A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis
Abstract Background Late stillbirth continues to affect 3–4/1000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced foetal movements are frequently reported by women prior to foetal death, but there remains a poor understanding of the reasons and how to d...
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2021
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oai:doaj.org-article:e7fa6e71f23e42679d56c7345eb831112021-11-21T12:16:00ZA better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis10.1186/s12916-021-02140-z1741-7015https://doaj.org/article/e7fa6e71f23e42679d56c7345eb831112021-11-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02140-zhttps://doaj.org/toc/1741-7015Abstract Background Late stillbirth continues to affect 3–4/1000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced foetal movements are frequently reported by women prior to foetal death, but there remains a poor understanding of the reasons and how to deal with this symptom clinically, particularly during the preterm phase of gestation. We aimed to determine which women are at the greatest odds of stillbirth in relation to the maternal report of foetal movements in late pregnancy (≥ 28 weeks’ gestation). Methods This is an individual participant data meta-analysis of all identified case-control studies of late stillbirth. Studies included in the IPD were two from New Zealand, one from Australia, one from the UK and an internet-based study based out of the USA. There were a total of 851 late stillbirths, and 2257 controls with ongoing pregnancies. Results Increasing strength of foetal movements was the most commonly reported (> 60%) pattern by women in late pregnancy, which were associated with a decreased odds of late stillbirth (adjusted odds ratio (aOR) = 0.20, 95% CI 0.15 to 0.27). Compared to no change in strength or frequency women reporting decreased frequency of movements in the last 2 weeks had increased odds of late stillbirth (aOR = 2.33, 95% CI 1.73 to 3.14). Interaction analysis showed increased strength of movements had a greater protective effect and decreased frequency of movements greater odds of late stillbirth at preterm gestations (28–36 weeks’ gestation). Foetal hiccups (aOR = 0.45, 95% CI 0.36 to 0.58) and regular episodes of vigorous movement (aOR = 0.67, 95% CI 0.52 to 0.87) were associated with decreased odds of late stillbirth. A single episode of unusually vigorous movement was associated with increased odds (aOR = 2.86, 95% CI 2.01 to 4.07), which was higher in women at term. Conclusions Reduced foetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Foetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks’ gestation, whereas a single episode of vigorous movement is associated with stillbirth at term.John M. D. ThompsonJessica WilsonBillie F. BradfordMinglan LiRobin S. CroninAdrienne GordonCamille H. Raynes-GreenowTomasina StaceyVicki M. CulllingLisa M. AskieLouise M. O’BrienEdwin A. MitchellLesley M. E. McCowanAlexander E. P. HeazellBMCarticleStillbirthFoetal deathFoetal movementsDecreased foetal movementsIndividual participant data meta-analysisHiccupsMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-12 (2021) |
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DOAJ |
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EN |
| topic |
Stillbirth Foetal death Foetal movements Decreased foetal movements Individual participant data meta-analysis Hiccups Medicine R |
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Stillbirth Foetal death Foetal movements Decreased foetal movements Individual participant data meta-analysis Hiccups Medicine R John M. D. Thompson Jessica Wilson Billie F. Bradford Minglan Li Robin S. Cronin Adrienne Gordon Camille H. Raynes-Greenow Tomasina Stacey Vicki M. Cullling Lisa M. Askie Louise M. O’Brien Edwin A. Mitchell Lesley M. E. McCowan Alexander E. P. Heazell A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis |
| description |
Abstract Background Late stillbirth continues to affect 3–4/1000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced foetal movements are frequently reported by women prior to foetal death, but there remains a poor understanding of the reasons and how to deal with this symptom clinically, particularly during the preterm phase of gestation. We aimed to determine which women are at the greatest odds of stillbirth in relation to the maternal report of foetal movements in late pregnancy (≥ 28 weeks’ gestation). Methods This is an individual participant data meta-analysis of all identified case-control studies of late stillbirth. Studies included in the IPD were two from New Zealand, one from Australia, one from the UK and an internet-based study based out of the USA. There were a total of 851 late stillbirths, and 2257 controls with ongoing pregnancies. Results Increasing strength of foetal movements was the most commonly reported (> 60%) pattern by women in late pregnancy, which were associated with a decreased odds of late stillbirth (adjusted odds ratio (aOR) = 0.20, 95% CI 0.15 to 0.27). Compared to no change in strength or frequency women reporting decreased frequency of movements in the last 2 weeks had increased odds of late stillbirth (aOR = 2.33, 95% CI 1.73 to 3.14). Interaction analysis showed increased strength of movements had a greater protective effect and decreased frequency of movements greater odds of late stillbirth at preterm gestations (28–36 weeks’ gestation). Foetal hiccups (aOR = 0.45, 95% CI 0.36 to 0.58) and regular episodes of vigorous movement (aOR = 0.67, 95% CI 0.52 to 0.87) were associated with decreased odds of late stillbirth. A single episode of unusually vigorous movement was associated with increased odds (aOR = 2.86, 95% CI 2.01 to 4.07), which was higher in women at term. Conclusions Reduced foetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Foetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks’ gestation, whereas a single episode of vigorous movement is associated with stillbirth at term. |
| format |
article |
| author |
John M. D. Thompson Jessica Wilson Billie F. Bradford Minglan Li Robin S. Cronin Adrienne Gordon Camille H. Raynes-Greenow Tomasina Stacey Vicki M. Cullling Lisa M. Askie Louise M. O’Brien Edwin A. Mitchell Lesley M. E. McCowan Alexander E. P. Heazell |
| author_facet |
John M. D. Thompson Jessica Wilson Billie F. Bradford Minglan Li Robin S. Cronin Adrienne Gordon Camille H. Raynes-Greenow Tomasina Stacey Vicki M. Cullling Lisa M. Askie Louise M. O’Brien Edwin A. Mitchell Lesley M. E. McCowan Alexander E. P. Heazell |
| author_sort |
John M. D. Thompson |
| title |
A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis |
| title_short |
A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis |
| title_full |
A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis |
| title_fullStr |
A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis |
| title_full_unstemmed |
A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis |
| title_sort |
better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis |
| publisher |
BMC |
| publishDate |
2021 |
| url |
https://doaj.org/article/e7fa6e71f23e42679d56c7345eb83111 |
| work_keys_str_mv |
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