A new program promoting maternal awareness of decreased fetal movement (DFM) during pregnancy is hoping to reduce the high and unwavering rates of stillbirth that exist in Australia and New Zealand.
More than 2700 families directly experience stillbirth every year in these countries, a rate which has not improved in the last two decades. The psychosocial effects of this can be devastating and long-lasting.
DFM is strongly associated with stillbirth risk. It is believed to be an adaptive response to placental dysfunction, in which the fetus minimises its own movements to conserve blood flow for vital organs. It has also been linked to intraamniotic infection; feto-maternal haemorrhage, emergency delivery, umbilical cord complications and placental insufficiency, low Apgar scores and acidemia, low birth weight, neonatal death and neurodevelopmental disability.
Though maternal reporting of DFM continues to be the most common reason for an unscheduled antenatal appointment, Vicki Flenady, Honorary Professor at the Mater Research Institute – UQ, tells us that awareness is still not where it needs to be, nor is the timeliness of the reporting.
“Not enough women are aware of the significance of DFM and, for those who are, the time many start to feel concerned and schedule an appointment is often too late”, she says ahead of the Obstetric Malpractice Conference.
“Our research indicates that 61 percent of mothers believe it to be normal for fetal movements to decrease in late pregnancy; 67 percent do not believe that fetal movements will help them identify if their baby is unwell; and 65 percent of those who are concerned would wait longer than 24 hours before seeking medical advice”.
“To effectively reduce the risk of stillbirth, DFM must be reported as soon as possible. Delays can be detrimental, with the risk of stillbirth increasing significantly every week in the antepartum period”.
The DFM Conundrum
Increasing maternal awareness of DFM seems like an obvious way to improve the current statistics, however, Prof. Flenady tells us that it is not necessarily a clear-cut solution. There is a possibility that it could lead to adverse outcomes, such as heightened maternal anxiety and greater rates of early induction, she explains.
Early induction, though an effective stillbirth prevention measure, in itself carries risks, including neonatal adverse outcomes and longer term developmental issues.
“As indicated in recent research from the UK, there is a possibility that a DFM awareness program could lead to more ‘false positive’ diagnoses and more (unnecessary) instances of early induction”, she says.
“We want to avoid creeping towards an earlier and earlier delivery date as a precautionary measure and reserve this, quite significant, procedure for women who really need it”.
This conundrum has prompted the Lancet’s Stillbirth Series to identify DFM as one of the top ten research priorities for stillbirth prevention -and is the impetus behind the My Baby’s Movements (MBM) research program.
MBM is a large scale, pragmatic, stepped wedged cluster randomized control trial, involving 300,000 women, which seeks to identify the outcomes of increased maternal perception of DFM.
Due for completion later this year, the program is investigating the efficacy of a mobile phone app – which allows mothers to monitor the timings of fetal movements – along with a complementary education initiative for families.
The research hopes to uncover whether increasing maternal perception of DFM will reduce the number of stillbirths that occur at 28 weeks or later, in a cost-effective manner; and without significantly increasing maternal anxiety.
“This is a really underbanked research niche”, says Prof. Flenady. “We are in desperate need of an effective screening tool that will give us real improvements in stillbirth rates.
“Most stillbirths happen in cases where mothers lack obvious risk factors, such as obesity, late age, or smoking. The MBM app certainly has the potential to be an effective screening tool, but we need to make sure it’s safe and effective”.
Prof. Flenady will share the preliminary findings of this research at the Obstetric Malpractice Conference due to take place 22-23 August 2019.