title: Interventions to enhance maternal awareness of decreased fetal movement: a systematic review.
abstract: BACKGROUND
  Decreased fetal movement is associated with adverse pregnancy and birth outcomes; timely reporting and appropriate management may prevent stillbirth.
  
  
  OBJECTIVE
  Determine effects of interventions to enhance maternal awareness of decreased fetal movement.
  
  
  METHODS
  Cinahl, The Cochrane Library, EMBASE, MEDLINE, PsycINFO and SCOPUS databases; without limitation on language or publication year.
  
  
  METHODS
  Randomised or non-randomised studies evaluating interventions to enhance maternal awareness of decreased fetal movement.
  
  
  METHODS
  Two authors independently extracted data and assessed quality.
  
  
  RESULTS
  We included 23 publications from 16 studies of fair to poor quality. We were unable to pool results due to substantial heterogeneity between studies. Three randomised controlled trials (RCTs) and five non-randomised studies (NRSs), involving 72 888 and 115 435 pregnancies, respectively, assessed effects of interventions on stillbirth and perinatal death. One large cluster RCT (n = 68 654) reported no stillbirth reduction, one RCT (n = 3111) reported significant stillbirth reduction, and one RCT (n = 1123) was small with no deaths. All NRSs favoured intervention over standard care; three studies (n = 31 131) reported significant reduction, whereas two studies (n = 84 304) reported non-significant reductions in stillbirth or perinatal deaths. Promising results from NRSs warrant further research. We found no evidence of increased maternal concern following interventions. No cost-effectiveness data were available.
  
  
  CONCLUSIONS
  We found no clear evidence of benefit or harm; indirect evidence suggests improved pregnancy and birth outcomes. The optimal approach to support women in monitoring their pregnancies needs to be established. Meanwhile, women need to be informed about the importance of fetal movement for fetal health.
  
  
  CONCLUSIONS
  The benefits and risks of interventions to increase pregnant women's awareness of fetal movement are unclear.
authors.affiliation: Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: B A
authors.initials: BA
authors.lastname: Winje
authors.affiliation: Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Wojcieszek
authors.affiliation: Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: L Y
authors.initials: LY
authors.lastname: Gonzalez-Angulo
authors.affiliation: Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: Z
authors.initials: Z
authors.lastname: Teoh
authors.affiliation: Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, Scotland.
authors.forename: J
authors.initials: J
authors.lastname: Norman
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: J F
authors.initials: JF
authors.lastname: Frøen
authors.affiliation: Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Flenady
mesh_terms: D001007:Anxiety / Q000209:etiology; D005324:Fetal Movement; D007722:Health Knowledge, Attitudes, Practice; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D033261:Maternal-Fetal Relations; D009035:Mothers / Q000193:education* / Q000523:psychology; D066087:Perinatal Death / Q000517:prevention & control; D064186:Prenatal Education / Q000191:economics / Q000379:methods*; D050497:Stillbirth
keywords: Awareness; decreased fetal movement; fetal movement counting; maternal concern; maternal-fetal attachment; stillbirth