Intervention to Increase Monitoring of Fetal Movements Not Helpful, Maybe Harmful

A large, randomized trial in the UK found that encouraging women to track their baby’s movements did not reduce stillbirth rates.

This week, conventional wisdom takes a hit in the form of this article, appearing in the Lancet, that suggests that encouraging women to monitor fetal movements during pregnancy may actually be harmful.

Fetal movements are a super fun part of pregnancy. That first kick is something everyone remembers. But monitoring fetal movements, whether in the form of kick counts or just paying particular attention to what is happening in there, can induce quite a bit of anxiety. Is it worth it?

The American Pregnancy Association states  “Though strongly recommended for high-risk pregnancies, counting fetal movements beginning at 28 weeks may be beneficial for all pregnancies.”

There are apps to track kick counts – all with adorable little icons – and most saying that monitoring fetal movements will help your baby in some way. 

But this large, randomized trial says otherwise. What’s going on?

The Lancet study uses an elegant design to figure out if what we’ve been telling pregnant women to do is wrong.

They took 33 hospitals throughout the United Kingdom and randomized them to different start times for a “reduced fetal movement” package of interventions.

The package contained an educational component for providers, pamphlets for pregnant women, and, importantly, specific guidelines for what to do when a woman reported reduced fetal movement:

-Immediate fetal heart rate monitoring

-Measurement of amniotic fluid

-Growth Scan

-And delivery for women who were at or beyond 37 weeks gestation.

Basically, the package put a huge emphasis on monitoring fetal movements and taking any report of reduced movement very seriously.

Primary Outcome: Stillbirth Rate

Primary Outcome: Stillbirth Rate

All told, more than 409,000 women delivered during the study period. But there was no statistical difference in the rate of stillbirth (the primary outcome) during the intervention period compared to the control period.

Secondary outcomes: Induction of labor / C-section

Secondary outcomes: Induction of labor / C-section

In fact, there was more induction of labor and more c-sections during the intervention which means, basically, that people were following instructions and delivering babies with reduced fetal movements.

But had that been the right choice, the stillbirth rate or perinatal mortality rate would have gone down in the intervention group but they didn’t. In fact, a post-hoc analysis revealed the rate of infant mortality from 28 days to 1 year of life was significantly higher in the intervention group.  

OK the data is pretty clear – an intervention to increase awareness about reduced fetal movement didn’t work. Does that mean that we should encourage women not to notice their babies’ movements?

Not necessarily. The most important thing to remember here is that women in the control periods were totally free to monitor their baby (try and stop them) and providers could act on that information in any way they saw fit. Maybe we are avoiding stillbirths already, but this intervention just freaked people out about reduced movements that they otherwise would have appropriately ignored.

What the study should tell us though, is that obsessive monitoring of fetal movements might not be right for everyone. I’ve known many pregnant women, and believe me, they are monitoring things quite closely thank you very much. In this case, mother’s instinct might be just the right intervention. 

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