Prevalence and outcomes of presentation for decreased fetal movements: insights from a retrospective cohort study

Maternal perception of Decreased Fetal Movements (DFM) is associated with adverse perinatal outcomes including stillbirth. Promoting awareness of fetal movements is a commonly used strategy to reduce preventable stillbirths; however, its efficacy remains uncertain. Anecdotal reports suggest increased rates of presentation with DFM and associated demand on maternity service with fetal movement awareness campaigns, but evidence is lacking. The main objective of this study was to describe prevalence of DFM and compare maternal characteristics and outcomes to pregnancies without DFM. We used electronic records of outpatient pregnancy assessment and birth records to ascertain presentation with DFM in our large urban tertiary care centre. We compared maternal characteristics and pregnancy and perinatal outcomes DFM at ≥ 28 weeks gestation and a singleton pregnancy to those without between January 2021 and December 2023. The main outcome was a composite adverse perinatal outcome. Of 10,741 singleton births, 8,587 were eligible for inclusion, and of these 2763 (32.2%) presented with DFM at ≥ 28 weeks gestation at least once. Those with DFM were more likely to be non-Indigenous, Australian-born, higher socioeconomic status (RR 1.02 (95% CI 1.00-1.05)) and not requiring an interpreter (RR 0.73 (0.63–0.85)). There was no difference in the primary outcome between those with DFM and those without (adjusted-RR 0.96 (0.88–1.05)), although Special Care Nursery admissions were increased (aRR 1.16 (1.01–1.33). Presentation with DFM was associated with induction of labour (aRR 1.25 (1.19–1.32)), emergency caesarean section (aRR 1.17 (1.07–1.28)). Rates of DFM presentation were generally higher than anticipated but less frequent with socioeconomic disadvantage suggestive of broader inequity in healthcare access, acceptability and health outcomes. Perinatal outcomes were similar between groups, but obstetric intervention was increased in the DFM cohort. Further research should explore the optimal approach to DFM to reduce adverse perinatal outcomes without excess harm.