Objective
Maternal perception of fetal movement indicates fetal well-being and might be associated with parity, maternal body mass index and placental location, , whereas reduced fetal movements are associated with several adverse neonatal outcomes, including stillbirth, fetal growth restriction, fetal distress, and preterm birth. , 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. , 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 Design
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.
Results
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.
| Variable | IFM group (n=282) | Control group (no IFM) (n=43,432) | P value |
|---|---|---|---|
| Apgar score<7 at 5 min | 3 (1.1) | 270 (0.6) | .259 |
| pH<7.1 | 6 (7.2) | 510 (4.9) | .316 |
| pH<7.0 | 2 (2.4) | 124 (1.2) | .259 |
| Umbilical cord complications | |||
| True knot | 4 (1.6) | 550 (1.4) | .787 |
| Cord around body or neck | 81 (32.3) | 11,246 (29.6) | .363 |
| Cord around body | 7 (2.8) | 1179 (3.1) | .772 |
| Cord around neck | 74 (29.5) | 10,067 (26.5) | .292 |
| Birthweight (g) | 3261.4±413.3 | 3228.4±491.9 | .183 |
| Small for gestational age | 22 (7.8) | 3370 (7.8) | .979 |
| Large for gestational age | 22 (7.8) | 4138 (9.5) | .325 |
| Macrosomia | 8 (2.8) | 2049 (4.7) | .137 |
| NICU hospitalization | 7 (2.5) | 1068 (2.5) | .980 |
| Stillbirth | 0 (0.0) | 89 (0.2) | 1.000 |
| Sepsis | 0 (0.0) | 5 (0.0) | 1.000 |
| Respiratory distress | 1 (0.4) | 154 (0.0) | 1.000 |
| Cerebral injury | 0 (0.0) | 2 (0.0) | 1.000 |
| Anemia or blood transfusion | 0 (0.0) | 14 (0.0) | 1.000 |
| Intrapartum death | 0 (0.0) | 9 (0.0) | 1.000 |
| Severe composite neonatal outcome | 1 (0.4) | 185 (0.6) | 1.000 |
| Neonatal hypoglycemia | 0 (0.0) | 239 (0.7) | .272 |
| Need for phototherapy | 13 (4.7) | 1823 (5.3) | .680 |
| Hypothermia | 0 (0.0) | 2 (0.0) | 1.000 |
| Meconium aspiration | 0 (0.0) | 11 (0.0) | 1.000 |
| Need for noninvasive ventilation | 0 (0.0) | 2 (0.0) | 1.000 |
| Mild composite neonatal outcome | 19 (6.9) | 2503 (7.2) | .827 |
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