title: Concerns for decreased foetal movements in uncomplicated pregnancies--increased risk of foetal growth restriction and stillbirth among women being overweight, advanced age or smoking.
abstract: BACKGROUND
  We aimed to determine whether the clinical characteristics of women in uncomplicated pregnancies presenting with decreased foetal movements (DFMs) would help target subgroups of women at the highest risk. Furthermore, we also aimed whether DFMs in complicated pregnancies identified the additional needs for intensified management.
  
  
  METHODS
  Singleton third trimester pregnancies (n=2374) presenting with DFMs from June 2004 through October 2005 were prospectively registered in 14 delivery units in Norway. Among pregnancies that were uncomplicated until registration for DFMs, cases with good outcomes (birth weight between 10th and 90th percentile, term delivery and live-born child) were compared with cases with adverse outcomes.
  
  
  RESULTS
  In uncomplicated pregnancies, maternal overweight, advanced age and smoking identified subgroups of cases at increased risk of foetal growth restriction and stillbirth. DFMs of longer duration, in particular the perceived absence of movements, identified cases at increased risk of stillbirth, irrespective of other maternal characteristics. When women with complicated pregnancies reported DFMs, additional indications for follow-up were found in 1/3 of cases.
  
  
  CONCLUSIONS
  Maternal overweight, advanced age, smoking and the duration of DFMs are the characteristics that help in identifying pregnancies that should be targeted for intensified management. Time matters and knowledge-based information are needed to improve foetal health.
authors.affiliation: Division of Obstetrics and Gynecology and Center for Perinatal Research, Medical Faculty, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway. julievh@medisin.uio.no
authors.forename: Julie V H
authors.initials: JV
authors.lastname: Tveit
authors.forename: Eli
authors.initials: E
authors.lastname: Saastad
authors.forename: Babill
authors.initials: B
authors.lastname: Stray-Pedersen
authors.forename: Per E
authors.initials: PE
authors.lastname: Børdahl
authors.forename: Jahn F
authors.initials: JF
authors.lastname: Frøen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology*; D005324:Fetal Movement; D006801:Humans; D008423:Maternal Age; D016017:Odds Ratio; D050177:Overweight / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D050497:Stillbirth