A systematic review and meta-analysis of risk factors for and outcomes associated with reduced fetal movements in pregnancy

A systematic review and meta-analysis of risk factors for and outcomes associated with reduced fetal movements in pregnancy

Carroll, Lorraine (1), Smith, Valerie (2), Gallagher, Louise (3)

(1) PhD Candidate, Trinity College Dublin, (2) Professor in Midwifery, Trinity College Dublin, (3) Assistant Professor in Midwifery, Trinity College Dublin

Background
A systematic review was conducted to synthesis the evidence on risk factors for and outcomes associated with RFM in pregnancy to determine significant associations and where possible to inform practice change.

Methods
PubMed, EMBASE, CINAHL, Maternity and Infant Care, PsycINFO, and Science Citation Index (23rd March 2018) with no filters was searched. Non-randomised studies reporting on pregnant women with at least one episode of RFM ≥ 24 weeks gestation were included. For comparator analyses, data for women without RFM were also included. Studies were independently screened, selected and data extracted by two review authors. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool.

Results
34 studies met the inclusion criteria. 13 risk factors were identified, 5 were found to be predictive of RFM in pregnancy: ethnicity (OR 2.59, 95%CI 2.40-2.80, 2 studies, 5365 participants, I²=0%), anterior placenta (OR 1.31, 95%CI 1.11-1.55, 3 studies, 6852 participants, I²=0%), smoking (OR 1.18, 95%CI 1.02-1.35, 5 studies, 29557 participants, I²=4%), oligohydramnios (OR 4.04, 95%CI 3.29-4.97, 3 studies, 39407 participants, I²=0%) and polyhydramnios (OR 2.01, 95% CI 1.44-2.81, 4 studies, 39487 participants, I²=28%). RFM was found to be associated with stillbirth (OR 5.23, 95%CI 2.49-10.98, 15 studies, 95,829, I=81%) and small for gestational age (SGA) (OR 1.82, 95% CI 1.61-2.05, 12 studies, 37,251 participants, I=41%). Women with RFM in pregnancy were also more likely to have induction of labour, instrumental birth and emergency caesarean section.

Conclusion
Early identification by healthcare professionals of modifiable and non-modifiable risk factors, can contribute to improvements in clinical management and care of women with reduced or absent movements during pregnancy, possibly leading to prevention and reduction of adverse pregnancy, birth, fetal and neonatal outcomes.

Ethics statement
This systematic review summarizes the existing research therefore ethical approval was not necessary.

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