FRIDAY, JULY 12, 2019
Sharp rise in stillbirth risk if baby quiet in evening - study
Pregnant women who notice their baby is less active than usual in the evenings should call their lead maternity carer
straight away, and not leave it to the morning, a midwife researcher says.
The advice comes after a finding from a New Zealand study that women who reported their babies were ‘quiet’ in the
evening, with light or no movement, had an almost four times’ greater risk of stillbirth compared to women with
nocturnally active babies.
“Some women put off contacting their midwife in the evening as they think it’s inconvenient and don’t want to seem
over-anxious,” says lead author, Billie Bradford, a PhD student in the University of Auckland’s Faculty of Medical and
Health Sciences and a practicing midwife based in Wellington.
“But, delays in women presenting with fetal movement concerns have been linked to complications including stillbirth in
other studies.
“All babies have some quiet times and some active times, but the evening is normally an active time, so if the baby
doesn’t have moderate or strong movements at that time like they normally would, a check-up is needed. In most cases,
this will provide reassurance that the baby is doing okay, although some women may need a follow-up scan or closer
monitoring.”
Stillbirth is defined as the loss of a baby after 20 weeks of pregnancy, and many stillbirths are thought to be
preventable. An estimated 2.64 million babies die before birth globally each year, including around 300 babies in
Aotearoa New Zealand. About one in every 500 women in New Zealand will experience a late stillbirth, losing her baby at
or after 28 weeks of pregnancy.
“Stillbirth is incredibly traumatic for families, and we felt there was potential to prevent some stillbirths if fetal
movement was better understood,” says Mrs Bradford. “We knew from other studies that women felt more movements in the
evening, but we weren’t sure how relevant this was to stillbirth.”
Researchers interviewed 164 women who had recently experienced a late stillbirth and asked them what their baby’s
movements had been like in the two weeks before the baby died. Around half of those women had lost their baby at 37
weeks or later.
For each stillbirth, three or four women at the same stage of pregnancy and from the same part of the country were also
interviewed (569 controls in total). Responses were then analysed to see what was different in the pregnancies where the
baby had died, compared to the ongoing pregnancies.
The findings, published in the high-ranking journal Scientific Reports, confirmed that decreased frequency and decreased strength of baby movements were linked to stillbirth. Most
strikingly, for babies who had quiet or light movement in the evening, stillbirth risk increased by nearly fourfold
(3.82 times).
“The good news for pregnant women is that feeling moderate or strong fetal movements in the evening is very reassuring
of a healthy baby. Feeling groups of strong movements and baby hiccups is also a good sign.”
A recent study by the same team described a ‘new normal’ for baby movements: a 24-hour pattern in which babies are more
active in the evening and at bedtime, with movements often getting stronger as babies come to term.
Senior author, University of Auckland Professor Lesley McCowan, says the latest findings raise the question of whether
fetal movement screening and monitoring in tune with babies’ 24-hour pattern of activity might help prevent stillbirths.
“Medical researchers are looking at ways to improve treatment outcomes in many areas by taking into account circadian
rhythms. A ground-breaking 2017 study found that open heart surgery was more successful when it was conducted in the
afternoon instead of the morning, all other things being equal, due to syncing with circadian rhythms. We need more
studies to investigate whether evening fetal movement screening and assessment may help prevent stillbirths,” says
Professor McCowan, head of the University’s Department of Obstetrics and Gynaecology.
The research team, which also included a researcher from the University-based Liggins Institute, is now looking at fetal
movement patterns in women at raised risk for stillbirth, such as women with obesity and women whose babies are not
growing well in the womb.
For now, the message for pregnant women is clear. Mrs Bradford: “We advise pregnant women to trust their gut, if they
really feel something is wrong with their baby’s movements, get a check-up, it may make all the difference.”
Ends
Scientific Reports: Associations between maternally perceived quality and pattern of fetal movements and stillbirth
Key points:
• A new study lead by the University of Auckland in New Zealand has found that women who reported their babies
were ‘quiet’ in the evening, with light or no movement, had an almost four times greater risk of stillbirth compared to
women with nocturnally active babies
• The study, involving 164 women who had experienced late stillbirth and 569 women with ongoing pregnancies, has
been published this week in Scientific Reports
• Lead author Billie Bradford, a midwife and researcher, says if pregnant women notice their babies becoming less
active in the evenings, they should call their maternity carer straight away for a check-up
• An estimated 2.64 million babies die before birth globally each year, including around 300 babies in Aotearoa
New Zealand
• The study was conducted across seven New Zealand district health boards: Waitemata, Auckland, Counties Manukau,
Waikato, MidCentral, Capital and Coast and Canterbury
ends