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Meta-Analysis
. 2025 Jun;132(7):1000-1009.
doi: 10.1111/1471-0528.18132. Epub 2025 Mar 17.

Risk Factors for Adverse Pregnancy Outcomes in Reduced Fetal Movement: An IPD Meta-Analysis

Yongyi Lu  1 , Victoria Palin  1 , Alexander Heazell  1   2
Affiliations
Meta-Analysis

Risk Factors for Adverse Pregnancy Outcomes in Reduced Fetal Movement: An IPD Meta-Analysis

Yongyi Lu et al. BJOG. 2025 Jun.

Abstract

Objective: Women experiencing reduced fetal movements (RFM) have an increased risk of adverse pregnancy outcomes (APO). This study aimed to identify factors most associated with APO in RFM pregnancies.

Design: Individual participant data meta-analysis (IPD-MA).

Setting: Multiple maternity units across the UK.

Population or sample: 1175 singleton pregnancies with RFM between 28+0 and 41+0 weeks' gestation from four prospective cohorts and two randomised controlled trials (RCTs).

Methods: Factors associated with APO were assessed using two-stage IPD-MA.

Main outcome measures: A composite adverse pregnancy outcome, including: adjusted Odds Ratio, stillbirth, fetal growth restriction (FGR, birthweight ≤ 3rd centile) and neonatal intensive care unit (NICU) admission.

Main results: APO occurred in 7.7% of RFM pregnancies, with FGR being the most common complication (4.6%). The strongest associations with APO were observed for abnormal fetal heart rate (adjusted Odds Ratio (aOR) = 3.65, 95% CI: 1.84-7.23), cigarette smoking (aOR = 2.96, 95% CI: 1.36-6.44) and maternal past medical history (aOR = 2.35, 95% CI: 1.14-4.82). Lower estimated fetal weight (EFW) centile was also significantly associated with APO (aOR = 0.97, 95% CI: 0.95-0.99), though substantial heterogeneity was present between studies (I2 = 80.74%, Q-statistic: p < 0.001).

Conclusions: IPD-MA enabled the synthesis of individual-level data across studies, allowing for more accurate and reliable associations by accounting for heterogeneity. Further work is required to investigate the model's generalisability across diverse populations.

Keywords: IPD‐MA; adverse pregnancy outcome; complications; decreased fetal movement; fetal growth restriction; fetal surveillance; perinatal mortality; placenta; stillbirth.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of the two‐stage IPD meta‐analysis.
FIGURE 2
FIGURE 2
Forest plots of the effect sizes of abnormal fetal heart rate, EFW percentile, past medical history and cigarette smoking status on APO, alongside the pooled effect size across six studies.
See this image and copyright information in PMC

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