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Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements.
JAMA Netw Open. 2021 04 01; 4(4):e215071.JN

Abstract

Importance

Stillbirth is a devastating pregnancy outcome with far-reaching economic and psychosocial consequences, but despite significant investment, a screening tool for identifying those fetuses at risk for stillbirth remains elusive. Maternal reporting of decreased fetal movements (DFM) has been found to be associated with stillbirth and other adverse perinatal outcomes.

Objective

To examine pregnancy outcomes of women presenting with DFM in the third trimester at a tertiary Australian center with a clear clinical management algorithm.

Design, Setting, and Participants

This cohort study used data on all births meeting the inclusion criteria from 2009 through 2019 at Mater Mothers' Hospital in Brisbane, Australia. This is a tertiary center and Australia's largest maternity hospital. All singleton births without a known congenital anomaly after 28 weeks' gestation were included. Among 203 071 potential participants identified from the hospital database, 101 597 individuals met the eligibility criteria. Data analysis was performed from May through September 2020.

Exposure

Presentation to hospital with DFM after 28 weeks gestation.

Main Outcomes and Measures

The primary outcome of this study was the incidence of stillbirth. Multivariate analysis was undertaken to determine the association between DFM and stillbirth, obstetric intervention, and other adverse outcomes, including being born small for gestational age (SGA) and a composite adverse perinatal outcome (at least 1 of the following: neonatal intensive care unit admission, severe acidosis [ie, umbilical artery pH <7.0 or base excess -12.0 mmol/L or less], 5-minute Apgar score <4, or stillbirth or neonatal death). The hypothesis being tested was formulated prior to data collection.

Results

Among 101 597 women with pregnancies that met the inclusion criteria, 8821 (8.7%) presented at least once with DFM and 92 776 women (91.3%) did not present with DFM (ie, the control population). Women presenting with DFM, compared with those presenting without DFM, were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P < .001), more likely to be nulliparous (4845 women [54.9%] vs 42 210 women [45.5%]; P < .001) and have a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P < .001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17 444 women [18.8%]; P < .001). During the study period, the stillbirth rate was 2.0 per 1000 births after 28 weeks' gestation. Presenting with DFM was not associated with higher odds of stillbirth (9 women [0.1%] vs 185 women [0.2%]; adjusted odds ratio [aOR], 0.54; 95% CI, 0.23-1.26, P = .16). However, presenting with DFM was associated with higher odds of a fetus being born SGA (aOR, 1.14; 95% CI, 1.03-1.27; P = .01) and the composite adverse perinatal outcome (aOR, 1.14; 95% CI, 1.02-1.27; P = .02). Presenting with DFM was also associated with higher odds of planned early term birth (aOR, 1.26; 95% CI, 1.15-1.38; P < .001), induction of labor (aOR, 1.63; 95% CI, 1.53-1.74; P < .001), and emergency cesarean delivery (aOR, 1.18; 95% CI, 1.09-1.28; P < .001).

Conclusions and Relevance

The presence of DFM is a marker associated with increased risk for a fetus. This study's findings of a nonsignificantly lower rate of stillbirth among women with DFM may be reflective of increased community awareness of timely presentation to their obstetric care clinician when concerned about fetal movements and the benefits of tertiary level care guided by a clear clinical management protocol. However, DFM was associated with increased odds of an infant being born SGA, obstetric intervention, early term birth, and a composite of adverse perinatal outcomes.

Links

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Authors+Show Affiliations

Turner JM
Mater Research, University of Queensland, South Brisbane, Queensland, Australia. Faculty of Medicine, University of Medicine, South Brisbane, Queensland, Australia.
Flenady V
Mater Research, University of Queensland, South Brisbane, Queensland, Australia. Faculty of Medicine, University of Medicine, South Brisbane, Queensland, Australia. National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Ellwood D
National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Coory M
National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Kumar S
Mater Research, University of Queensland, South Brisbane, Queensland, Australia. Faculty of Medicine, University of Medicine, South Brisbane, Queensland, Australia. National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.

MeSH

AdultCase-Control StudiesCesarean SectionFemaleFetal MovementHumansPregnancyPregnancy Trimester, ThirdPremature BirthQueenslandRetrospective StudiesRisk AssessmentStillbirth

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33830228

Citation

Turner, Jessica M., et al. "Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements." JAMA Network Open, vol. 4, no. 4, 2021, pp. e215071.
Turner JM, Flenady V, Ellwood D, et al. Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements. JAMA Netw Open. 2021;4(4):e215071.
Turner, J. M., Flenady, V., Ellwood, D., Coory, M., & Kumar, S. (2021). Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements. JAMA Network Open, 4(4), e215071. https://doi.org/10.1001/jamanetworkopen.2021.5071
Turner JM, et al. Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements. JAMA Netw Open. 2021 04 1;4(4):e215071. PubMed PMID: 33830228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements. AU - Turner,Jessica M, AU - Flenady,Vicki, AU - Ellwood,David, AU - Coory,Michael, AU - Kumar,Sailesh, Y1 - 2021/04/01/ PY - 2021/4/8/entrez PY - 2021/4/9/pubmed PY - 2021/8/20/medline SP - e215071 EP - e215071 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 4 N2 - Importance: Stillbirth is a devastating pregnancy outcome with far-reaching economic and psychosocial consequences, but despite significant investment, a screening tool for identifying those fetuses at risk for stillbirth remains elusive. Maternal reporting of decreased fetal movements (DFM) has been found to be associated with stillbirth and other adverse perinatal outcomes. Objective: To examine pregnancy outcomes of women presenting with DFM in the third trimester at a tertiary Australian center with a clear clinical management algorithm. Design, Setting, and Participants: This cohort study used data on all births meeting the inclusion criteria from 2009 through 2019 at Mater Mothers' Hospital in Brisbane, Australia. This is a tertiary center and Australia's largest maternity hospital. All singleton births without a known congenital anomaly after 28 weeks' gestation were included. Among 203 071 potential participants identified from the hospital database, 101 597 individuals met the eligibility criteria. Data analysis was performed from May through September 2020. Exposure: Presentation to hospital with DFM after 28 weeks gestation. Main Outcomes and Measures: The primary outcome of this study was the incidence of stillbirth. Multivariate analysis was undertaken to determine the association between DFM and stillbirth, obstetric intervention, and other adverse outcomes, including being born small for gestational age (SGA) and a composite adverse perinatal outcome (at least 1 of the following: neonatal intensive care unit admission, severe acidosis [ie, umbilical artery pH <7.0 or base excess -12.0 mmol/L or less], 5-minute Apgar score <4, or stillbirth or neonatal death). The hypothesis being tested was formulated prior to data collection. Results: Among 101 597 women with pregnancies that met the inclusion criteria, 8821 (8.7%) presented at least once with DFM and 92 776 women (91.3%) did not present with DFM (ie, the control population). Women presenting with DFM, compared with those presenting without DFM, were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P < .001), more likely to be nulliparous (4845 women [54.9%] vs 42 210 women [45.5%]; P < .001) and have a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P < .001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17 444 women [18.8%]; P < .001). During the study period, the stillbirth rate was 2.0 per 1000 births after 28 weeks' gestation. Presenting with DFM was not associated with higher odds of stillbirth (9 women [0.1%] vs 185 women [0.2%]; adjusted odds ratio [aOR], 0.54; 95% CI, 0.23-1.26, P = .16). However, presenting with DFM was associated with higher odds of a fetus being born SGA (aOR, 1.14; 95% CI, 1.03-1.27; P = .01) and the composite adverse perinatal outcome (aOR, 1.14; 95% CI, 1.02-1.27; P = .02). Presenting with DFM was also associated with higher odds of planned early term birth (aOR, 1.26; 95% CI, 1.15-1.38; P < .001), induction of labor (aOR, 1.63; 95% CI, 1.53-1.74; P < .001), and emergency cesarean delivery (aOR, 1.18; 95% CI, 1.09-1.28; P < .001). Conclusions and Relevance: The presence of DFM is a marker associated with increased risk for a fetus. This study's findings of a nonsignificantly lower rate of stillbirth among women with DFM may be reflective of increased community awareness of timely presentation to their obstetric care clinician when concerned about fetal movements and the benefits of tertiary level care guided by a clear clinical management protocol. However, DFM was associated with increased odds of an infant being born SGA, obstetric intervention, early term birth, and a composite of adverse perinatal outcomes. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/33830228/Evaluation_of_Pregnancy_Outcomes_Among_Women_With_Decreased_Fetal_Movements_ DB - PRIME DP - Unbound Medicine ER -