Quantitative analysis of fetal general movements: methodological considerations

Hof, Judith ten; Nijhuis, Ilse J. M.; Nijhuis, Jan G.; Narayan, Harini; Taylor, David; Visser, Gerard H.A.; Mulder, E.J.H.

doi:10.1016/s0378-3782(99)00035-3

Cited by 49 publications

(36 citation statements)

References 28 publications

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“…The concomitant decline of the percentage incidence of fetal body movements we found is in agreement with a number of previous studies (7,10,14), although the reported values were either lower (7, 10) or higher (14) than the values we found. This difference in absolute values is probably due to differences in methodology, as described elsewhere (17).…”

Section: Discussionmentioning

confidence: 99%

“…However, because of the absence of a uniform definition of a body movement, and differences in study design (longitudinal or cross-sectional) and data analysis, the reported mean/median values and ranges of normality differ greatly among the various studies (7-16), as we have recently described (17). Moreover, there is still some controversy regarding whether the movement incidence does or does not decline with advancing gestation.…”

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confidence: 97%

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Longitudinal Study of Fetal Body Movements: Nomograms, Intrafetal Consistency, and Relationship with Episodes of Heart Rate Patterns A and B

Hof¹,

Nijhuis²,

Mulder³

et al. 2002

Pediatr Res

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Our objective was to investigate the longitudinal development of incidence parameters of fetal body movements to define normal reference ranges, to relate them to episodes of fetal heart rate patterns A and B, and to determine the intrafetal consistency for these parameters. Twenty-nine fetuses were studied longitudinally from 24 wk of gestation. Fetal body movements and heart rate were recorded at fortnightly intervals between 24 and 36 wk of gestation and weekly from 36 wk of gestation. Data were analyzed using multilevel analysis. Reference ranges were constructed for the percentage of observation time that movements were present, the number of movement bursts per hour, the mean burst duration, and the median onset-onset interval. The median percentage incidence of fetal body movements decreased from 17% at 24 wk to about 7% near term. The developmental course was the same during active episodes. Body movements also decreased during episodes of relative quiescence, in the course of pregnancy. Intrafetal variance was on average 40 -80% of the total range of the four movement parameters. Normal reference ranges were developed for incidence parameters of fetal body movements from 24 wk of gestation onward. The overall decline in the incidence of movements during pregnancy appeared to be a developmental phenomenon and not due to progressively increasing episodes of fetal quiescence. Individual fetuses showed a degree of consistency in the percentage incidence of body movements, but intra-and interfetal variances were generally high, resulting in wide ranges. (Pediatr Res 52: 568-575, 2002) Abbreviations FHR, fetal heart rate FHRP, fetal heart rate patternThe majority of neurodevelopmental disabilities have been estimated to originate from prenatal factors (1). Both the quantity and quality of fetal body movements have been recognized as important indicators of fetal well being and of the integrity of the CNS (2, 3). Studying fetal body movements could therefore provide a key to elucidate the prenatal etiology and pathogenesis of abnormal neuromotor development, which might, eventually, facilitate early intervention and optimal treatment before, during, and after birth. There is evidence that the quality of fetal body movements is more likely an indicator of brain integrity than the quantity of movements (4, 5). However, before either of the two can be used as such in clinical practice, the normal developmental course and its possible sources of variation must be defined. This requires the use of a prospective longitudinal study design (6). In the present study, we focused on the developmental course of various quantitative aspects of fetal body movements.Several authors have reported on the incidence of fetal body movements. However, because of the absence of a uniform definition of a body movement, and differences in study design (longitudinal or cross-sectional) and data analysis, the reported mean/median values and ranges of normality differ greatly among the various studies (7-16), as we have recently describ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 97%

Longitudinal Study of Fetal Body Movements: Nomograms, Intrafetal Consistency, and Relationship with Episodes of Heart Rate Patterns A and B

Hof¹,

Nijhuis²,

Mulder³

et al. 2002

Pediatr Res

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“…As a result, although maternal report of felt fetal movement is used as a clinical indicator of well-being (Rayburn, 1990), its limitations should be acknowledged when used in research if there are no alternate methods available. Normative estimates regarding fetal motor activity based on ultrasound or actography vary due, at least in part, to differences in how investigators define the end of one movement and the beginning of the next (ten Hof et al, 1999). In general, data from our prior work confirm that of others such that in the latter half of gestation fetuses move approximately once per minute, and are active between 10% and 30% of the observation time (DiPietro, Caulfield, et al, 2004; Nasello-Paterson, Natale, & Connors, 1988; Roberts, Griffin, Mooney, Cooper, & Campbell, 1980; Roodenburg et al, 1991).…”

Section: Chapter 6 Fetal Motor Activitymentioning

confidence: 99%

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DiPietro¹,

Costigan²,

Voegtline³

2015

Monographs Society Res Child

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Among the earliest volumes of this Monograph series was a report by Lester Sontag and colleagues, of the esteemed Fels Institute, on the heart rate of the human fetus as an expression of the developing nervous system. Here, some 75 years later, we commemorate this work and provide historical and contemporary context on knowledge regarding fetal development, as well as results from our own research. These are based on synchronized monitoring of maternal and fetal parameters assessed between 24 and 36 weeks gestation on 740 maternal-fetal pairs compiled from eight separate longitudinal studies, which commenced in the early 1990s. Data include maternal heart rate, respiratory sinus arrhythmia, and electrodermal activity and fetal heart rate, motor activity, and their integration. Hierarchical linear modeling of developmental trajectories reveals that the fetus develops in predictable ways consistent with advancing parasympathetic regulation. Findings also include: within-fetus stability (i.e., preservation of rank ordering over time) for heart rate, motor, and coupling measures; a transitional period of decelerating development near 30 weeks gestation; sex differences in fetal heart rate measures but not in most fetal motor activity measures; modest correspondence in fetal neurodevelopment among siblings as compared to unrelated fetuses; and deviations from normative fetal development in fetuses affected by intrauterine growth restriction and other conditions. Maternal parameters also change during this period of gestation and there is evidence that fetal sex and individual variation in fetal neurobehavior influence maternal physiological processes and the local intrauterine context. Results are discussed within the framework of neuromaturation, the emergence of individual differences, and the bidirectional nature of the maternal-fetal relationship. We pose a number of open questions for future research. Although the human fetus remains just out of reach, new technologies portend an era of accelerated discovery of the earliest period of development.

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“…General movements increase during the first weeks of pregnancy; then they reach a plateau and remain at this level for the first two trimesters, only to decrease again around term (Roodenburg et al 1991;ten Hof et al 1999). Although the space within the uterus becomes increasingly limited during the end of pregnancy, it seems more likely that the decrease of general movements is a result of the central nervous system development.…”

Section: Startles and General Movementsmentioning

confidence: 99%