My Baby’s Movements: a stepped‐wedge cluster‐randomised controlled trial of a fetal movement awareness intervention to reduce stillbirths

Abstract

Objective The My Baby’s Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (the MBM intervention). Design Stepped‐wedge cluster‐randomised controlled trial. Setting Twenty‐seven maternity hospitals in Australia and New Zealand. Population Women with a singleton pregnancy without major fetal anomaly at ≥28 weeks of gestation from August 2016 to May 2019. Methods The MBM intervention was implemented at randomly assigned time points, with the sequential introduction of eight groups of between three and five hospitals at 4‐monthly intervals. Using generalised linear mixed models, the stillbirth rate was compared in the control and the intervention periods, adjusting for calendar time, study population characteristics and hospital effects. Main outcome measures Stillbirth at ≥28 weeks of gestation. Results There were 304 850 births with 290 105 births meeting the inclusion criteria: 150 053 in the control and 140 052 in the intervention periods. The stillbirth rate was lower (although not statistically significantly so) during the intervention compared with the control period (2.2/1000 versus 2.4/1000 births; aOR 1.18, 95% CI 0.93–1.50; P = 0.18). The decrease in stillbirth rate was greater across calendar time: 2.7/1000 in the first versus 2.0/1000 in the last 18 months. No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident. Conclusions The MBM intervention did not reduce stillbirths beyond the downward trend over time. As a result of low uptake, the role of the intervention remains unclear, although the downward trend across time suggests some benefit in lowering the stillbirth rate. In this study setting, an awareness of the importance of fetal movements may have reached pregnant women and clinicians prior to the implementation of the intervention. Tweetable abstract The My Baby’s Movements intervention to raise awareness of decreased fetal movement did not significantly reduce stillbirth rates.

Maternal perception of fetal movements: Views, knowledge and practices of women and health providers in a low-resource setting

“…Although there has been recent interest in maternal perception of FMs and evidence is being sought in large trials in high-income countries, there is no single RCT in settings with the highest burden [ 15 ]. Recent trials in HICs showed educational and management packages or FMs awareness intervention did not improve perinatal outcomes [ 21 , 24 ]. However, awareness of fetal movement is already incorporated in stillbirth reduction strategies in HIC and stillbirth are much less common.…”

Fetal Movement Counting in Prolonged Pregnancies: The COMPTAMAF Prospective Randomized Trial

“…Three recent studies have investigated the impact of an information campaign about fetal movements [ 16 , 17 , 18 ]. These three randomized controlled cluster studies were conducted on 40,000 to 400,000 patients.…”

“…More recent randomized cluster trials did not find differences in neonatal outcomes. Some authors have even shown an increase in the rate of induction, cesarean section, and admission in neonatal units for more than 48 h [ 16 , 17 , 18 ]. All these studies were performed on pregnant women from 24 or 28 WG.…”

Reduced fetal movements: Time to move on?

“…Surprisingly, the incidence of RFM presentations is largely unreported. 5,6 Yet the 'performance' of a risk factor is related not just to sensitivity but to its specificity. Indeed, in a case-control study of stillbirths, 11 33.8% of controls experienced RFMs.…”