Abstract
BackgroundFetal movement counting has long been suggested as a screening tool to identify impaired placental function. However, quantitative limits for decreased fetal movement perform poorly for screening purposes, indicating the need for methodological refinement. We aimed to identify the main individual temporal patterns in fetal movement counting charts, and explore their associations with pregnancy characteristics.MethodsIn a population-based prospective cohort in Norway, 2009–2011, women with singleton pregnancies counted fetal movements daily from pregnancy week 24 until delivery using a modified "count-to-ten” procedure. To account for intra-woman correlation of observations, we used functional data analysis and corresponding functional principal component analysis to identify the main individual temporal patterns in fetal movement count data. The temporal patterns are described by continuous functional principal component (FPC) curves, with an individual score on each FPC for each woman. These scores were later used as outcome variables in multivariable linear regression analyses, with pregnancy characteristics as explanatory variables.ResultsFetal movement charts from 1086 pregnancies were included. Three FPC curves explained almost 99% of the variation in the temporal data, with the first FPC, representing the individual overall counting time, accounting for 91% alone. There were several statistically significant associations between the FPCs and various pregnancy characteristics. However, the effects were small and of limited clinical value.ConclusionsThis statistical approach for analyzing fetal movement counting data successfully captured clinically meaningful individual temporal patterns and how these patterns vary between women. Maternal body mass index, gestational age and placental site explained little of the variation in the temporal fetal movement counting patterns. Thus, a perceived decrease in fetal movement should not be attributed to a woman’s basic pregnancy characteristics, but assessed as a potential marker of risk.
Highlights
Fetal movement counting has long been suggested as a screening tool to identify impaired placental function
Maternal obesity was significantly positively associated with scores on FPC1, and negatively associated with scores on FPC2, i.e. longer counting times with a decreasing trend as pregnancy advances
Maternal overweight was negatively associated with FPC3, i.e. shorter counting times in the mid period
Summary
Fetal movement counting has long been suggested as a screening tool to identify impaired placental function. Quantitative limits for decreased fetal movement perform poorly for screening purposes, indicating the need for methodological refinement. We aimed to identify the main individual temporal patterns in fetal movement counting charts, and explore their associations with pregnancy characteristics. Fetal movement (FM) counting by pregnant women has long been suggested as a screening tool to identify impaired placental function. The rationale is that a fetus will respond to reduced uteroplacental blood flow and fetal hypoxia by decreasing gross fetal movements [1]. Decreased fetal movement (DFM) is associated with. Ways to improve our understanding of relevant temporal patterns in FM counting data and what changes in FM counting that are clinically relevant, are urgently needed
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