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Correlation study between increased fetal movement during the third trimester and neonatal outcome

BMC Pregnancy and Childbirth volume 19, Commodity number:467 (2019) Cite this article

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Abstract

Groundwork

We aimed to analyze the correlation between increased fetal movements in the third trimester and neonatal outcomes.

Methods

We enrolled pregnant women (n = 219) who reported increased/excessive fetal movements in the third trimester in our hospital. A control group of salubrious women (n = 278) who had undergone regular childbirth and commitment in our infirmary during the same menses and did not written report aberrant fetal movements were besides recruited. All pregnant women underwent fetal not-stress test. Nosotros analyzed the neonatal weight, appearance, pulse, grimace, activity, and respiration score, degrees of amniotic fluid contamination, amniotic fluid volume, conditions of umbilical cord around the cervix and cord length, and incidence of small for gestational age. In add-on, the incidence of preterm commitment, cesarean department charge per unit, postpartum hemorrhage, and other postpartum complications were also analyzed. We and so analyzed the correlation between increased/excessive fetal activity and neonatal outcomes.

Results

Women with complaints of increased/excessive fetal movements exhibited increased fetal movements mainly around 31 and 39 weeks of gestation. Several pregnancy variables, including number of previous delivery, gestational age (less than 34 weeks and more 37 weeks) and vaginal birth charge per unit, were associated with increased/excessive fetal movements. In add-on, women who reported increased/excessive fetal movements had higher odds of large for gestational age (LGA), particularly those with gestational historic period over 37 weeks.

Conclusion

Increased/excessive fetal movements may be used to predict adverse neonatal outcome such every bit LGA.

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Background

Globally, 2.6 million infants were stillborn each yr [1]. Hence, many efforts accept been invested to report modifiable take a chance factors, which could be used as targets to innovate intervention to alleviate the risk of stillbirths. These efforts were mainly retrospective studies with example-controls to investigate risk factors such every bit fetal movements due to mother'southward experience, sleep position during maternity, maternal intuition, exercise, and diet [2,3,four]. These studies have confirmed that fetal abnormalities tin exist detected early on by monitoring fetal motility, which are a common complaint by significant women during the third trimester. Furthermore, these studies reported that reduced fetal motion is a clear maternal symptom associated with stillbirth and poor prognosis of neonates [5,6,7,eight], maybe through placental dysfunction [9].

While reduced fetal movements ofttimes crusade business and anxiety among women and also required clinical assessments [6], clinical data regarding the relationship of increased/excessive fetal movements and prognosis of neonatal outcomes are currently not adequately available. A questionnaire study in Nigeria establish that women tend to limited concern on excessive movement in a significantly higher rate than on reduced movements (31.1% vs. 21.viii%) [10]. Hence, it is important to study whether excessive fetal movements are associated with whatsoever adverse neonatal outcomes. This information would exist used to guide medical professionals in providing nursing to women, and would also allow more than detailed information to exist provided to women in order to reduce maternal anxiety.

To this terminate, we analyzed the neonatal weight, appearance, pulse, grimace, activity, and respiration (APGAR) score, degrees of amniotic fluid contagion, amniotic fluid volume, conditions of umbilical cord around the neck and string length, and incidence of small for gestational age of pregnant women, with or without complaints of increased fetal movements. In addition, the incidence of preterm delivery, cesarean section rate, postpartum hemorrhage, and other postpartum complications were also analyzed. We so reported the correlation between increased/excessive fetal activity and neonatal outcomes in this written report.

Methods

Study participants

A cohort study was conducted by prospectively recruiting women who were admitted to the Emergency Department of Obstetrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University with a complaint of increased/excessive fetal movements from April 1st 2017 to November 30th 2017. Our Emergency Department provides 24-h service and has the adequacy to assess approximately 3000 women per year. We enrolled significant women (due north = 219) who reported having increased/excessive fetal movements in the third trimester in our infirmary. We also included a control group of healthy women (n = 278) who had undergone regular childbirth and commitment in our hospital during the same period and did not report abnormal fetal movements. All significant women underwent fetal non-stress examination (NST).

Inclusion criteria were: 1) women over 28 weeks' gestation; ii) with commitment record in our infirmary during the study period. Exclusion criteria were: 1) women who had antenatally-diagnosed congenital anomalies and/or had multiple pregnancy; two) with medical conditions requiring medication that could affect fetal movements during the study.

Fetal condition was measure by attention staff using NST at our Obstetrics Emergency Section. After delivery, chart review was performed by the authors, and the pregnancy characteristics and outcomes were evaluated. Demographics data (eastward.k. marital status and maternal age) and characteristics related to pregnancy (e.g. number of previous deliveries, gestational age, maternal weight at last calendar week of gestation) were collected, and several adventure factors for fetal prognosis outcomes (eastward.thousand. hypertension more 140/90 mmHg, and diabetes) were assessed. Finally, commitment (east.one thousand. cesarean section rate, neonatal weight, APGAR score, degrees of amniotic fluid contamination, amniotic fluid volume, conditions of umbilical cord around the neck and cord length, and incidence of pocket-sized for gestational historic period) and postpartum complications (eastward.g. postpartum hemorrhage, Neonatal Intensive Intendance Unit admission) information were also obtained. The APGAR score was determined by evaluating the newborn baby on v simple criteria on a calibration from cipher to two, and then summing upward the v values. The degrees of stained amniotic fluid were defined every bit follows:

1. one.

   Form one: a minor amount of meconium in a large corporeality of amniotic fluid, with slightly green or yellow discoloration.

2. 2.

   Class two: a moderate corporeality of meconium in a fair corporeality of amniotic fluid, with articulate meconium staining shown as 'khaki green' or brownish in color.

3. iii.

   Form three: a large amount of meconium in a reduced amount of amniotic fluid, with heavy meconium staining shown as thick with 'pea soup' consistency.

Data analysis

Women with increased/excessive fetal movements were compared to the control group of women. Predictive Analytics Software 18 (IBM, 2009) was used for data analysis. Continuous information were analyzed using the t-test. Categorical data were analyzed using Pearson's Chi-squared test. Multivariable logistic regression was so used to model the association between increased/excessive fetal movement and neonatal weight and pre-term delivery. In the model, we controlled for variables and covariates known to be associated with neonatal weight and pre-term commitment, including gestational historic period, maternal weight at last week of gestation, delivery mode, and hypertension.

Results

From Apr 1st 2017 to November 30th 2017, in that location were a total of 219 women recruited via the Obstetrics Emergency Section in our hospital with a complaint of increased/excessive fetal movements. We also included a total of 278 good for you women who had undergone regular childbirth and delivery in the Department of Obstetrics at our hospital during the same menstruation and did not written report abnormal fetal movements. As a result, we analyzed a total of 497 women who had commitment in our hospital. In general, nigh 9.6% of pregnant women who were treated in our hospital reported experience of increased/excessive fetal movements. The characteristics of the analytic accomplice are shown in Table 1. Subjects were largely nulliparous (67.viii%). Nosotros also plant that hypertensive disease of pregnancy (12%) and diabetes (eight%) were the nearly common comorbid weather condition. The rates of pre-term, pocket-size-for-gestational-age neonates, postpartum hemorrhage (more than 500 ml), Neonatal Intensive Intendance Unit admission were relatively depression. In women with a complaint of increased/excessive fetal movements, increased fetal movements appeared mainly between 31 and 39 weeks of gestation (Fig. ane).

Table 1 Characteristics of enrolled pregnant women

Full size table

Fig. 1

Number of women who experienced increased/excessive fetal movements during the third trimester of pregnancy

Total size prototype

Using chi-foursquare tests, nosotros found that several pregnancy variables were associated with increased/excessive fetal movements (Table two): number of previous delivery [odds ratio (OR) 2.two, 95% conviction interval (CI) 1.v–iii.0], gestational age (less than 34 weeks and more than than 37 weeks; OR two.ane, 95% CI ane.4–3.ane) and vaginal birth (OR 1.7, 95% CI 1.1–2.9). In improver, nosotros plant that women who experienced increased/excessive fetal movements had less incidence of pre-term delivery (OR i.iv, 95% CI one.0–ii.1), and the newborns had higher neonatal weight (OR two.5, 95% CI 1.6–iii.two) (Tabular array ii).

Tabular array ii Characteristics of neonates

Full size table

In the multivariable model estimating the association between increased/excessive fetal movement and neonatal outcomes (Table 3), there were higher odds of large for gestational age (LGA) in women who had increased/excessive fetal movements (adjusted OR one.86, 95% CI i.69–2.07). Higher odds of LGA were also associated with women who had increased/excessive fetal movements and gestational age more 37 weeks (adapted OR 1.98, 95% CI 1.35–ii.24).

Table 3 Logistic regressions modeling issue of fetal movements and gestational age on neonatal outcome [adjusted odds ratios (95% conviction intervals)]

Full size table

Word

In the present written report, we constitute that the percentage of women who reported increased/excessive fetal movements was relatively higher in those who had the outset-time pregnancy compared the control group. This incidence rates dropped in those who had a history of pregnancy. This phenomenon may be due to the outset pregnancy, during which pregnant women are non experienced in the method of counting fetal motion and appear more sensitive and cautious during counting. Hence, these first-time meaning women may report increased fetal movements more frequently, which might compromise the objectivity of data in the current report. In fact, increased/excessive fetal movement is quite a common experience afterward 37 weeks of gestation. Therefore future investigations should include more objective measurements to address this limitation.

Ane important finding in our study is that, most of the neonates with increased fetal movement did not show poor prognosis. Instead, we observed better prognosis, which was reflected in the lower percentage of pre-term infants in women who had increased fetal movement. The neonatal weight of the newborns was significantly higher in women who had increased fetal movement than those of the control group. However, this may be also due to a higher percentage of pre-term infants in the control group, resulting in a decrease in the weight of newborns in the control group. Furthermore, in women who had increased fetal movements, we observed that increased fetal movements appeared mainly between 31 and 39 weeks of gestation. This increased fetal movement at 31 weeks of gestation is likely because that fetal weight gain is in an accelerated menstruum, when the fetal movement may exist frequent and obvious. At the 39th calendar week of pregnancy, the frequency of false contractions increased, coupled with the proximity of childbirth. These factors may also contribute to the enhanced consciousness of fetal motion in women. Furthermore, our findings that about nine.6% pregnant women reported feel of increased/excessive fetal movements were similar with previous reports. In the state of affairs, task, deportment, and results (STARS) accomplice written report, 1714 women were recruited from more than vii countries, and viii.five% of respondents reported excessive fetal movements [11]. Among the respondents, the symptom frequency from the four major countries who participated in the survey remained consistent. Similarly, the frequency of perceived excessive fetal movements was shut to that of the 10% of women who was analyzed in a stillbirth report in Sweden [12]. Interestingly, similar to our report, the perception of excessive fetal movements was reported more frequently (12% of respondents) when gestation was beyond 37 weeks [12]. Together with our reports, these results suggested that women in the third trimester of pregnancy may meet more frequent excessive fetal movements.

Some other important finding in our written report is that, our regression analysis institute that higher odds of LGA were associated with women who had increased/excessive fetal movements and gestational age over 37 weeks. One of the primary run a risk factors of LGA is poorly-controlled diabetes, particularly gestational diabetes, as well as pre-existing diabetes mellitus [thirteen,14,15,xvi], which increase maternal plasma glucose and insulin levels, every bit well as stimulates fetal growth. In add-on, studies have shown that gestational age more 40 weeks and excessive maternal weight gain can increase incidence of LGA [15]. Consistent to this literature, our report confirmed that gestational age over 37 weeks was associated with increased incidence of LGA. Furthermore, women with increased/excessive fetal movements besides had higher incidence of LGA, especially when the gestational age was more than 37 weeks.

Changes in amniotic fluid may indicate fetal intrauterine hypoxia, fetal acidosis in the fetus, and the abnormal fetal growth [17, eighteen]. Surprisingly, we did not observe whatever difference in amniotic fluid volume or degrees of stained amniotic fluid in women who had increased fetal movement when compared to those of the command group. In addition, in that location was no correlation between increased fetal action and the incidence of umbilical cord around the neck. These results suggested that amniotic fluid volume and contamination and the incidence of umbilical string around the neck may not be the contributing factors in increased fetal movements.

While our study did not report increased cases of stillbirth in women who experienced increased/excessive fetal movements. Case-command studies accept been performed in order to examine if there is any deviation in the frequency of increased/excessive fetal movements between pregnancies with live births and those with stillbirth. In the Auckland Stillbirth Study, women who had stillbirth experienced more single episodes of excessive fetal action [19]. However, more than one episode of vigorous fetal activity was less likely perceived by those who had stillbirth. In add-on, women who had stillbirth were less likely to written report the perception of increased fetal movements compared to controls [nineteen]. Furthermore, one episode of vigorous activity was more likely perceived past women who had stillbirth in the STARS study [20]. Hence, these results suggest that a sudden episode of excessive fetal activity may point the compromise of fetus that is related to the disturbance of environs in uterus. Future studies with a larger cohort will be necessary to examine this hypothesis.

Conclusion

Our study is the first prospective written report to investigate the correlation between incidence of excessive fetal activity and neonatal outcomes. Historically, the uncertainty regarding measuring and reporting excessive fetal movements has led to focusing on reduced fetal motion and its effects on perinatal mortality and morbidity [21, 22]. While our study found no evidence for the association of excessive fetal movement with perinatal bloodshed, we did report adverse neonatal result (i.e., LGA) was correlated with increased/excessive fetal movements, peculiarly when the gestational age was more than 37 weeks. An improved agreement into the cause of excessive fetal activities and outcomes would allow future studies to investigate whether reduced adverse neonatal outcomes can be achieved past encouraging women to study excessive fetal activities followed by appropriate intervention. This would also provide translational value to modifiable risk factors for improving perinatal and neonatal outcomes.

Availability of information and materials

The datasets generated and/or analysed during the current study are non publicly available due to results are obtained from identifying images and/or other clinical details of participants that may compromise anonymity, but are available from the corresponding author on reasonable asking.

Abbreviations

APGAR:

Appearance, pulse, grimace, activity, and respiration

CI:

Confidence interval

LGA:

Large for gestational age

NST:

Not-stress test

OR:

Odds ratio

STARS:

Situation, task, actions, and results

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Acknowledgements

Not applicable.

Funding

This work was funded by Shanghai Municipal Instruction Commission-Gaoyuan Nursing Grant Support (project: Hlgy1816ky). The funding body played no role in the design of the study and collection, assay, and estimation of data and in writing the manuscript.

Author information

Affiliations

1. Section of Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600# Yishan Road, Xuhui District, Shanghai, 200233, Red china

   Cuiqin Huang, Wei Han & Yajing Fan

Contributions

Data drove and analysis: CH, WH; Study designed and manuscript writing: YF. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Yajing Fan.

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Ethics approval and consent to participate

All participants have given informed and written consent. This written report was canonical past the ethics committee of Shanghai 6th People's Infirmary, Shanghai Jiao Tong University, and followed the ethical guidelines laid down in the 1975 Proclamation of Helsinki.

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Not Applicable.

Competing interests

The authors declare that they accept no competing interests.

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Huang, C., Han, West. & Fan, Y. Correlation study between increased fetal movement during the third trimester and neonatal result. BMC Pregnancy Childbirth 19, 467 (2019). https://doi.org/ten.1186/s12884-019-2637-iv

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• Received: fourteen Dec 2018

• Accepted: 26 November 2019

• Published: 04 Dec 2019

• DOI : https://doi.org/10.1186/s12884-019-2637-4

Keywords

• Fetal movements
• Neonatal outcome
• Large for gestational historic period
• Correlational study

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