Perinatal risk factors for and outcomes associated with reduced fetal movements in pregnancy

Background / Aim: Maternal perception of reduced fetal movements (RFM) in pregnancy is a common reason for referral to maternity services. Systematic reviews were conducted to synthesise and update the evidence from studies on risk factors for, and pregnancy, birth and neonatal outcomes associated with RFM in pregnancy. Method: We searched PubMed, Embase, CINAHL, PsycINFO, Maternity and Infant, and Science Citation Index (8 September 2022) for non-randomised studies involving pregnant women ≥24 weeks’ gestation, who presented with a primary complaint of RFM compared to women without RFM. Two review authors independently screened and selected studies for inclusion and assessed risk of bias and extracted data from included studies. Results: Fifty-two studies met the inclusion criteria. Risk factors for RFM were nulliparity (OR 1.38, 95% CI 1.07-1.78, 26 studies, I²=98%), anterior placenta (OR 1.31, 95% CI 1.17-1.47, 5 studies, I²=34%), assisted conception (OR 1.52, 95% CI 1.13-2.05, 6 studies, I²=87%) and medical history of psychiatric illness (OR 1.56, 95% CI 1.10-2.22, 3 studies, I²=80%). Ethnic minority groups sought care less often for RFM. The risk of stillbirth associated with RFM is declining (from OR 5.23 in 2018 to OR 3.36 in 2022) but remains associated with babies born small for gestational age (OR 1.37, 95% CI 1.17-1.61, 20 studies, I²=77%) and induction of labour (OR 1.79, 95% CI 1.50-2.13, 16 studies, I²=96%). Conclusions: Contemporary evidence signifies women that require additional support through information and education on fetal movements and RFM. Enhancing clinician’s knowledge of potential outcomes associated with RFM in pregnancy can contribute to improvements in the management and care of women with reduced or absent movements during pregnancy.