Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy.
International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, and Reggio Emilia, Modena, Italy.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2193664. doi: 10.1080/14767058.2023.2193664.
Active fetal movements (AFMs) are a sign of the well-being of the baby during pregnancy and suggests the integrity of the cardiovascular, musculoskeletal, and nervous systems of the fetus. The abnormal perception of AFMs is associated with an increased risk of adverse perinatal outcomes such as stillbirth (SB) and brain damage. Several definitions of " decreased fetal movements" have been proposed, but none of them has been universally accepted. The aim of the study is to investigate the perinatal outcomes in relation to AFMs frequency and perception in term pregnancy with an ad hoc questionnaire administered to the women before delivery.
This was a prospective case-control study on pregnant women at term referring to the Obstetric Unit of the University Hospital of Modena, Italy, between January 2020 and March 2020. A validated questionnaire was administered to women who agreed to participate in the study. Therefore, women were subdivided into the case and control groups: cases included women who experienced adverse perinatal outcomes (APO) such as perinatal mortality (SB and early neonatal mortality), operative delivery (cesarean section or vacuum) due to fetal distress, Apgar 5' < 7, neonatal resuscitation at birth and NICU Admission, while controls were women who experienced delivery and birth without APO in the same period.
Seventy-seven cases and 178 controls that compiled the questionnaire were included in the analysis. Characteristics significantly associated with APO were low education (OR 1.57, CI 95% 1.11-2.22), nulliparity (OR 1.76, CI 95% 1.20-2.58), obesity (OR 1.55, CI 95% 1.10-2.17), neonatal male gender (OR 1.92 CI95% 1.33-2.78) and centile at birth (< 10° and >90°) (OR 2.77, 95%CI 2.17, 3.55). There was no association between any answer about strengths, frequency and vigor of perceived fetal movements and APO. Even any maternal perception of fetal hiccups or uterine contractions wasn't associated with APO. On the other hand, women who referred to frequent change positions during sleep (OR 1.55 CI95% 1.05-2.30) and women who snore (OR 1.43 CI95% 1.01-2.05) showed a statistically significant increase of APO.
Our data confirm the significant association between modifiable risk factors (such as obesity and low education) and APO. Thus, healthcare providers should be aware of the importance of intervention in reducing obesity, therefore snoring and related sleep apnea syndrome. Finally, changing position during sleep while not the perception of modified/reduced fetal movements significantly could induce the worst obstetric outcomes.
胎儿主动运动（AFM）是妊娠期间胎儿健康的标志，提示胎儿心血管、肌肉骨骼和神经系统的完整性。异常感知 AFM 与不良围产儿结局（如死胎（SB）和脑损伤）的风险增加有关。已经提出了几种“胎儿运动减少”的定义，但没有一种被普遍接受。本研究的目的是通过在分娩前向孕妇发放专门的问卷，调查与足月妊娠中 AFM 频率和感知相关的围产儿结局。
这是一项前瞻性病例对照研究，纳入了 2020 年 1 月至 2020 年 3 月期间在意大利摩德纳大学医院产科就诊的足月孕妇。向同意参加研究的妇女发放了经过验证的问卷。因此，妇女被分为病例组和对照组：病例组包括经历不良围产儿结局（如围产儿死亡率（SB 和早期新生儿死亡率）、因胎儿窘迫而进行的剖宫产或真空分娩、Apgar 5' < 7、新生儿出生时复苏和新生儿重症监护病房（NICU）入院）的妇女，而对照组为在同一时期经历无围产儿结局的分娩和出生的妇女。
纳入分析的有 77 例病例和 178 例对照，完成了问卷。与围产儿结局显著相关的特征包括低教育水平（OR 1.57，95%CI 95% 1.11-2.22）、未婚（OR 1.76，95%CI 95% 1.20-2.58）、肥胖（OR 1.55，95%CI 95% 1.10-2.17）、新生儿男性性别（OR 1.92 CI95% 1.33-2.78）和出生时的百分位数（<10°和>90°）（OR 2.77，95%CI 2.17，3.55）。任何关于感知到的胎儿运动强度、频率和活力的答案与围产儿结局均无关联。甚至母亲感知到胎儿打嗝或子宫收缩也与围产儿结局无关。另一方面，报告经常在睡眠中改变体位的妇女（OR 1.55 CI95% 1.05-2.30）和打鼾的妇女（OR 1.43 CI95% 1.01-2.05）的围产儿结局显著增加。
我们的数据证实了可改变的危险因素（如肥胖和低教育水平）与围产儿结局之间的显著关联。因此，医疗保健提供者应意识到干预肥胖、打鼾和相关睡眠呼吸暂停综合征的重要性。最后，改变睡眠中的体位而不是感知到的胎儿运动减少或改变，可能会导致最差的产科结局。
