Fetal Movements in Normal and Complicated Pregnancies

Abstract

Background Presentation with decreased fetal movements (DFM) is associated with adverse pregnancy outcomes including fetal growth restriction and stillbirth. The optimal approach to fetal movement monitoring and management of presentations for DFM is controversial. Further, information provided to pregnant women about fetal movements is inconsistent, in part due to a paucity of data about normal fetal movement patterns in healthy pregnancies. For women with high body mass index (BMI) the significance of DFM has also been contested. Thus, the aims of this thesis are to describe perceived fetal movements, including strength, frequency and pattern, in women with normal pregnancy outcome, women with late stillbirth, and women with obesity. Methods Fetal movement data were collected using an identical interviewer-administered questionnaire across three studies. The first was a cross-sectional study of fetal movements in women (n=274) in the third trimester with subsequent normal pregnancy outcome. The second was a case-control study of late stillbirth; cases (n=164) were interviewed within six weeks of a third trimester stillbirth about fetal movements in the two weeks before their baby died and controls (n=569) were matched by location and gestation but had ongoing pregnancies. The third study compared maternally perceived fetal movement quality and pattern in women with obesity (n=239) to women with normal BMI (n=149). Results In the cross-sectional study, a diurnal fetal movement pattern, involving increasing likelihood of perception of strong fetal movements later in the day was present. In the case-control study, perception of quiet fetal movement in the evening was associated with increased odds of stillbirth (aOR 3.82, 95% CI 1.57-9.31), as was perception of decreased frequency (aOR 2.14, 95% CI 1.25-3.67). In women with obesity, compared to women with normal BMI, perceived strength and frequency of fetal movements were not different. However, women with obesity were more likely to report strong fetal movements when hungry (29.1% vs 17.7%, p=0.001) and quiet fetal movements after eating (47.4% vs 32.0%, p=0.001). Conclusions The fetus has a diurnal movement pattern. Fetal movement strength and frequency are not altered in women with obesity. Quiet fetal movements in the evening may indicate fetal compromise.