidental fall or motor vehicle accident. Multivariable logistic regression found that IFM was a nonsignificant risk factor for composite adverse neonatal outcomes, induction of labor, and vacuum-assisted deliveries.TableNeonatal outcomes of the IFM group compared with that of the control groupVariableIFM group (n=282)Control group (no IFM) (n=43,432)P valueApgar score<7 at 5 min3 (1.1)270 (0.6).259pH<7.16 (7.2)510 (4.9).316pH<7.02 (2.4)124 (1.2).259Umbilical cord complications True knot4 (1.6)550 (1.4).787 Cord around body or neck81 (32.3)11,246 (29.6).363 Cord around body7 (2.8)1179 (3.1).772 Cord around neck74 (29.5)10,067 (26.5).292Birthweight (g)3261.4±413.33228.4±491.9.183Small for gestational age22 (7.8)3370 (7.8).979Large for gestational age22 (7.8)4138 (9.5).325Macrosomia8 (2.8)2049 (4.7).137NICU hospitalization7 (2.5)1068 (2.5).980Stillbirth0 (0.0)89 (0.2)1.000Sepsis0 (0.0)5 (0.0)1.000Respiratory distress1 (0.4)154 (0.0)1.000Cerebral injury0 (0.0)2 (0.0)1.000Anemia or blood transfusion0 (0.0)14 (0.0)1.000Intrapartum death0 (0.0)9 (0.0)1.000Severe composite neonatal outcome1 (0.4)185 (0.6)1.000Neonatal hypoglycemia0 (0.0)239 (0.7).272Need for phototherapy13 (4.7)1823 (5.3).680Hypothermia0 (0.0)2 (0.0)1.000Meconium aspiration0 (0.0)11 (0.0)1.000Need for noninvasive ventilation0 (0.0)2 (0.0)1.000Mild composite neonatal outcome19 (6.9)2503 (7.2).827Data are presented as number (percentage) or mean±standard deviation, unless otherwise specified.IFM, increase fetal movement; NICU, neonatal intensive care unit.Cohen. Fetal movement as a predictor of neonatal adverse outcomes. Am J Obstet Gynecol 2022. Open table in a new tab Overall, 43,714 women were in the study cohort, including 282 (0.65%) presenting with IFM who were compared with 43,432 (99.35%) who reported no change in fetal movement during pregnancy. Women in the IFM group were more likely to be nulliparous and to have epidural anesthesia than the control group (53.7% vs 32.3% [P<.001] and 74.1% vs 61.3% [P<.001], respectively). Placental locations were comparable between groups. Induction of labor and vacuum-assisted delivery were more common in the IFM group than in the control group (30.5% vs 21.7% [P=.001] and 13.1% vs 8.0% [P=.001], respectively). However, these 2 differences were not seen after subgroup analysis for nulliparas. No difference was found between groups in terms of the severe and mild composite adverse neonatal outcomes and any other neonatal complication, including umbilical cord complications (around the neck, around the body, around body or neck, or true cord knot) (Table). No case of stillbirth or intrapartum death was found in the IFM group. A relatively large proportion of women (23 [8.2%]) in the IFM group had a previous visit (2 weeks earlier or more) with an abdominal injury because of an accidental fall or motor vehicle accident. Multivariable logistic regression found that IFM was a nonsignificant risk factor for composite adverse neonatal outcomes, induction of labor, and vacuum-assisted deliveries. Data are presented as number (percentage) or mean±standard deviation, unless otherwise specified. IFM, increase fetal movement; NICU, neonatal intensive care unit. Cohen. Fetal movement as a predictor of neonatal adverse outcomes. Am J Obstet Gynecol 2022. ConclusionMaternal perception of IFM did not seem to be associated with adverse neonatal outcomes or umbilical cord complications. The perception of IFM was more common among nulliparous women. In addition, it might be associated with greater awareness of fetal movements after sustaining abdominal trauma during the pregnancy. Placental location was not linked to IFM. Maternal perception of IFM did not seem to be associated with adverse neonatal outcomes or umbilical cord complications. The perception of IFM was more common among nulliparous women. In addition, it might be associated with greater awareness of fetal movements after sustaining abdominal trauma during the pregnancy. Placental location was not linked to IFM.