Investigation of the outcomes of pregnancies complicated by increased fetal movements: a prospective cohort study

Investigation of the outcomes of pregnancies complicated by increased fetal movements: a prospective cohort study

Imogen Sharp (1), Temidayo Adeyeye (1), Kimberley Farrant (1), Linda Peacock (1), Amy Mahdi (2), Andrew N Sharp (2), Susan L Greenwood (1), Alexander EP Heazell (1)

(1) The University of Manchester Maternal and Fetal Health Research Centre, UK; (2) Liverpool Women’s Hospital, UK.

Background:
Whilst the significance of reduced fetal movements is well established in maternity care, retrospective studies suggest that a single episode of significantly increased fetal movements (IFMs) may also be associated with late stillbirth. To date there have been no prospective studies examining the association between IFMs and adverse pregnancy outcomes. This study aimed to report the outcome of pregnancies associated with a maternal perception of IFMs, as well as determining which factors were associated with an increased risk of adverse pregnancy outcome in this cohort.

Methods:
Women reporting IFMs after 28 weeks’ gestation were recruited from St Mary’s Hospital, Manchester and Liverpool Women’s Hospital, UK between 01.09.17-31.12.18. Demographic and clinical information was obtained and an ultrasound scan was performed to assess fetal biometry, liquor volume and umbilical artery Doppler. Maternal and fetal outcome data was collected post-delivery. Adverse outcome was defined as: stillbirth; birthweight < 3rd centile; 5 minute Apgar score ≤7; umbilical arterial pH ≤7.05; and admission to neonatal intensive care.

Results:
63 women with IFMs participated. 7 (11.1%) of pregnancies ended in adverse outcome (birthweight <3rd centile 2 (3.2%), pH≤7.05 1 (1.6%), NICU admission 4 (6.4%). Adverse outcome was associated with an increasing maternal age (Odds Ratio (OR) 1.15, 95% CI 0.98-1.35; p=0.07) as was increased gravidity (OR 1.30, 95% CI 1.02-1.65; p=0.03) and previous pregnancy loss <24 weeks’ (OR 2.26, 95% CI 1.19-4.30; p=0.01). There was no relationship with other clinical or sonographic measurements and adverse outcome in this population.

Conclusion:
In this prospective study IFM was not associated with a high frequency of adverse outcomes. Currently available investigations were not able to differentiate pregnancies ending in adverse outcome. Further work is required to determine the strength of association between IFMs and adverse pregnancy outcome.

Ethics statement:
Data was collected as part of the INVEST (Investigation of the Outcome of Pregnancies Complicated by Increased Fetal Movements) study (ethics reference: 17/NW/0229). Written informed consent was provided by all participants.

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