The association between increased fetal movements in the third trimester and perinatal outcomes; a systematic review and meta-analysis

Abstract

Background: Fetal movement monitoring is one of the strategies used to assess the fetus's health. Until now, most studies focused on the decreased fetal movement and neonatal outcome, although this systematic review and meta-analysis is designed to assess the association between increased fetal movements (IFM) with perinatal outcomes.

Method: The electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched for studies investigating the perinatal outcome of women with increased fetal movements from inception to July 2023. Following that, a random-effect meta-analysis model was used to obtain the combined diagnostic and predictive parameters including perinatal mortality (still birth and early neonatal mortality), operative delivery, Apgar score, neonatal resuscitation at birth and NICU Admission.

Results: After the initial screening, seven studies examining the association between increased third trimester fetal movement and various perinatal outcomes were included. Meta-analysis revealed a significant reduction in the risk of cesarean delivery among patients with IFM compared to controls, suggesting a potential protective effect during childbirth. However, no statistically significant difference was observed in birth weight, small or large for gestational age births, neonatal intensive care unit admission, maternal age, umbilical cord around the neck, gestational diabetes mellitus, and hypertension, indicating that IFM may not be a major predictor of adverse perinatal outcomes or maternal conditions. Notably, IFM was significantly associated with a higher likelihood of labor induction.

Conclusion: The findings suggest that IFM may have a protective effect against cesarean delivery. Additionally, IFM does not appear to be significantly associated with maternal age, umbilical cord around the neck, gestational diabetes mellitus and hypertension. However, the observed significant association with labor induction warrants further investigation.

Keywords: Fetal demise; Fetal movement; Pregnancy; Systematic review.

Fig. 1

Flow diagram of the recruiting studies according to PRISMA

Fig. 2

Forest plot for random-effect meta-analysis comparing risk of cesarean delivery between increased fetal movement patients and control group

Fig. 3

Forest plot for random-effect meta-analysis comparing standard birth weight mean difference between increased fetal movement patients and control group

Fig. 4

Forest plot for random-effect meta-analysis comparing risk of small for gestational age (SGA) between increased fetal movement patients and control group

Fig. 5

Forest plot for random-effect meta-analysis comparing risk of large for gestational age (LGA) between increased fetal movement patients and control group

Fig. 6

Forest plot for random-effect meta-analysis comparing risk of NICU admission between increased fetal movement patients and control group

Fig. 7

Forest plot for random-effect meta-analysis comparing maternal age between increased fetal movement patients and control group

Fig. 8

Forest plot for random-effect meta-analysis comparing rate of umbilical cord around neck between increased fetal movement patients and control group

Fig. 9

Forest plot for random-effect meta-analysis comparing prevalence of GDM between increased fetal movement patients and control group

Fig. 10

Forest plot for random-effect meta-analysis comparing prevalence of HTN between increased fetal movement patients and control group

Fig. 11

Forest plot for random-effect meta-analysis comparing number of cases underwenting labor induction between increased fetal movement patients and control group

Fig. 12

Forest plot for random-effect meta-analysis comparing odds of increased fetal movement between cases with adverse perinatal outcomes and regular pregnancy controls. Adverse perinatal events were defined as perinatal mortality (still birth and early neonatal mortality), operative delivery (cesarean section or vacuum) due to fetal distress, Apgar min 5 < 7, neonatal resuscitation at birth (including both invasive ventilation such as mechanical ventilation; non-invasive ventilation such as oxygen therapy, nasal CPAP, high flow), and NICU Admission